French Emergency Systems Stressed by Lack of Staff; Foreign Practitioners Recruited to Fill Gaps

A growing number of patients are passing through EMS and emergency rooms in France, which like many countries has a chronic lack of staff for these vital sectors.

According to data from the French Ministry of Health, since the beginning of the 2020s the number of patients visiting emergency rooms has surpassed 20 million people a year, compared to 17 million to 18 million people several years ago.

The main cause is the general lack of primary practitioners in France and the aging of the local population. More than 6 million French people find themselves without a treating doctor and lack of medical care.

Marc Noizet, head of the French national EMS (Samu-Ergences de France) said in a 2024 interview with France Info the situation in the sector is very complex and needs urgent actions of the state.

“The human and financial resources at the hospitals and their emergency departments are now limited, we can no longer do things as before,” Noizet said. “In addition, very serious studies show that mortality increases in emergency rooms because patients wait in the corridors. This increase can be explained because their arrival is not regulated.”

French President Emmanuel Macron, promised in an April 2023 address to the nation to solve the problem of overcrowding of French emergency departments by the end of 2024. However, according to recent statements from representatives of the French EMS community, the country is still far from implementation of these plans, while the current situation continues to deteriorate.

The French news media has recently called Île-de-France—the most populous region of France, with an estimated population of 12 million people including the city of Paris—as “the first medical desert in the country.”

Doctor Hocine Saal, head of the emergency department at the Paris Montreuil hospital, said the Montreuil commune is considered a medical desert, just like half of the region.

"Today emergency services are the last bastion of the healthcare system,” Saal said. “Each year, the number of people who require emergency medical services increases on average 3% to 5%. If we don't adapt, the level of saturation will grow. That's the situation today."

Emergency departments and EMS systems in France compensate for the lack of general practitioners without having additional human resources. That negatively affects the quality of provided EMS services and leads to longer waiting times.

To cope with the increase in the number of patients, Saal rebuilt the entire organization of the service, starting at the entrance. After the waiting room, each patient passes in front of a reception and special duty orientation nurse who triages patient. The nurse decides whether the patient should go to the emergency room or another department.

The same situation is observed in other Paris hospitals and their emergency departments. For example, at Argenteuil hospital, which with 75,000 adult patients per year is considered one of the largest in the Paris region. In 2023, it experienced an 11% increase in the number of patients passing through its doors. According to Doctor Catherine Le Gall, who heads the emergency department, “the intensity of work today is not acceptable.”

As the French population ages, emergency doctors in France face fewer life-threatening emergencies and more medico-social demands. According to local analysts and doctors, the problem is that there is no specialized service for patients who are difficult to integrate into the system of emergency reception. This is an area that general medicine used to do but there are fewer general practitioners at present, which puts an additional pressure on the EMS sector.

Foreign doctors are being recruited to combat some of this lack of personnel. Paid and treated like interns, they are very important for the entire French EMS and healthcare sectors.

France has opened 700 additional training places to attract additional foreign personnel to the country’s EMS and healthcare sectors. Most local analysts, however, call these measures belated, as the current level of understaffing is estimated at 20% to 25% and the country will need about three to four years to solve the existing personnel shortage.

There are also plans for more active integration of nursing personnel in the EMS sector of France. The French Ministry of Health dictates that nurses must be “trained in emergency medicine care” and act as paramedics and ambulance doctors “within the scope of their skills.”

Similar to other Western European nations, the pressure on the French EMS sector has been steadily growing since the turn of the millennium, as an aging local population coupled with insufficient financial compensation for personnel led to massive outflow from the profession.

In this regard, French healthcare authorities are considering imposing limits on the number of emergency room arrivals and implementing of other measures aimed at stabilizing the situation in the sector. These plans have angered some local unions. There have been calls for strikes and rallies across France, as, according to them, these state plans intend to “block access to the hospital, continue to close beds and attack staff.”