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Démographie médicale et carrières des médecins généralistes : les inégalités entre générations

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  • Brigitte Dormont
  • Anne-Laure Samson

Abstract

[ger] In Frankreich wird das Angebot an ambulanter Gesundheitsversorgung seit 1971 durch den Numerus clausus reguliert, der die Zahl der Medizinstudenten, die in das zweite Studienjahr aufgenommen werden, beschränkt. Ursprünglich auf 8 588 Plätze festgelegt, hat diese Zahl in Wirklichkeit erst ab 1978 abgenommen und fiel im Jahr 1993 auf 3 500 Plätze. Die großen Kohorten im Gefolge des Babybooms und die geringe anfängliche Beschränkung führten zu Generationen mit zahlreichen jungen Ärzten. Erst ab 1987 (also neun Jahre nach 1978 aufgrund der Dauer des Medizinstudiums) wirkt sich der Numerus clausus auf die Zahl der jungen Mediziner aus. Anhand eines repräsentativen Panels von Allgemeinmedizinern des Sektors 1 im Zeitraum 1983-2004 lassen sich die Determinanten ihrer Honorare und die Auswirkungen der Schwankungen des Numerus clausus auf ihre Berufslaufbahn analysieren. Ort und Tariferhöhungen haben eine erhebliche Auswirkung auf ihre Honorare. Die Profile der Berufslaufbahnen der Ärzte unterscheiden sich stark von denen der Arbeitnehmer: Bei sonst gleichen Bedingungen steigen ihre Honorare zu Beginn ihrer Berufslaufbahn rasch an und sind dann im Schnitt ab dem zwölften Berufsjahr rückläufig. Alles deutet darauf hin, dass die Ärzte ihre Anstrengungen auf die ersten Berufsjahre konzentrieren, um in der Folgezeit ihre Arbeitsbelastung zu mindern. Die Honorare der Ärzte hängen weitgehend von der medizinischen Demographie bei ihrer Niederlassung ab. Die Unterschiede zwischen den regulären Honoraren der einzelnen Kohorten können bei sonst gleichen Bedingungen bis zu 20% erreichen. Auf die Kohorten der in den 1980er Jahren niedergelassenen Ärzte wirken sich zugleich der Babyboom und ein hoher . Numerus clausus aus, denn sie beziehen die niedrigsten Honorare. Durch die Absenkung des Numerus clausus . hat sich die Situation der späteren Kohorten verbessert. Einem Vergleich der Honorarverteilungen im Hinblick auf die stochastische Dominanz ist zu entnehmen, dass die Abweichungen aufgrund der nicht beobachteten Heterogenität die durchschnittlichen Unterschiede zwischen den Kohorten nicht ausgleichen. Medizinische Demographie und Berufslaufbahnen der Allgemeinmediziner: Ungleichheiten zwischen den Generationen . [fre] En France, l’offre de soins ambulatoires est régulée depuis 1971 par le numerus clausus, qui fixe le nombre d’étudiants admis en deuxième année de médecine. Fixé initialement à 8 588 places, il n’a vraiment diminué qu’à partir de 1978, jusqu’à atteindre 3 500 places en 1993. L’arrivée des cohortes nombreuses du babyboom et la faiblesse des restrictions initiales ont permis l’installation de générations nombreuses de médecins débutants. Ce n’est qu’à partir de 1987 (soit neuf ans après 1978, du fait de la durée des études médicales) que l’on observe un impact du numerus clausus sur le nombre de médecins débutants. Un panel représentatif des généralistes du secteur 1 sur la période 1983-2004 permet d’analyser les déterminants de leurs honoraires et l’impact des fluctuations du numerus clausus sur leurs carrières. La localisation et les revalorisations tarifaires ont un impact considérable sur les honoraires. Les profils de carrières des médecins diffèrent fortement de ceux des salariés: toutes choses égales par ailleurs, leurs honoraires progressent rapidement en début de carrière pour diminuer en moyenne dès la douzième année d’expérience. Tout se passe comme si les médecins préféraient concentrer leur effort au début de leur expérience professionnelle pour alléger ensuite leur charge de travail. Les honoraires des médecins dépendent fortement de la situation de la démographie médicale lors de leur installation. L’écart entre les honoraires permanents des différentes cohortes peut atteindre 20 %, toutes choses égales par ailleurs. Les cohortes installées dans les années 1980 subissent les impacts conjoints du baby-boom et d’un numerus clausus élevé: elles perçoivent les honoraires les plus faibles. La diminution du . numerus clausus a permis d’améliorer la situation des cohortes ultérieures. Une comparaison des distributions d’honoraires en termes de dominance stochastique montre que les écarts liés à l’hétérogénéité non observée ne compensent pas les différences moyennes entre cohortes. Démographie médicale et carrières des médecins généralistes: les inégalités entre générations [eng] Since 1971 the number of doctors providing ambulatory care in France has been restricted by the limited number of places for students in the second year of medical studies. Initially set at 8588 places, the number only started to fall