How can a country as developed as France be running short of doctors? The answer isn’t found in today’s hospitals, but in the lecture halls of the 1970s and 1990s. At that time, the state deliberately shut off the faucet of medical vocations. Fifty years later, the bill has come due, and it is steep.
- The numerus clausus, introduced in 1971, saw its places drop from 8,588 in 1972 to only 3,500 in 1993, creating a deferred shortage of doctors.
- With 9 to 12 years of study required, the effects of these restrictions did not become evident until the early 2000s to 2010s, triggering a steady decline in general practitioners through 2024.
- Replaced by the numerus apertus in 2021, the system shows signs of improvement, with an expected 30% more doctors by 2040, but the measure is already criticized by the health minister who wants to abolish it.
- 1971-1993: The dizzying drop in the supply of doctors
- Nine to twelve years of training: why yesterday’s effects hit France today
- 2021: The end of numerus clausus — a turning point too late to fill the void
1971-1993: The dizzying decline in the supply of doctors
It all began in 1971, when numerus clausus appeared in French medical faculties. The idea seemed reasonable: regulate the number of second-year students to guarantee the quality of training. By 1972, 8,588 places were opened nationwide, a figure that appeared to meet the country’s needs.
But over the decades, this faucet gradually shut off. Public authorities feared an oversupply of care, which they equated with uncontrollable health costs. Year after year, quotas were cut, without real anticipation of future demographic needs.
The low point came in 1993: only 3,500 places were opened, less than half of the 1972 figure. In other words, in two decades, France reduced by more than half the number of future doctors trained each year, without regard to the consequences that would surface a generation later.
This budget decision, intended to curb short-term spending, would in fact set up a lasting shortage. For in medicine, the effects of a policy are never measured immediately.
9 to 12 years of training: why yesterday’s effects are hitting France today
To understand this lag, one must look at the real duration of medical studies. Between the first year of access to health studies, externship and internship, it takes between 9 and 12 years before a student becomes a fully qualified general practitioner or specialist. It’s a marathon, not a sprint.
Concretely, the decisions taken in 1993 only produce their effects around the turn of the 2000s and 2010s, when these restricted cohorts finally enter the job market. And the phenomenon self-feeds: fewer students trained yesterday means fewer doctors in post today to supervise and train the next generations.
The figures from DREES confirm this time lag. The number of general practitioners declined steadily between 2018 and 2024, before edging back up slightly. As of January 1, 2026, France had 100,974, i.e., 955 more than a year earlier. A welcomed rebound, but arriving after years of decline.
Medical density tells the same negative tale: it rose from 331 doctors per 100,000 people in 2012 to 351 per 100,000 in 2026. A real, but slow, improvement, and above all highly uneven across territories, which explains why some French citizens still struggle to find a primary care doctor even as overall numbers increase.
2021: The end of numerus clausus — a turning point too late to fill the void
In light of this observation, the law of July 24, 2019 replaced the numerus clausus with numerus apertus, applicable from the 2020-2021 academic year. Concretely, intake capacities are no longer fixed uniformly nationwide, but university by university and program by program, with the stated objective of training more doctors. The historic mechanism definitively disappeared in 2021, fifty years after its creation.
Early results are beginning to be felt. According to DREES, France counted 242,200 doctors in active practice on January 1, 2026, about 5,000 more than a year earlier. The growth even reached 2.1% between 2025 and 2026, compared with 1.6% the previous year and 1.4% the year before. A gradual acceleration, showing that the policy shift is starting to bear fruit.
DREES projections, published in October 2026, anticipate about a 30% increase in active doctors by 2040 and up to 75% by 2060, based on the current total of 261,800 doctors and students. This trend assumes the admission of 12,200 students each year into the second year of medical studies, as well as 2,500 doctors graduating abroad per year. The DREES also notes that the medical demography of 2040 is largely pre-scripted, given the long duration of studies makes any adjustment extremely slow.
In practice, the effort is also reflected in the opening of intern positions. A decree dated August 4, 2026 opened 10,260 positions for 2026-2027, including 4,070 in general medicine and 212 in geriatrics, a specialty particularly sensitive to the aging population. But numerus apertus itself is now a matter of debate: in June 2025, Health Minister Yannick Neuder announced on France Inter his desire to abolish it, arguing that it still does not enable enough doctors to be trained to meet the country’s needs.
Fifty years after the establishment of the numerus clausus, France is discovering just how far-sighted public health policy can shape the future. Numbers are rising, intern positions are multiplying, but it will still take a decade, or even two, before today’s decisions truly fill the void created by yesterday’s. In medicine, time is never caught up; it is crossed.
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