The attending physician: compass or obstacle?

Faced with growing tensions in access to specialized care. Similarly. Moreover. Moreover, the National Academy of Medicine calls for rethinking the organization of the care path, going so far as to qualify the brake doctor. Nevertheless, A position that arouses a strong opposition from the general practitioners, defenders of a proven coordination model. Similarly, Decryption of arguments, territorial issues and reform tracks.

When the academy shakes up the care pathway – Attending physician: compass obstacle?

In June 2025. Furthermore, the National Academy of attending physician: compass obstacle? Moreover, Medicine published a report entitled Shortages of specialist doctors. attending physician: compass obstacle? new Moreover. In addition, excluding general medicine (Adopted on June 24, 2025, 64 votes for, 4 against, 7 abstentions), which aroused strong controversy by qualifying attending physician: compass obstacle? Moreover, new the course of the attending physician “handicap” in the organization of the French health system. Similarly, This proposal. Furthermore. For example. aimed at fluidifying access to specialists to respond to medical shortages, caused the indignation of general practitioners, who defend their central role in the coordination of care.

The point of view of the National Academy of Medicine

The report (PEPPED-PEDECIN-APRES-VOTE.PDF report) highlights the shortages of specialist doctors (excluding general medicine). In addition, a problem experienced “very negatively” by the French, with marked territorial and specialized disparities. For example, According to the National Council of the Order of Doctors (CNOM), in 2025, out of 201,239 active doctors, 40.7 % are generalist, 46.5 % medical specialists, and 12.7 % surgeons. Similarly, attending physician: compass obstacle? new If the attending physician: compass obstacle? Similarly, number of specialists increased (24.4 %for medical, 23.1 %for surgicals between 2015 and 2025), this growth benefits hospital (18.8 %) and mixed exercises attending physician: compass obstacle? new (17.4 %), while liberal specialists decrease (-4.7 %). However, In comparison, the general practitioners saw their workforce drop by 1.4 % over the same period.

The academy identifies four main causes of shortages:

1. An insufficient number of specialists trained. Consequently, faced with the growing needs of an aging population and the increase in chronic pathologies and cancers.

2. An organization of care -based care, rather than a population approach, deemed “outdated”.

3. An unbalanced territorial distribution. Consequently, with inequalities aggravated by demography (eg 45,000 inhabitants per year in Occitania) and the concentration of university hospital centers (CHU).

4. A lack of attractiveness. However. particularly for the liberal exercise. attending physician: compass obstacle? new with consultation deadlines of up to several months for specialties such as attending physician: compass obstacle? dermatology or rheumatology.

To remedy these challenges. the Academy offers a series of recommendations. including a reorganization attending physician: compass obstacle? new of care to exceed the current model, centered on the general practitioner as “compulsory gateway” (p. 6). The report criticizes the idea that the attending physician is systematically the first appeal. noting that for certain pathologies, a specialist can become de facto the attending physician. He suggests direct access to certain specialties (dermatology, rheumatology, urology, orthopedics) to reduce deadlines and rationalize certain prescriptions (e.g. knee MRI), while maintaining the general practitioner’s coordination role. This proposal is part of a vision of “decompartmentalization” of the system. integrating new technologies such as artificial intelligence (AI). telemedicine, and a territorialized approach involving regional health agencies (ARS) and local communities (p. 2).

The academy attending physician: compass obstacle? new also insists on:

• Prospective planning of needs: Develop a “territorial health index” based on epidemiological data. indicators attending physician: compass obstacle? such as localized potential accessibility (APL) to better quantify needs by territory and specialty (p. 8-9).

  attending physician: compass obstacle? new

• Territorial universitarization: encourage the loyalty of medical students in their regions via internships in under-to-do zones. university antennas, and associated teaching positions funded by regions and ARS (p. 10).

• Reinforced attractiveness: to improve working conditions, remuneration, and access to modern technical platforms to encourage installation, especially in liberal (p. 7).

• An organization in networks: To be inspired by specialties such as urology. which structured teams from 3 to 5 practitioners covering over-parties, reducing isolation and improving continuity of care (p. 34-35).

The Academy argues that the current system. centered on the offer. no longer meets the needs attending physician: compass obstacle? new of a diversified. aging population, and that the career of the attending physician, although Essents, can be a brake in certain cases, in particular for rapid access to attending physician: compass obstacle? specialists in under-to-do areas.

Attending physician: compass obstacle? new

Attending physician: compass obstacle? new

Attending physician: compass obstacle?

The attending physician: compass obstacle? new generalist response: an essential pillar

On July 7. 2025. a joint statement from unions (MG France. FMF, doctors for tomorrow, Isnar-IMG, SML, CSMF, UFML-Syndicat, SOS Doctors France) denounced the proposal of the Academy as a “brutal and unjustified questioning”. The generalists argue that:

• The attending physician is a benchmark: he provides coordination. knows patients, and guarantees the coherence of care, reducing the risk of fragmentation.

• A validated model: international studies (eg OECD) show that systems with a strong treating doctor improve the quality. efficiency and efficiency of care.

• The attending physician: compass obstacle? new real problems: the difficulties of access to care stem from a lack of means. recognition, and attractiveness for general medicine, and not from an excess of coordination.

They describe the idea of “handicap” as a “confusion between the compass. the rut”, pleading for a attending physician: compass obstacle? strengthening of general attending physician: compass obstacle? new medicine rather than bypass.

Echoes in the medical community

On X, several health professionals have expressed their frustration. One of them fears that the reform pushes certain general practitioners to less demanding activities. while another regrets the lack of evaluation of the doctor of the attending physician. in force for two decades, and his inability to influence the deficit of Social Security. These reactions reflect a feeling of abandonment in the face of degraded working conditions.

Build a concerted response

The report of the National Academy of Medicine highlights a pragmatic vision attending physician: compass obstacle? new to respond to. the shortages of specialists. but its proposal to go beyond the course of the attending physician was badly received by the generalists. who see a threat to the coordination of care. Rather than opposing the two approaches. a balanced solution would consist in strengthening general medicine while facilitating access to specialists in attending physician: compass attending. physician: compass obstacle? new obstacle? targeted contexts, based on territorial networks and modern technologies. The tracks mentioned on both sides would be deserves to be articulated in a concerted approach. In 2025. faced with a healthy health system. the attending physician remains a pillar, but it must be supported by increased means and a reinforced collaboration with specialists.

Resources

• National Academy of Medicine: Report 2025

• Union press release: FMF