Proposition 53K1085

Projet de loi réduisant la durée des études de médecine.

General information ¶

Authors

PS | SP Colette Burgeon, Marie-Claire Lambert, Yvan Mayeur, Franco Seminara

Submission date

Jan. 19, 2011

Official page

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Status

Adopted

Requirement

Simple

Subjects

doctor medicine medical training teaching length of studies

Voting ¶

Voted to adopt

Groen CD&V Vooruit Ecolo LE PS | SP ∉ Open Vld N-VA LDD MR VB

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Discussion ¶

March 24, 2011 | Plenary session (Chamber of representatives)

Full source

I am referring to my written report.

Mr. Speaker, the N-VA was won for Mr. Lambert’s bill. It is of course a good thing that there is an equalization with Europe of the duration of study for the medical training.

However, it is important to take care that students get equal employment opportunities after six years of study or after seven years of study.

The planning committee and all stakeholders, universities, RIZIV and so on, will need to work on this quickly so that the situation with regard to future opportunities for the students is clear.

It will also take no longer so long before the preparations for the 2011-2012 academic year begin. It is therefore important that the Communities quickly work on the exact content of the training. Here too, it should be clear what changes for the student and the renewed courses should ensure high quality.

In Flanders, however, the universities have asked not to separate the reduction of the duration of study from the contingent. Flanders has been working on this for a long time and wants to maintain this as it monitors the quality of the training. We therefore call on the French-speaking Community to take responsibility for this.

Mrs. Van Moer, congratulations on your maiden speech. (Applause of Applause)

Mr. Speaker, this bill aims to reduce the medical education, which currently lasts seven years, to six years. It is a logical consequence of an evolution that has occurred in many fields in recent years, in particular the destruction of the Ministerial Decree of 21 February 2006, the various European directives that take six years as the starting point for a doctor’s training and the consensus that had grown among all actors in our own country. Belgium follows a European evolution.

The European Directive of 15 April 1993 facilitating the free movement of doctors and the mutual recognition of their diplomas, certificates and other titles also stipulates that the training shall include at least six years of study or 5 500 hours of theoretical and practical training. Even in subsequent European directives, six-year training was used as a starting point.

The annulment of the Ministerial Decree of 24 February 2006 by the State Council, due to the difference in treatment of the general physician and the specialist, required the issuance of a new Ministerial Decree, in order to maintain the current regime and to prevent general physicians from having to pursue a 10-year training. However, it was clear to everyone that this was not desirable and that a definitive arrangement was needed.

In that framework, the Minister of Health had set up a working group with all relevant actors and the community ministers of education, in order to reach a solution that would allow the medical training to be limited to six years. The working group reached a consensus on this issue. The fall of the government prevented the work from being completed.

During the discussion in the committee, a large consensus was achieved for the reduction to six years. For Flanders, this adjustment does not pose any problems, since the Flemish universities had already organized themselves on this. However, it is important to emphasize that they could only do so because there is an entrance test in Flanders. In this sense, it is and remains important that we adhere to the numerus clausus as organized in Flanders and the contingent as organized on the federal level.

During the discussion, we were able to take note of the fact that solutions are being worked on for a number of practical problems that arise as a result of the reduction of training. I specifically think of the problem of contingent in 2018, the year in which twice as many students will graduate, and the problem of the interns. Therefore, I look forward to the opinion of the Planning Committee, which is apparently expected in June of this year.

Mr. Speaker, Mr. Minister, dear colleagues, it is a great pleasure for me to present to you a text that makes the unanimity of all the actors concerned by the proposed legislative amendment and which also received a unanimous vote in the Health Committee.

Deans of all universities in the country, medical unions, student representatives and communities unanimously agreed on this proposal that aims to reduce the duration of basic medical studies. If these studies are currently seven years long, we propose to increase it to six.

The first reason that motivated the deposit of this text was related to our concern to work towards the attractiveness of general medicine. Indeed, although the general medicine studies are currently nine years, it happens that following a decision of the State Council, future Belgian students intending to pursue a career as a general physician will be obliged to pursue, from 2017, ten years of training. Ten years is a long time, especially since Belgium would then be an exception in the European landscape, all Member States having opted for a nine-year training.

The fact of allowing an extension of these studies is obviously not at all in line with the imperative need to encourage medical students to orient themselves towards this essential but so compelling profession as is general medicine.

Some may be concerned about the quality of the training. I want to reassure them. If the deans of the medical faculties of our country, the Communities and the Academy of Medicine approved this measure, it is ⁇ not with the idea of diminishing the quality of the basic training of doctors. It is true that a complete reorganization of the course will be necessary, but this is part of the competence of the Communities. Indeed, while it is the responsibility of the federal state to determine the overall duration of the education required for the exercise of medicine, it is the competence of the Communities to arrange the precise programme of each year of study and the modalities in which the diploma is obtained.

I would like to reassure you because the Minister of Health, Ms. Onkelinx, wishing to carry out this project before the fall of the government, had long negotiated with the representatives of the Communities and the deans of our medical faculties so that everything was ready, from 2011, for an entry into force of the reform.

The fall of the government has hampered this project. That is why we propose, in order not to rush anything and for things to be prepared with care and care, the entry into force of the new system at the academic return of 2012.

That said, the Communities will not be the only ones who will have to prepare this reform with great care. Indeed, in 2018, it is a double number of medical students who will graduate and will be able to exercise their profession. Therefore, the Medical Planning Commission will have to adjust the numerus clausus quotas accordingly.

