Which general practitioner for tomorrow?
Press release from the French National Academy of Medicine
March 30, 2023
According to the French National Chamber of Physicians, 84 133 doctors were practicing general medicine as a regular activity at the beginning of 2022. In 50 years, their number has been multiplied by 3, while the population has only grown by 17%, but this growth has come at the cost of major territorial inequalities (less than 70 private general practitioners per 100,000 inhabitants in the departments of Mayenne, Sarthe, Orne, Eure, Eure-et-Loir, Oise, Val-de-Marne, Ain and Seine-Saint-Denis, when seven departments have more than 120 per 100,000 inhabitants). Furthermore, almost 20,000 of these doctors have moved towards a “Special Practice” medicine, from homeopathy, naturopathy and acupuncture, to mesotherapy and vertebrotherapy, including osteopathy and aesthetic medicine… (1, 2).
Faced with the increasing specialization of medicine, resulting from progress in diagnostic and therapeutic techniques, patient today reports the need both to obtain an appropriate medical information and to benefit from an enlightened management of his/her disease, including with the specialist. Within the framework of this double need, sometimes disturbed by a consumerist spirit, the practice of general medicine is confronted with multiple and upsetting challenges and makes us wonder about the evolution of the role of the general practitioner who is indeed faced with multiple developments in several domains:
1) technology: the development of artificial intelligence, which aims to revolutionize diagnosis and therapeutic indications, and the rise of telemedicine, which means that doctor and patient can no longer be physically in the presence of each other;
2) diagnosis and therapy that are evolving so rapidly that upgrading skills is a real challenge;
3) professional practice: the encouragement to form a care team gathered around the patient care protocol,
4) societal environment: the patient, alone or through an associative framework, has now a quick access to information concerning his/her health.
These developments also occur in the context of new determinants of the relationship to work : a more pronounced taste for teamwork between the doctor and other caregivers; an increased feminization of the medical profession (65% of general practitioners under the age of 40 are women (1)); a desired reduction in the time devoted to professional life; and an unrewarding remuneration: although general medicine is considered as a specialty, the general practitioner is less well paid than the majority of specialists.
In this context of upheaval, a law, recently adopted at first reading by the French National Assembly, plans to allow patients a direct access to some categories of nurses, by giving them the right to prescribe within a specific framework (3). This law raises the question of the role of general practitioner who, in the evolution of the current healthcare system, sees his or her role as coordinator and referent of the patient becoming central. Concerned by the impact that these orientations are likely to have on the role of the general practitioner, already confronted with rapid and heavy changes in the exercise of his/her profession, the French National Academy of Medicine wishes to recall (4) the place which must be reserved for the
doctor in the patient’s care pathway:
– His/her mission is to carry out, as close as possible to the patient, preventive actions, primary care medicine, long-term follow-up and coordination of patient care;
– He/she must ensure the overall management of the health of his/her patient, which is at the heart of his/her mission as a referring doctor;
– The use of digital diagnostic and therapeutic means and the transfer of tasks with other healthcare personnel are necessary within the framework of close collaboration within adequate medical and paramedical structures, but the general practitioner must retain his role as coordinator and as the patient’s personal referent throughout his/her care pathway.
 Conseil national de l’Ordre des médecins, Atlas de la démographie médicale 2022, https://www.conseil-national.medecin.fr/sites/default/files/external-package/analyse_etude/11jksb5/cnom_atlas_demographie_medicale_2022_tome_1.pdf
 Direction de la Recherche, des Études, de l’Évaluation et des Statistiques, 07/2022 https://drees.shinyapps.io/demographie-ps/
 Assemblée Nationale, Session Ordinaire de 2022-2023, Discussion de la proposition de loi de Mme Stéphanie Rist et plusieurs de ses collègues portant amélioration de l’accès aux soins par la confiance aux professionnels de santé, 19 janvier 2023
 Académie nationale de médecine, Avis sur « Quels rôle et place pour le médecin généraliste dans la société française au XXIe siècle ? Du médecin traitant à l’équipe de santé référente » (rapporteur : G. Vallancien), 14 février 2023