• Bui Dang Ha Doan, Danièle Lévy, Juan Teitelbaum, and Hélène Allemand.
• Centre de Sociologie et de Démographie Médicales.
• Cah Sociol Demogr Med. 2009 Jan 1;49(1):3-98.

AbstractIn the French health care system, most of the ambulatory health services are provided by independent practitioners, GP's and specialists, paid on a fee-for-service basis. Nearly all French residents are enrolled in a public sickness insurance fund. The fund pays directly to the doctor (or reimburse to the patient) on the basis of a honorarium-scale, negotiated by the fund and the medical associations. The specialists working in a private hospital (called "clinique") are considered physicians in independent practice and paid on a fee-for-service basis, whereas the specialists working in public (or para-public) hospitals are salaried. In early 2008, approximately 60 percent of all the medical profession were in independent practice. Out of 100 independent practitioners, 52 declared that their workload was "normal" and 44 that their own was "too heavy". Only 2 percent declared that their workload was "insufficient". The survey showed no correlation between the number of independent physicians working in an area and the average workload of each of them. The competition among medical offices was rather low. At the time of the survey, the French health system was dominated by a wide feeling of medical workforce shortage. However, only one quarter of the independent physicians were convinced that shortage existed in their own area. Difficulties and problems arisen from the relationship with partners were mentioned by a great number of independent practitioners: exaggerate requests from the patients (mentioned by 62%), bureaucratic approaches from the sickness insurance fund (32%), working ties with the public or para-public hospitals (23%)...During the period 2005-2008, the proportion of practitioners having difficulties in their professional relations has increased, in particular among specialists. However, during the same period, there was a change in the mood of the medical profession. The proportion of independent physicians who estimated that their standards of living have remained unchanged or have improved reached 43% in 2008, from 17% three years earlier. This upward trend was even more noticeable among specialists. As concerns the means they used for continuing education, most independent practitioners mentioned the medical journals (87%), the medical textbooks (73%), the medical congresses (66%), the Internet (58%). The refreshing forums organized by professional associations had also a good ranking (64%).

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