For Karima*, 39, the last visit to the prefecture turned into a nightmare. His residence permit was not extended. “I only have a receipt,” she laments. However, this pediatric orthopedic surgeon has been working for two years in a hospital in the Paris suburbs, including in the emergency room where she is on call at least four nights per month. “My general surgery colleagues asked me to come in to help them out a little,” explains the practitioner from the Maghreb*. “I’m not going to let them down,” she says, without knowing how much longer she will be able to practice.
The hospital agreed to let her work, but Karima fears the end of her contract, which is renewed every six months. She is one of some 4,000 qualified practitioners outside the European Union (called Padhue), who have worked in French hospitals for years under various precarious statuses, such as that of "acting as an intern" (FFI).
“The tasks that I occupy are tasks of responsibility, tasks of a practitioner, even if I am considered as an intern with a contract worth 1,400 euros net to be renewed every six months. If the prefecture refused to extend my title of stay is because of these breaches of contracts" regrets the doctor, who constantly juggles with the administration to try to stabilize her situation. “This time, the prefecture is asking me for a work authorization provided by the Regional Health Agency (ARS), which no longer wants to give it because the law has changed.”
In question, the expiration on December 31 of an exceptional regime which allowed establishments to hire Padhue under various precarious statuses, making it now impossible for them to remain in their positions. Since January 1, 2024, these doctors must pass a very selective competition called “knowledge verification tests” (EVC), to be able to be reinstated. But places are expensive: 2,700 positions for more than 8,000 candidates in 2023, some of whom are trying their luck from abroad. As a result, a majority of Padhue found themselves on the floor this year.
After an outcry from the unions, the executive finally promised to "regularize a number of foreign doctors", and decided to extend their temporary work authorizations by one year, until they pass the 2024 EVC session .
“I don’t understand why people don’t judge me on my experience here”
But for Karima, a graduate in general surgery, the problem is far from being resolved. She tried to take the EVC for pediatric orthopedic surgery in 2023, except that her file was refused. "I am told that I do not have the right diploma, that I need one in pediatric orthopedics, but this diploma does not exist in my country! I do not understand why I am not judged on my experience here. I operate alone, I consult, I have my own patients,” says the practitioner.
When she arrived in France in 2020, she had not planned to settle on this side of the Mediterranean. “I had obtained a secondment from work to come and do advanced training in orthopedic surgery in France, because I had noticed gaps in the service where I worked in the Maghreb,” she explains. But after almost two years in an associate trainee position in a Nice university hospital, Karima found herself stuck in France because of the Covid-19 pandemic and the closure of the borders with her country. She lost her post in the Maghreb.
See alsoReport: foreign doctors to deal with the shortage in France
In Nice, she remembers this period when she fought on the Covid-19 front, alongside French caregivers, lending a hand in intensive care. "We have saved lives. And we will continue to do so. It's our job. Sometimes in the emergency room, I find myself in a situation where I have to react in a split second, make the right gestures, make the right decision to save someone".
“I regularly have to pack my bags.”
Return to the Maghreb? The surgeon sometimes thinks about it: "I ask myself the question, I wonder if I can still hold on in this situation. But I have a job that I love very much, especially with children. I am attached to my patients. When I see in their eyes that they are satisfied, I feel useful.” However, the idea of leaving is gaining ground without being able to plan ahead, on a daily basis. “I regularly have to pack my bags. I even hesitate to order new furniture.” So his relatives encouraged him to apply in Germany. “Colleagues went there. They were accepted on application and took German language courses,” she says.
In a context of overloading its health system, France, which nevertheless has a crying need for reinforcements, risks seeing these thousands of doctors prefer other European states.
Dr Aristide Yayi, originally from Burkina Faso, came to demonstrate in front of the Ministry of Health to defend the Padhue, on February 15, 2024. © Bahar Makooi / France 24
Dr. Aristide Yayi, originally from Burkina Faso and graduated in forensic medicine in Dakar, Senegal, has been practicing multi-purpose medicine for three years in the Ephad of the Commercy hospital in the Meuse. A sector that is seriously lacking in doctors. “My contract runs until July 2024. After that I don’t know what happens next,” regrets the young doctor, because he wants to develop a pain management service for the elderly at Ephad. A project that could never see the light of day if its situation is not regularized. "I go through training courses and six-month contracts as an 'ignorant intern'. It's always uncertainty and precariousness. I have the feeling that I am considered as a sub- doctor,” he believes.
Hospital services threatened without its foreign doctors
Several department heads, particularly in Île-de-France, have warned that they would be “forced to close” their department without the presence of these Padhue. During his press conference on January 16, French President Emmanuel Macron admitted that France needed these practitioners, saying he wanted to "regularize a number of foreign doctors, who hold our system at arm's length." A promise recalled by the Prime Minister, Gabriel Attal, in his general policy speech at the end of January.
A speech that must be followed by facts, the unions are now demanding. Received Thursday by the Ministry of Health, they welcomed the publication, the day before, of the decree extending temporary work authorizations for foreign doctors who undertake to pass the 2024 EVC session. “A first step” which “only postpones the problem for a year”, denounces Olivier Varnet, general secretary of the National Union of Hospital Doctors FO.
In the meantime, foreign doctors are toasting. Nearly 1,900 of them are unable to exercise at the moment. "My old department is desperately looking for someone to replace me. They are really in trouble. I was responsible for two units with twenty patients each. We are walking on our heads...", complains Mostapha, who worked in a follow-up care and rehabilitation service in Normandy. His contract as an “associate attached practitioner” was suspended on January 1, since he was not admitted to the knowledge verification tests. “The hospital wanted to detain me but the ARS did not grant authorization,” says the forty-year-old.
“Candidates were failed with an average of more than 15”
A graduate of the Faculty of Algiers in physical medicine and rehabilitation, he followed his wife, of French nationality, to France three years ago. “I have no problem with papers, I have a 10-year resident card,” he continues.
Mostapha joined his fellow doctors and a union delegation received on February 16 by the Ministry of Health. © Bahar Makooi / France 24
Mostapha hopes that his case will be examined more closely, and that the new circular will allow him to regain his position. But he no longer believes in the validation of his course by the EVC: "I intend to repeat it since for the moment there is no solution, although the chances of having it are more and more reduced because of the number of positions. It's worse than selective."
Many unions, such as the CGT doctors' collective, believe that this exam is akin to a numerus clausus rather than a "knowledge test". “Candidates were failed with an average of more than 15,” denounces Laurent Laporte, secretary general of the Federal Union of Doctors, Engineers, Managers and Technicians of the CGT. “Too academic”, “random”, “opaque” and “discriminating for doctors who work sixty hours a week”, still accuse the unions, to whom the Ministry of Health promised, on February 15, a “reformulation of the 'EVC' with modalities more adapted to reality.
*This person wishes to remain anonymous
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