in 1978, until it reached 3500 places in 1993. The arrival on the scene of the large babyboom cohorts and inadequate initial restrictions meant that many generations of young doctors started practicing. It was only in 1987 (i. e. nine years after 1978, due to the length of medical studies) that we can start to see the impact of the limited number of medical school places on the number of young doctors. Taking a representative sample of •sector 1’ GPs (public doctors who charge the officially negotiated rates) over the period 1983-2004 made it possible to analyse the determinants for their earnings and the impact on their careers of fluctuations in the number of medical school places. Location and increases in rates of pay had a considerable impact on earnings. The career paths of doctors are very different from those of salaried employees: all things being equal, their earnings rise quickly at the start of their careers and then fall, on average from the twelfth year of practicing onwards. It is as if doctors preferred to concentrate their efforts at the start of their working lives and then reduced their workload. Doctors’ earnings depend heavily on the demography of the medical profession when they start practicing. The gap between the permanent earnings of the different cohorts can be up to 20%, all things being equal. The cohorts who started practicing in the 1980s suffered the combined impact of the baby boom and a high number of medical school places: they earned the least. The fall in the number of medical school places improved the situation for subsequent cohorts. A stochastic dominance comparison of earnings distribution shows that the disparities connected with unobserved heterogeneity do not compensate for the average differences between cohorts. The Demography of the Medical Profession and the Careers of General Practitioners (GPs): Intergenerational Inequalities [spa] En Francia, desde 1971, la oferta de atención ambulatoria está regulada por el numerus clausus, que determina el número de estudiantes admitidos en segundo año de medicina. Limitado inicialmente a 8.588 plazas, sólo ha disminuido verdaderamente a partir de 1978, hasta llegar a 3.500 plazas en 1993. La llegada de las numerosas cohortes del baby-boom y la poca firmeza de las restricciones iniciales permitieron que se instalaran numerosas generaciones de médicos principiantes. Es sólo a partir de 1987 (es decir nueve años después de 1978, dada la duración de los estudios de medicina) que se observa un impacto del numerus clausus en la cantidad de médicos principiantes. Un panel representativo de los médicos generalistas del sector 1 en el periodo 1983-2004 permite analizar los factores determinantes de sus honorarios y el impacto de las fluctuaciones del numerus clausus en sus carreras. La ubicación y las revalorizaciones tarifarias tienen un impacto considerable en sus honorarios. Las experiencias profesionales de los médicos difieren mucho de las de los asalariados: siempre y cuando las cosas no varíen, sus tarifas progresan rápidamente al principio de la carrera y disminuyen, por término medio, a partir del segundo año de experiencia. Todo se desarrolla como si los médicos prefirieran concentrar su esfuerzo al principio de su experiencia profesional para aligerar, más tarde, su carga de trabajo. Los honorarios de los médicos dependen altamente de la situación demográfica médica en el momento de su instalación. La diferencia entre las tarifas permanentes de las distintas cohortes puede alcanzar 20%, siempre y cuando las cosas no varíen. Las cohortes instaladas en los años 80 sufren los impactos conjuntos del babyboom y de un numerus clausus elevado: perciben los honorarios más bajos. La disminución del numerus clausus ha permitido mejorar la situación de las cohortes siguientes. Una comparación de la distribución de honorarios en términos de predominancia estocástica muestra que las diferencias relacionadas con la heterogeneidad no observada no compensan las diferencias medias entre cohortes. Demografía médica y carreras de los médicos generalistas: las desigualdades entre generaciones

Suggested Citation

  • Brigitte Dormont & Anne-Laure Samson, 2008. "Démographie médicale et carrières des médecins généralistes : les inégalités entre générations," Économie et Statistique, Programme National Persée, vol. 414(1), pages 3-30.
  • Handle: RePEc:prs:ecstat:estat_0336-1454_2008_num_414_1_7026
    DOI: 10.3406/estat.2008.7026
    Note: DOI:10.3406/estat.2008.7026
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    1. Eric Delattre & Anne-Laure Samson, 2012. "Stratégies de localisation des médecins généralistes français : mécanismes économiques ou hédonistes ?," Économie et Statistique, Programme National Persée, vol. 455(1), pages 115-142.

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