Dear colleagues, by approving this text, we will give Belgium the opportunity to join other European countries in the organization of medical studies, which is ⁇ not negligible in the current context of European inter-university exchanges.

In addition, by reducing basic medical training by one year, we give all future doctors the opportunity to start their paid internship one year earlier. However, starting to earn a living at 24 rather than at 25, is not negligible for many of them.

Dear colleagues, you will have understood that it is with great enthusiasm that my group will vote on this proposal submitted following the fall of the government which failed to carry out its project.

This text is a logical evolution in the European context. It also responds, let us recall, to a request from different actors.

However, even if this text is voted, everything remains to be done. Indeed, first and foremost, the number of years of study, which will pass from seven to six years, will result in program adjustments. The doctors of the medical faculties are also deeply concerned with this issue. But everything remains to be done also at the federal level, in particular on two aspects. First, there is the question of the "double output" which is planned in 2018, knowing that the number of graduated doctors will, as of 2014, be greater than the number of INAMI numbers granted.

Recently graduated doctors must be assured that they will not find themselves trapped by the impossibility of acquiring an INAMI number indispensable for practice. Training doctors, leaving them out of medical studies and not granting them an INAMI number while they have successfully completed quality studies is obviously nonsense. This is politically irresponsible.

Alongside the problem of INAMI numbers and the debate related to contingent, there is obviously a second issue to be settled at the federal level, that of post-study for training, whether for specialists or general physicians. Again, leaving out of studies is one thing. There is still a need to have a master stage because these stages will be mandatory. Again, in the perspective of a number of students doubled in 2018, there will obviously need to have twice as many masters of internship, whether for specialists or general physicians.

Mr. Speaker, dear colleagues, as much as this text is a step forward, so many other steps must be taken on the political level, including at the federal level. The government in current affairs cannot be a pretext behind which to shrink because it is tomorrow that the questions will arise. We must avoid having significant disadvantages in years that are already announced problematic for young doctors graduated from 2014 and even more from 2018.

Many things have already been said by my colleagues. I keep it short. My party also supported the proposal. We find it a good proposal, of course, provided that the quota is ⁇ ined, which has already been cited by several colleagues.

Several colleagues have pointed out the practical problems that ⁇ may arise after 2018. A double lifting graduates requires more internships and more internships. I am sorry that the Minister is not here today. I think it will be especially important for her, together with the services, to motivate the doctors to provide internships. Through fees and through the nomenclature and through other means, it will have to ensure that solutions come.

I think there is also a lot of work for communities. I look especially at Flanders, where the situation is different than in Wallonia, because the entrance exam already exists there. I hope that the seven-year training will not make our doctors even more specialized in physics, chemistry and mathematics, but that the medicalization will continue from the first year. Doctors have an important social dimension. Hopefully for graduate doctors from now on, the patient will be at the center. Based on the first studies of the decans of the various universities, I am not so sure of this.

I also find it a pity that the Minister is not here. In the committee, we were unable to conduct the discussion on the following topic. I hope this will be a first step to address the shortage of doctors in many specialties. It is not just about doctors. I see today that there are too few pediatricians, child psychiatrists and endocrinologists. I can continue like that for a while. Also in geriatrics, the demand is very high. I hope that one wants to take that point with it and that in the coming years, the general medicine and many specialisations will become more attractive.

We support this proposal. Again, I think it is a lack of respect that the Minister was not present at the discussion in the committee and that she is not here today. I hope she hears what the Commissioners say today. The debate will continue in the committee.

Mr. Speaker, my group will vote on this bill reducing the duration of medical studies from seven to six years.

The change does not change much for generalists: instead of seven plus two, it will be six plus three. It shortened by one year the course of medical specialists. Furthermore, it will allow a better consideration of the work provided by internship students and medical practitioners, who will be doctors at that time. This will induce less slavery, which is a progress.

However, I would like to draw the attention of my colleagues who directed the project to the fact that the problem of admission to studies in the French Community is obviously not solved at all. In the Flemish Community, there is an entrance examination, but the French Community currently does not organize any examination at the entrance of studies.

This is how, in recent times, there has been a real cry of alarm from the deans of medical faculties. They wonder how to ensure quality education as the number of students is increasing. The problem is the compatibility between the number of students and the possibilities of training in the French Community; it is absolutely not a question of the number of years. The Minister of Health should pay special attention to this point.

My group is supportive of an entrance examination and, possibly, the introduction of a year of propedeutics so that students can upgrade before the start of university studies; my group has submitted proposals in this regard to the French Community.

We will also support this proposal. Its great advantage is that it allows for the harmonisation at European level of the organization of the years of study. Overall, the number of years of study needed to train a doctor will eventually remain the same.

Mr. Bacquelaine, this does not solve at all the problem of access to studies, whether in the French Community with the difficulties we have or in the Flemish Community where despite the devices, we find ourselves with too few students at the end of the course. There is no perfect system and no bad one. This will not solve the shortage of doctors, especially among generalists. This will force us to review in other instances, in the Communities, the organization of health studies in general. There will probably be more creativity and openness between the different branches of studies in the field of health, which makes this change possible.

It is in this sense that we intend to use this federal-voted device, to appeal to our Community and request to rethink the organization of medical studies because it is not enough to say that we change the number of years in basic education.