Medicine: the French model, imitated by Italy

A complex system. The result of a tormented evolution, which led to the abolition of the numerus clausus. The French model of access to the health professions, which the Italian reform seems to want to adopt, does not have the linearity that some simplifications attribute to it. Or rather: it had them, but they did not work.

After the general opening in 1969, which led to overcrowding of the faculties, France had already adopted a very simple system in 1971. Free access for all, then an examination after the first year - common to medicine and dentistry - and access with a closed number defined according to the absorption capacity of university hospitals. In 1979, faced with what has remained the country's central problem, the medical desert in the countryside, the number of candidates to be admitted was also defined on the basis of the needs of the population: there were 8,500 in 1972, they dropped to 3,500 between '93 and '98 and then rose to 9,361 in 2020. The system then changed in 2009 with the introduction of a first year common to all health professions, including pharmacy and obstetrics: the Paces, Première année commune aux études de santé. It did not work for a very simple reason: the exams were too difficult, and there were unassigned places, even though the system allowed for the possibility of a second test. Many French people studied in Romania (2,000 in 2020), Belgium, Hungary or Australia.

Since 2009, alternative and experimental routes have been flanked to solve the problem. The final reform came in 2019, and came into force in 2021. It provides for two routes, both of which are very selective. The first is the Pass, Parcours Accès Spécifique Santé (Pathway for Specific Access to Healthcare). It is, in fact, the old Paces, but foresees that the student adopts a 'minor', complementary course of study - law, economics, literature... - in case he/she does not succeed in pursuing health studies, which grants 12 credits out of a total of 60. The best students - no more than 50% of the total - are admitted directly to the health faculties; the others, who pass an initial assessment by qualifications, must pass an examination, mostly oral. The Pass does not provide for the possibility of a second test. Those who fail can enter the second year of the 'minor' degree course, but all is not lost: they can switch to the other route, the L.As, Libre Accés Santé (free access to healthcare).

The L.As. is a three-year university degree covering subjects that are also very far removed from healthcare - e.g. law, mathematics, computer science, economics - but the healthcare entrance module allows, at the end of each year and if the required credits have been acquired, to take part in a competition for access to the second year of the faculties of medicine, dentistry, midwifery, physiotherapy. The examination may also be repeated in the second or third year. About 40% of the available places are reserved for L.As. students. There is no 'closed number', but what is called an 'open number': each faculty may define how many students to admit on the basis of a set range - a minimum and a maximum - also after consulting the Agences Régionales de Santé. The number can be adapted to needs at any time: the first of those not admitted can always be re-admitted.