Medical studies: drop in the number of interns, first choice for cosmetic surgery… 2025, a year apart ?

Les internes XXX Midi Libre – ARNAUD MONNIER

Cosmetic surgery comes first in the choices of specialties for medical internships, decided at the end of November, while sectors in need of “arms”, emergency services, general medicine or even psychiatry are far behind in a particular year where the promotion of interns will be reduced by a thousand doctors in France, thirty in Occitanie-est..

Plastic surgery ahead of ophthalmology and dermatology, general medicine in 37th position, emergency medicine 36th and psychiatry 40th: are the choices of specialties, made at the end of November by future medical interns, problematic in a context of medical deserts, tensions in emergency services, and an acute crisis in psychiatry? ?

“This year, six specialties have not managed to fill the available positions. Public health has only filled 26% of the available places, medicine and occupational health 61%, medical biology 67%, psychiatry 76%, geriatrics 79%”, notes the magazine l'Étudiant, which draws up an inventory based on the list of admissions published in the Official Journal, in the absence of a readable ranking: 13 different rankings are now established around 44 specialties.

The specialties that come out on top in the choice of interns in 2024. Midi Libre – SOPHIE WAUQUIER

The context is particular: a thousand students are missing for 2024-2025, at the national level, and 30 in Occitanie Est, “that is 8.5% less, well below the 15% announced”, indicates Isabelle Laffont, Dean of the Faculty of Medicine of Montpellier-Nîmes. This is a side effect of the reform of medical studies: students preferred to repeat rather than “wipe the plaster” of a class facing new exams, the Ecos (objective structured clinical examinations), in 2024.

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“Aesthetic medicine is also the choice of surgery for major burns”

Rémi Salomon, head of the pediatric nephrology department at Necker Hospital in Paris, president of the medical conference of the establishment (it represents doctors) of the AP-HP in Paris, national president of the conference of presidents of CME, does not hide his concern: “When we see this ranking of the choices of specialties in internships, we can say that there is a problem. The needs in psychiatry, geriatrics, general medicine or public health are so great and the positions are not all filled, far from it. We must collectively ask ourselves the question of how to open more positions in these disciplines, and above all encourage students to choose them by making them more attractive”, he says on Linkedin.

“We must introduce little-known specialties, such as medical biology or public health. We never think about them when choosing our internships. We must not focus on the choice of cosmetic surgery”, adds Killian L'Helgouar'h. Intern in Montpellier, president of the Isni (General Assembly of the National Intern Union), he recalls that barely “20 reconstructive surgery positions are to be filled in France”, without denying that “the specialty is in high demand” by the 9000 students who enter the internship.

“Aesthetic medicine is not just a way of entering establishments with very lucrative activities, it is also the choice of reconstructive medicine for major burn victims”, qualifies Isabelle Laffont. She acknowledges that future doctors are nevertheless tempted by activities that are less personally demanding. “An exercise that allows you to reconcile your professional and personal life, in a supervised working time”, adds Killian L’Helgouar’h.

“We won't have the same problems as elsewhere”

In Occitanie-est, there is no real question of neglected specialties, assures Colin Azria, president of the Nîmes-Montpellier interns' union. “We have an attractive teaching and living environment, the sun and the mountains… the 325 boarders in this year are evenly distributed, and the boarders with the highest national rankings ask to come to us,” the student assures us. Even if “general medicine, which represents 50% of the positions offered”, does not have full staff.

“General medicine is one of the specialties that has lost the most positions, like emergency medicine and resuscitation, but these are specialties with large or very large staff. Thirteen specialties have lost one position, four specialties have lost two”, details Dean Isabelle Laffont, who specifies that here, “psychiatry is the specialty that has gained the most positions”. Three more.

She adds that the situation will evolve “in the next two years”. “We will increase this number of positions very quickly, with the effect of the removal of the numerus clausus of 2019 and the gradual increase in the number of second-year medical students. We have gone from 260 students in 2019 to 400 in 2023, an increase of 54%.”

“We will not have the same problems as elsewhere, but we are not answering the question of the presence of doctors in under-dense areas, explains Colin Azria. We are working with local authorities to distribute interns throughout the territory”.

A leitmotif. At the Universities of E-Health in Castres on November 26 and 27, Pascal Durand, director of projects at the ARS, recalled the need “to install around 2,600 general practitioners in Occitanie within ten years, while at the same time, 3,000 should graduate from the faculties of Toulouse and Montpellier”. There is urgency as “the “wall” of aging is looming in the region within five years”.

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