France faces a major health challenge: the shortage of doctors. This issue directly impacts the quality of care and the public health system.

As of January 1, 2025, France had 241,255 active physicians, a moderate increase of 1.7% compared to 2024. However, this increase masks a worrying reality: the shortage of general practitioners, essential for frontline care.

This shortage, aggravated by an unequal distribution of professionals across the country, is creating "medical deserts." Today, 87% of the metropolitan and overseas territories suffer from limited access to care, particularly in rural areas.

In this article, we will analyze the causes, consequences, and possible solutions to ensure equitable medical coverage and address future challenges.

Overview of the shortage of doctors in France

The gradual decline in the number of general practitioners

France is facing a worrying decline in the number of general practitioners. Between 2007 and 2025, the country lost one in four general practitioners, a decrease of more than 8% over this period.

This trend is largely due to the non-replacement of retirements, which exacerbates the shortage in this essential sector of primary care. With the exception of a few rare departments such as Savoie and Loire-Atlantique, all French territories have recorded a decline in their medical density. Some regions, such as Paris and Nièvre, lost up to a quarter of their general practitioners between 2007 and 2016.

This demographic decline affects both rural and urban areas, making access to care increasingly difficult for residents. For example, the Bourgogne-Franche-Comté region has only 9.1 general practitioners per 10,000 inhabitants, a figure well below the national average of 11.3. In addition, nearly 43% of general practitioners are over 60 years old, which suggests even greater challenges in the years to come.

The alarming situation among specialists

The shortage of general practitioners is already a concern, but the situation among specialists is hardly more reassuring. While some specialties, such as dermatology and ophthalmology, are overrepresented in large urban areas such as the Provence-Alpes-Côte d'Azur region, suburban and rural areas suffer from a severe shortage of specialists.

In regions such as Alpes-de-Haute-Provence and Haut-Var, less than 20% of specialists are under 40 years old, which accentuates the inequalities in access to specialized care. This concentration of specialists in large cities, to the detriment of rural and peri-urban areas, highlights the need for localized regulation of the medical offer. Such an adjustment is essential to guarantee equitable access to care for the entire population.

Multifactorial causes of physician shortage

Aging of the medical population

The aging of the medical population is one of the major causes of the shortage of doctors in France. Nearly 43% of general practitioners are now over 60 years old, and this trend is only increasing with time.

This phenomenon leads to a high retirement rate, which is not always offset by the arrival of new physicians. This situation is particularly critical in rural areas, where physicians are often older than in urban areas, thus exacerbating medical deserts.

The perverse effects of the numerus clausus

The numerus clausus, which limits the number of students admitted to the first year of medical studies, has perverse effects on medical demographics. Although this system aims to regulate the number of future physicians, it does not take into account the actual needs of the territory and geographical disparities. This limitation can lead to a shortage of physicians in certain regions, while other areas may have a surplus of healthcare professionals.

Moreover, the numerus clausus does not necessarily promote the establishment of young doctors in the most needy areas.

Unattractive working and compensation conditions

The working conditions and compensation of physicians in France are often unattractive, particularly for general practitioners. Long working hours, a high administrative burden, and compensation that does not always meet expectations contribute to discouraging young physicians from choosing this path.

In addition, the pressure exerted by patients and the healthcare system, as well as the lack of administrative and logistical support, exacerbate burnout and demotivation among healthcare professionals.

Difficulties related to the organization of the healthcare system

The organization of the French healthcare system also presents significant challenges that contribute to the shortage of doctors. The administrative complexity, regulatory constraints, and financial difficulties encountered by private practice and hospital doctors are all factors that make the practice of medicine less attractive.

Moreover, debates surrounding the regulation of the establishment of doctors in the territory, while aimed at improving access to care, may be perceived as coercive and discourage some doctors from settling in areas where they are most needed.

Impact on public health and access to care

The increase in medical deserts

The increase in medical deserts has serious implications for access to care for a large portion of the French population. In 2024, 87% of metropolitan and overseas territories were classified as medical deserts, affecting six million French people who did not have a primary care physician.

These areas, often rural or peri-urban, suffer from a chronic shortage of doctors, which leads to significant difficulties for patients. They often have to travel long distances to obtain basic care, which exacerbates their situation.

The lengthening of delays in obtaining appointments

The shortage of general practitioners and specialists also results in longer delays in obtaining appointments. Patients often have to wait several weeks or even months to see a doctor, which can delay the diagnosis and treatment of potentially serious illnesses.

This situation is particularly concerning for patients suffering from chronic conditions who require regular monitoring and prompt management.

The consequences on hospital emergency services

Healthcare deserts and the shortage of doctors also have direct consequences on hospital emergency services. With fewer primary care physicians, patients are more likely to turn to the emergency room for care that could have been provided in a doctor's office.

This overloads the emergency services, which are already often saturated, and can lead to delays in the management of real emergencies. This overload can compromise the quality of care and endanger the lives of patients who require immediate intervention.

