Training of Occupational Physicians in France

JF Caillard . University of Rouen

OH Education and Training for everyone every year

Strasbourg. ICOH. September 2005

 

60 561 000 inhabitants (63 millions DOM-TOM included) au 1er january 2005

35 527 760 de 20 à 64 ans

(source INSEE).

France

STRASBOURG

Occupational Health and Occupational Medicine in France

• First medical aproach in workplaces at the end of XIXth Century

• 1874: Creation of Labour Inspection

• 1898: First Work Injuries Compensation Act

• 1916: « De la main d’œuvre nationale après la guerre » J Leclerc and P Mazel (specialists in forensic medicine): the basis of the content of the future organisation of Occupational Medicine

• 1946: Services of Occupational Medicine mandatory by law for every paied worker

Basic Functions of Occupational Medicine in France

• Activities on the workplace (one third of occ.physician’s working time)– Improvement of working conditions– General hygiene of the workplace – Ergonomics– Prevention of work-related diseases and accidents– Health education– Epidemiology of work-related diseases

• Health surveillance of workers– Medical examinations providing job-fitness certificates

• Pre-employment and periodic• Return to work

– Vaccination– Networking with health and insurance organisations

• The Occ.Physician is an advisor on OHS matters

Trends in Occupational Medicine along the XXth century

• First period : 1900 end of the 50ties– Public health purposes and starting identification of OH hazards and

effects – first approach in prevention

• From 1960 to 1969– OM practice mainly focused on medical surveillance

• From 1969 to 1988– One third of the working time to be devoted to working conditions

• From 1988 to 2000 – Trend toward primary prevention and multidisciplinarity – planification of

activities based upon risk-assessment

• From 2004 on– Multidisciplinarity is an obligation – Less medical surveillance – Risk

assessment is a priority – National Plan in OH – Innovation encouraged

 

1 350 000 enterprises

13 000 000 paied workers benefit from OHS +6 000 000 (non private sector)

12 000 000 in 350 interenterprises services

1 000 000 in 750 in-enterprises services

7000 specialised occupational physicians

8 000 staff members (assistants, secretaries, nurses, oh technicians …

OHServicesSource: CISME

 

Occupational health services are organised and financed by the employers.

Direct cost: 920 millions €

½ of preventive medicine expenses

By comparison: cost for compensation of occupational diseases in 2002: 1121,46

m€ Source: CISME – ministry of labour

OHServices

French system of prevention of occupational risks

Ministry of LabourNational council for thePrevention of OH risks Social Security

INRSNational Institute of Research and Safety

ANACT

ARACT

Labour LocalAuthorities

CNAM

Regional Commission of OMRegional Observatory of OH

Institutes /Dpt OM/OHEin University -Hospitals

ENTERPRISESEmployer -

Occupational Health TeamEmployees representatives - HSWCTC

EMPLOYEES

Social SecurityOH Prevention

Services

RegionalLaboratoriesINVS

AFSSEINERIS

History of Training and Education in Occupational Medicine in France

• First Training Courses existing since the 30ties, particularly in Lyon, Lille, Paris (volountary basis)

1957: a special diploma is mandatory to be employed as occupational physician

• 19571977: 1 year training consisting only in theoretical

• courses: certificat [CES]

• 1977 1983: 2 years with one month in a OHS service • for practical training: certificat [CES]

150I

500

History of Training and Education in Occupational Medicine in France

1983: Reform in medical studies: 4 years are needed for all specialties(residency) at the end of 6 years of general learning

II

[Occupational Medicine becomes a full speciality]

• 1983 2004…: 4 years residency after a competition

(volountary basis) • (1992:special access for physicians with > 5 years practice):

diploma: [DES]

• 2005 ….: 4 years residency after a national examination

(mandatory basis) : diploma [DES]

140I

250

50I

70

History of Training and Education in Occupational Medicine in France

• 1998 – 2000 and 2002 - 2004: for those practicing

without any diploma: 2 years theoretical training

while continuing practicing: [licence] to be

authorised to practice

• 2003 – 2006: for non OH Practitionners wishing to

join an OHService and be trained during the first

period of professional exercise: 2 years:

diploma [capacity]

1300

<100

Organisation of the training

• Institutes/Departments/ Units of Occupational Medicine in 19 University-Hospitals in charge of :– Teaching– Research– Occupational health activities

– Clinics of occupational diseases– OH Services for Hospitals, Universities …..

