Press release
For a regionalized medical internship
January 23, 2026
The causes of difficulties in accessing medical care are numerous , but two are essential: the reduction in available medical time and the heterogeneity of the territorial distribution of healthcare professionals.The place where the internship is carried out is a decisive factor in installation, suggesting that it would be beneficial to encourage students to stay in their home region to carry out their third cycle of medical studies (internship) (currently, on average, only 25% of students carry out their internship in their home region, with disparities ranging from 10% to 60% depending on the region).Moreover , the region of internship should under no circumstances be imposed as the region of installation
1. The internship: gradual loss of its regional roots
The aim of the internship competition, when it was created in 1802 in Paris, and then in the cities where the faculties were located, was to create a medical elite, benefiting from training at the patient’s bedside. This hospital internship was supplemented by the creation in 1943 of the health region internships, which enabled secondary hospitals to be equipped and high-quality medical teams to be set up in the provinces. The university system for training specialist doctors, via specialized study certificates (CES), was created in 1949 to meet the growing need for specialist doctors, which the internship system could no longer meet.
From 1982 onwards, the competitive entrance examination for interns, access subsequently organized on an inter-regional basis, became the only route to a specialty. In 2004, it was replaced by national examinations (ECN), then from 2021 by national dematerialized tests (EDN) and objective and structured clinical examinations (ECOS), open to all candidates from French or European Union universities. Most ‘European’ students ranked in these exams, which give access to postgraduate studies in France, are young French nationals who began their studies in a European university.
Currently the national matching procedure for access to postgraduate studies takes into account candidates’ wishes, expressed by specialty and by subdivision (territory attached to a University Hospital Centre), in descending order of priority and a weighting of the results according to wishes expressed. Students base their final choice on the specialty and then on the subdivision, with the least attractive ones being chosen by default, often with the only motivation being the possibility of accessing to their desired specialty.
2. Proposed developments
Keeping common national dematerialized tests (EDN), synchronous in all universities with national rankings is necessary. Thus, the proposed developments in this note are based on adaptations of the national matching procedure which must continue to ensure that the students’ merit is considered, a principle to which they are committed.
The return to an internship entirely organized by region is not conceivable with more than ten thousand potential candidates. Part of the regionalization of internships appears to be a good compromise in favor of regions attractiveness whose medical demography is in difficulty.
2.1 – Choice by region then by subdivision
The students’ wishes will focus on regions and no longer on subdivisions. The choice of one of the region subdivisions will then be made by ranking rank. Systematic mobility within the university hospitals in the region will be favorable to the quality of training.
2.2 – Taking into account applications from priority regions in the rankings
The possibility of expressing choices of priority regions will be offered, optionally or compulsorily, when registering for the tests. A weighting coefficient corresponding to the regional priorities will be included in the
national matching procedure, favoring students who have expressed interest in 2 or 3 priority regions. The attractiveness of these priority regions will thus be improved: the assumption is that the least attractive regions and those with the greatest difficulties in terms of medical demography will attract applications from students from these regions, increasing their chances of accessing to the specialty of their choice.
2.3 – Proposed criteria for prioritizing regions
Since 2019, the ONDPS (Observatoire National de la Démographie des Professions de Santé, National Observatory of the Demography of Health Professions) has introduced a ‘framework’ for allocating posts for interns between subdivisions, giving priority to territorial rebalancing. The interns’ positions allocated to the 10 subdivisions with the lowest demographic medical resources have been significantly increased, without however requiring students to remain in their subdivision of origin. It is this categorization which will be used to define priority regions.
2.4 – Consideration of the “Public service commitment contract” (CESP) in the pairing procedure.
The CESP is a device that grants an allowance to graduate students who contract, subject to practicing in a sub dense area for a duration equivalent to the number of years the allowance was paid. The CESP attractiveness should be strengthened if the commitment was accompanied by a provision opening the choice of the specialty by adding another weighting coefficient in the national matching procedure.
Recommendations
The French Academy of Medicine and France Universities propose:
1- A partial regionalization of the internship to promote the attractiveness of those regions with the greatest difficulties in terms of medical demographics.
2- A choice by region and not by subdivision to reinforce the internship territorialization.
3- The possibility of choosing priority regions at the time of application, taken into consideration in the rankings by incorporating an additional weighting coefficient in the national matching procedure.
4- Making the public service commitment contract more attractive by offering the choice of the specialty by adding a second additional weighting coefficient in the national matching procedure.
ACADÉMIE NATIONALE DE MÉDECINE
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Site : www.academie-medecine.fr