The solutions considered and their limitations

The elimination of the numerus clausus and the reform of healthcare studies

One of the major solutions being considered to alleviate the shortage of doctors in France is the abolition of the numerus clausus. Decided on in 2019, this reform aims to radically transform the healthcare system by increasing the number of students admitted to the second year of health studies. As a result, the number of places in medicine is set to rise from 11,500 in 2024 to 16,000 in 2027, representing a significant increase in the number of medical students.

However, this elimination has not yet produced the expected results in terms of reducing territorial inequalities. The Court of Auditors has emphasized that the planning of training courses should be improved according to the needs of the territories and training capacities. It also recommended the re-establishment of a single access route to medical studies to simplify a current system deemed complex.

Incentives for establishment in under-resourced areas

To encourage young doctors to settle in underserved areas, several measures have been put in place. The Minister of Health, Yannick Neuder, has announced proposed legislation to offer financial incentives and specific benefits to doctors who choose to settle in these regions.

These measures include assistance with installation, tax exemptions, and continuing education tailored to the specific needs of these areas.

Although promising, these initiatives still face practical limitations. The quality of life, career opportunities, and working conditions in these areas often remain less attractive than in large urban areas, which continues to discourage many young doctors.

The use of telemedicine and new technologies

Telemedicine and new technologies represent another solution considered to improve access to care, particularly in underserved areas. Telemedicine allows patients to consult doctors remotely, thus reducing geographical barriers and appointment delays.

Telemedicine platforms and remote diagnostic tools are increasingly being used to address the shortage of physicians.

However, this solution is highly dependent on the available digital infrastructure and connectivity in rural areas, which may be deficient. Furthermore, telemedicine cannot completely replace local care and in-person consultations, which remain essential for many patients.

The development of interprofessional cooperation

Interprofessional cooperation between physicians, nurses, physical therapists, and other healthcare professionals is a key solution to improving the efficiency and quality of care. Multidisciplinary care teams enable shared responsibilities and optimized resource allocation, thereby better meeting patient needs.

However, this approach requires effective coordination and communication between the various healthcare professionals, which can be complex to implement and maintain. In addition, regulatory barriers and differences in professional practices can hinder the adoption of these collaborative care models.

Conclusion

The shortage of doctors in France, particularly among general practitioners and specialists, represents a major crisis for the healthcare system. Medical deserts, exacerbated by the aging of the medical population and unattractive working conditions, have a serious impact on access to care for millions of French people.

The solutions considered, such as the elimination of the numerus clausus, incentives for establishment in underserved areas, and the use of telemedicine, must be implemented urgently and in a coordinated manner. It is essential that public policies be adapted to encourage young doctors to settle in rural areas, while improving their working conditions and remuneration. Collective and immediate action by political decision-makers, healthcare professionals, and civil society is essential to resolve this issue and guarantee equitable and quality access to care for all.

FAQ

What are the main factors contributing to the shortage of doctors in France, particularly in terms of demographics and geographical distribution?

The shortage of doctors in France results from several key factors. First of all, the aging population leads to an increase in healthcare needs, while a low rate of generational renewal, linked to a number of deaths exceeding births, exacerbates the situation. In addition, the unequal geographical distribution of doctors accentuates the problem: rural areas are often less attractive due to difficult working conditions, less competitive remuneration and limited career prospects. In addition, young doctors tend to work fewer hours than their predecessors and favor urban centers.

How have public authorities responded to the problem of healthcare deserts thus far, and what plans and initiatives have been implemented?

Faced with medical deserts, public authorities have implemented various initiatives. Regional Health Agencies (ARS) play a key role in identifying and targeting under-served areas to improve the provision of care. Financial incentives and specific benefits are offered to doctors who agree to settle in these areas.

In addition, telemedicine is encouraged to expand access to remote care, particularly in isolated regions. Training and recruitment programs for healthcare professionals are also being strengthened to address labor shortages.

What are the expected consequences of the decline in the number of doctors on public health and the healthcare needs of the French population, especialmente considering the aging of the population?

The decrease in the number of doctors in France poses considerable challenges for public health. Although a temporary increase is expected, the aging population continues to increase the demand for care. This situation exacerbates medical deserts, where six million French people are deprived of a primary care physician and eight million live in under-resourced areas.

Furthermore, general practitioners are already heavily impacted by burnout, with nearly 45% of general practitioners affected. Increased demand could exacerbate this professional exhaustion, thus affecting the quality of care provided.

What long-term measures, such as raising the numerus clausus, are expected to improve medical density in France, and when might they produce significant effects?

To address the shortage of doctors, the numerus clausus is gradually being replaced by a numerus apertus, allowing a substantial increase in the number of medical students. Between 2025 and 2027, the number of places will increase from 11,500 to 16,000, with 12,000 places already planned for the start of the 2025 academic year.

This reform is designed to strengthen the medical density in France and should produce significant effects from 2026-2027, when the new graduates will begin to practice.