Cahiers de sociologie et de demographie medicales最新文献

On the basis of 3 surveys conducted among French physicians in 1967, 1977 and 2007, the study aims at identifying the current state and the developments during the recent decades of certain aspects related to medical practice: distribution of physicians according to the place of work, their weekly working time, the time they devote to medical readings, the means they utilize for continuing education. In 2007, out of 100 active physicians, 60 are in private practice, 19 work in university hospitals, 23 in other hospitals, 19 in health centers, 6 in the expertise societies or the control departments of sickness insurance funds, 17 in other medical activities and 11 carry out non-medical activities. Each of these figures includes the professionals having other activities elsewhere. These physicians in poly-practice are 47 percent of the medical profession nowadays, they were 58 percent 3 decades earlier. In other words, mono-practice, or exclusive practice, is fastly expanding. The weekly working time of medical doctors in 2007 is 47.9 hours, as compared to 37.9 hours in the whole active population in France. The working time of female doctors (42.4 hours) is much shorter than that of their male colleagues (52.3 hours). However, during the period 1977-2007, the salient feature was that physicians reduced sharply their time of work, from 52.9 hours to 47.9 hours. The decrease was an affair of men, as female doctors have not shortened their own time. Similarly, time shortening was mostly an affair of young and middle-aged physicians, whereas their senior colleagues have performed only a slight reduction. As a result, in 2007, the physicians aged 55 years and over have the longest working time (48.7 hours) as compared to the work week of 46 hours of physicians aged under 40. During the last 3 decades, the time devoted to medical readings has also decreased: 4.3 hours a week in 1977, and only 2.9 hours in 2007, a rhythm 3 times faster than the reduction of the working time. The time devoted to medical readings was equivalent to 8 percent of the working time in 1977 but the ratio decreased to 6 percent nowadays. However, surprisingly, the medical journals and textbooks remain today among the most popular tools quoted by French physicians among the means they utilize for their continuing education. The fact does not hide the spectacular expansion of the medical congresses which were less frequently quoted in the past, and the brutal emergence of internet on the stage of medical continuing education.

The discussion and debate stimulated by these papers focused across a range of issues but there were four main areas of questioning: "measuring" and monitoring migration (issues related to comparability, completeness and accuracy of data sets on human resources); the impact of migration of health workers on health systems; the motivations of individual health workers to migrate (the "push" and "pull" factors) and the effect of policies designed either to reduce migration (e.g "self ufficiency") or to stimulate it (e.g active international recruitment). It was recognised that there was a critical need to examine migratory flows within the broader context of all health care labour market dynamics within a country, that increasing migration of health workers was an inevitable consequence of globalisation, and that there was a critical need to improve monitoring so as to better inform policy formulation and policy testing in this area.