The French Republic was born in 1793, fruit of a long and tormented political history. France is a constitutional republic with a semi presidential regimen, and it has around 67 million people. The French national statement is “to govern the nation, by the nation and for the nation”, which fits well with our motto: “liberté, égalité, fraternité”. The capital is Paris, and the official language is French. Paris and the French Riviera are both high touristic places.
France can be considered the place where neurology and neuropathology were born, thanks to Charchot and Vulpian. In 1862, Jean-Martin Charcot (1825-1893) and his friend Vulpian became both heads of the neurology division in the “La Pitié-Salpetrière” hospital in Paris. During their career, Charcot & Vulpian performed a systematic clinical and anatomical description of many neurological diseases. Their tremendous work cannot be summarized in a few lines. All fields of the neurology were explored and revised, including multiple sclerosis, amyotrophic lateral sclerosis (which was also called Charcot’s disease), spinal amyotrophy (Charcot-Marie-Tooth), and also psychiatry, like the famous studies on hysteria which contributed to the worldwide reputation of Charcot.
The French health care system is largely financed by the government national health insurance. In its assessment of 2,000 world health care systems, the World Health Organization found that France provided the “close to best overall health care” in the world. In 2011, France spent 11.6% of GDP on health care (around 4,086 USD per capita), a number much higher than the average spent by other countries in Europe, although less than in the USA. Approximately 77% of health expenditures are covered by government funded agencies.
Instead, the government has taken responsibility for the financial and operational management of health insurance (by setting premium levels related to income and determining the prices of goods and services refunded). The French government generally refunds patients 70% of most health care costs, and 100% in case of costly or long-term ailments. Most general physicians are in private practice but draw their income from the public insurance funds.
There are 39 Faculties of Medicine in France with a total of about 41, 600 residents in medicine. Around 2,470 neurologists currently work in France (3.5 neurologists for 100,000 people), and 66 % of the them works in the hospital whereas 33% in the private system or both. About 48% of the French neurologists are women.
To become a neurologist in France, one has to first obtain a scientific baccalaureate. After that, one has to pass a very competitive examination, the PACES which concludes a common first year for health studies (only 18 % has been admitted to medicine in 2017). Afterward, one will go through five years of medical training. At the end of the general training, another selective exam is necessary to enter the residency program, the so called ECN (“épreuves nationales classantes”). According to the ECN rank, one will be allowed to choose the type of residency and where to do it. At the end of four years of residency in neurology, one will have the final medical and the specialization degree.
Our medical and neurological educational training is provided in French.
The French College of Teachers of Neurology (Collège des Enseignants de Neurologie/ CEN, currently led by Pr Mathieu Zuber, see https://www.cen-neurologie.fr/) is driving a dynamic policy to facilitate and enrich the training of young neurologists. It gathers the directors of neurology residency programs for each French region to integrate and share the training strategy adopted at a national level.
This program allows to evaluate students with standardized tools, and to organize in partnership with the French Society of Neurology a yearly 2-day symposium in Paris welcoming 450 residents in neurology. They will present the 6-8 best clinical research studies and will ask young academic neurologists (nominated within the previous 12 months) to give lectures, to drive controversies, and to chair round tables.
Example in Lille:
The medical Faculty is part of the University of Lille, and works closely with the university hospital of Lille. For historical reasons, Lille is the only university centre for a region of 4 million inhabitants, while most university centres in France cover an area of 1 million. The university team consists of 6 full professors, 2 associate professors, and 6 assistant professors and 13 senior physicians employed only on the hospital. Besides, the 3 professors of pharmacology, a professor of histology and the 2 professors of neurophysiology are also neurologists. Being the only university centre for 4 million people it explains why our recruitment for rare diseases is important, and also the thrombectomy rate, Lille being the only centre with thrombectomy in this region, while rt-PA can be delivered in 12 centres.
The « Société Française de Neurologie » (SFN) was founded in 1949. It has a President and a Board subjected to re-election every year. Up to date, the SFN comprised about 850 members (including young neurologists with a dedicated junior status). The current President is Pr Gilles Edan (from Rennes) and the next President for 2018 will be Pr Bruno Dubois (from Paris). The SFN is the natural interlocutor of the public health authorities for all matters to do with neurology. The SFN promotes clinical research in neurology by organizing three annual scientific congresses and by editing a peer reviewed scientific journal, “La Revue Neurologique”. For young neurologists, the SFN provides Master research bursaries and congress travel grants. The SFN participates also to educational programs for French speaking African and Asian countries. The official website is http://www.sf-neuro.org with a monthly newsletter.
The most recent and important achievements in our country are not specific for neurology: the health insurance system, created by Charles de Gaulle after World War II, ensure a 100% re-imbursement for all serious disorders (using a generous definition of serious: for instance, appendicectomy is serious), including a pregnancy and children up to 4 years, and a 70% re-imbursement for minor problems, the rest being covered by private insurances. Therefore, nobody is really anxious about not to be able to afford for health care for serious diseases.
Since 2002, all French governments had health plans, and there has been a coherence between these plans despite the political changes. Neurology is one of the specialty that benefits most from these plans: cancer program with the president Chirac (with a part for neuro- oncology), Alzheimer program with the president Sarkozy, that was very successful and been extended by the president Hollande to a “neurodegenerative program”, rare disease program, stroke program, etc. Neurology is part of most health plans initiated during the last 15 years.
To summarize, in France there are number of high expertise centers in all the subspecialities of neurology with international leaders; a dynamic research in neurosciences; a health care system that gives patients access to the latest medical advances, and a well-known quality of life!
Please read more articles by French authors published in the European Journal of Neurology here.
Article contributed by Caroline Moreau MD, PhD; Didier Leys, MD, PhD, Gilles Edan, MD PhD, Khe Hoang Xuan, MD, PhD