• 27 professors – 35 assistant-professors• Co-operation within a network of professionals,

researchers, institute,private organisations at regional, national and sometimes international level

National theoretical programme

1. Introduction to labour sciences

2. Laws and regulations in OHS

3. Work physiology and ergonomics

4. Toxicology and industrial hygiene

5. Work related diseases

6. Epidemiology – statistics – computer science

7. Management of occupational hazards

8. Miscellaneous

Theoretical and practical training

DES – Residency

Theory: 300 hours

Practice: 2 years in clinics (or equivalent)

2 years in OH services,

institutions, research centers …

Licence and Capacity

Theory: 280 hours

Practice: work in an OH service during >2 years including 6 months in a University-Hospital (Capacity)

Two main issues

• To face the shortage of occupational physicians in the country

• To adapt the programme and the training methods

To face the shortage of occupational physicians in the country

• Parameters to take in account:(source. Labour medical inspectorate 2003)

– The total number of needed OP is fixed by regulations: - 1 full time equivalent 1500 to 3300 employees (depending of risk assessment)

- 66 % of OP are female (5 026) et 34 % males (2 585).

- 59 % of OP are more than 50 years old (35,56 % females et 23,50 % males).

- 41 % of OP work >152 h/month - 59 % < 152h/month

To face the shortage of occupational physicians in the country

To face the shortage of occupational physicians in the country

  

Année

 Déficit calculé DARES sms 15%

 Déficit calculé DARES sms 20%

 Déficit calculé DARES sms 25%

 Flux de sortie des internes

 Départ des médecins du travail à 65 ans

-136 -401 -665

-29 -293

-118

    ESTIMATION DU DEFICIT APRES REFORME POUR LE REGIME GENERAL

 Evolution du déficit chiffre DARES sms 15%

 Evolution du déficit chiffre DARES sms 20%

 Evolution du déficit chiffre DARES sms 25%

2002 -270 -535 -799 232 98

2003 -136 -401 -665 239 47 56 -209 -473

2004 56 -209 -473 225 45 236

2005 236 -29 -293 225 50 411 146

2006 411 146 -118 225 93 543 278 14

2007 543 278 14 155 120 578 313 49

2008 578 313 49 86 127 537 272 8

2009 537 272 8 86 140 483 218 -46

2010 483 218 -46 86 205 364 99 -165

2011 364 99 -165 86 292 158 -107 -371

2012 158 -107 -371 86 331 -87 -352 -616

2013 -87 -352 -616 86 413 -414 -679 -943

2014 -414 -679 -943 86 432 -760 -1025 -1289

To face the shortage of occupational physicians in the country

• Solutions ?

- to lobby in order to get more positions for residency

- to increase multidisciplinarity with more « non medical » professionals

- to allow trained physicians to practice occupational medicine part-time

- to increase the global «numerus clausus »

To adapt the programme and the training methods

• New regulations and new needs in Occupational Health• Increasing consensus on good practice• Importance of ethics• Influence of international co-operation: - EASOM (European schools of occupational medicine

- UEMS (Union of European Medical Specialities - ENSOP (European Network of Societies of Occupational Physicians

- Faculty of Occupational Medicine in UK Ewan MacDonald (Occup Environ Med 2000;57:98–105)

- American College of Occupational and Environmental Medicine Panel

.

To adapt the programme and the training methods

Working Group of the French College of Occupational Medicine Teachers (waiting more than 5 years for labour market and government decisions on reforms)

• Designing of a new programme including/developing new items with 3 main issues for student learning:

– Knowledge

– Experience

– Competence

• Opening the discussion with stakeholders (focus groups) before approval

To adapt the programme and the training methods

• Examples of new items:

– Risk assessment

– Promotion and maintenance of work ability

– Mental health

– Environmental health

– Public health surveillance

– Communication

– Management of projects

– Team working

– Ethics

– Research methodology

To adapt the programme and the training methods

• Specialisation of and co-operation between regional departments of OH and call to the best specialists

• E-learning and distance leanrning• Participative teaching• Problem solving• International teaching (European LMD)• Multidisciplinary training for teachers (already done) and students

(to be done)

• Sharing experience world-wide:

« Thanks to the Organising and Scientific Committes of this International Congress »