Demography of French anaesthesiologists. Results of a national survey by the French College of Anaesthesiologists (CFAR) and the French National Society of Anaesthesia and Intensive Care (SFAR), supported by the National Institute for Demographic Studies (INED)
Background and objective: The perception of a looming manpower shortage led the French College of Anaesthesiologists (CFAR) and the French Society of Anaesthesia and Intensive Care (SFAR), with assistance from the National Institute for Demographic Studies (INED), to conduct a national survey of French anaesthesiologists in order to determine precise physician characteristics data, analyse professional practices and project future service provision.
Methods: The survey was based on self-administered individual questionnaires, approved by the National Committee on Informatics and Freedom (CNIL). The survey was carried out at the end of 1998 among 1484 hospitals (590 public and 894 private), under the supervision of local referees and regional co-ordinators.
Results: Of 9741 anaesthesiologists' posts, 5694 (58%) are in public hospitals, 3569 (37%) in private practice and 478 (5%) in private hospitals within the National Health Service, i.e. the participant au service public hospitalier (PSPH). Complex validation of the results was necessary to account for the missing responses and multiple sites of activity. The survey identified 8876 specialists practising anaesthesia and intensive care in France at the beginning of 1999, including 216 in French overseas territories. This figure is consistent with that published by the Medical Council (Ordre des Médecins) on 1 January 1999, identifying 8950 anaesthesiologists in France, including 234 in the overseas territories. Annual growth in the anaesthesiologist population has fallen from 9% pre-1989 to 0% in 1999. Male anaesthesiologists outnumber females (35.7%). The average age has risen from 42.8 yr in 1989 to 45.9 yr in 1999. The age distribution of anaesthesiologists has become bell shaped, reflecting reduced numbers of younger practitioners. There are currently 14.75 anaesthesiologists per 100 000 people (compared to 12.9 in 1989), a figure slightly above the European average, but there is considerable geographical inequality between the north and south of France, with increased concentrations in large cities that contain university hospitals.
Conclusions: Future service provision must take account of falling numbers of new anaesthesiologists and an increase in retirements, but must also include changes in working practices, such as the European Working Time Directive. If anaesthesia manpower shortages are to be avoided, there must be a restructuring of the workplace, a redefinition of tasks and improved management of working time.(Accepted June 2003)
Key Words: ANAESTHESIOLOGY; DELIVERY OF HEALTHCARE, health resources, health manpower; HEALTH SERVICES ADMINISTRATION, organization and administration, professional practice.
c1 Correspondence to: Silvia Pontone, Service d'Anesthésie et de Réanimation Chirurgicale, Hôpital Robert Debré, 48 boulevard Sérurier, 75019 Paris, France. E-mail: firstname.lastname@example.org; email@example.com; Tel: +33 01 40 03 2000, ext 215; Fax: +33 01 40 03 2237
1 CFAR-SFAR-INED Working Group also includes: Y. Auroy, C. Conseiller, J. M. Dumeix, P. Feiss, J. Garric, E. Giraud, M. C. Laxenaire, A. Lienhart, M. Palot, and J. L. Pourriat.