Proposition 54K3032

Projet de loi modifiant la loi du 10 mai 2015 relative à l'exercice des professions des soins de santé, visant à instaurer un contingentement des médecins et des dentistes formés dans une université étrangère.

General information ¶

Author

LE Catherine Fonck

Submission date

April 3, 2018

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

doctor health policy dentist access to a profession

Voting ¶

Voted to adopt

LE N-VA VB

Voted to reject

PVDA | PTB

Abstained from voting

Groen CD&V Vooruit Ecolo PS | SP DéFI ∉ Open Vld MR PP

Party dissidents ¶

• Peter Luykx (CD&V) voted to adopt.

Contact form ¶

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Discussion ¶

Feb. 21, 2019 | Plenary session (Chamber of representatives)

Full source

Nathalie Muylle, rapporteur, refers to the written report.

This text aims to limit the assignment of INAMI numbers to doctors and dentists trained abroad. Before coming to the bottom of the subject, I would like to recall here the interest of being able to study abroad, in part or more comprehensively, whether in the European Union or on a more international scale, especially for caregivers since this is the subject of this proposal. I myself benefited from it.

This interest is major, but it cannot turn into a reverse discrimination for our young doctors and dentists, or a damage to the future of our health care system. For years I have mobilized myself against what I consider to be a total absurdity, but also an unacceptable injustice. It is, in my view, absolutely absurd to limit the number of future Belgian doctors and dentists while, at the same time, the number of doctors and dentists trained abroad – in any case with regard to the European Union – is in no way limited.

Examples are questionable. I will only mention two. In 2015, there were more INAMI numbers assigned to doctors and dentists trained abroad than to doctors and dentists trained in French-speaking universities. This is questioning, unfair, absurd. The French community is concerned in a greater way, the situation there is more problematic. But equally eloquent examples exist in the Flemish Community: in 2015, 35% of dentists who obtained an INAMI number in the Flemish Community came from other EU states. For the same year, in the French Community, 51% of dentists who obtained an INAMI number had been trained abroad and more ⁇ within the European Union.

As you can see, the door is completely open to European doctors and dentists with almost automatic issuance of an INAMI number, even when our Belgian doctors and dentists are contingented. This is an unacceptable reverse discrimination. It makes no sense to continue to contingent our doctors and dentists if we leave the door open to foreign doctors and dentists, especially to Europeans.

The Planning Commission, which you all know, has, on its own, validated the need to contingent the doctors and dentists trained abroad or then, she said, “the contingent of the Belgians would no longer make sense.” This must be done in compliance with European law. In this regard, I would simply like to refer to the case-law of the Court of Justice of the European Union and the Constitutional Court. I not only had the opportunity to explain it broadly at the level of developments in the bill and the text, but also to expose it in a committee.

Mr. Speaker, I propose not to repeat these various items longer here, as part of our plenary discussion.

The various arguments developed in the text show and demonstrate that we are not infringing the right to free movement. It is, I repeat, a question of limiting this right in a proportionate manner while pursuing a legitimate goal of protecting public health and preserving health policies in the medium and long term.

If I say this, dear colleagues, it is because the uncontrolled influx of doctors and dentists trained abroad can aggravate the shortage of Belgian doctors and dentists. Remember here that the Planning Commission takes into account the flow of these foreign doctors and dentists. As a result, there will be an impact on the calculations made by the Planning Commission which must determine public health needs. The more the number of doctors and dentists trained abroad increases, the more the Planning Commission, by incorporating them, will be forced to reduce the INAMI numbers available for all Belgian doctors and dentists graduated. This may cause or increase a shortage in the event that this care staff would return to their country of origin.

The decision we make today will allow us to give oxygen and release INAMI numbers for our young Belgian doctors and dentists. This is an indispensable step. I also hope that the Minister or the Minister in charge will quickly take the royal orders of execution. I would like to thank the various colleagues who supported the proposal in the committee.

Finally, let me address the issue of subquotas. In fact, this case cannot be examined solely under the lobe of this bill. This is a much broader issue in order to ensure coverage and the future of healthcare. In this regard, there are shortages for certain specialties in certain regions or municipalities. These shortages, whether they concern general practitioners or certain specialties such as ophthalmology or dermatology for which the waiting times are ⁇ long, require multiple answers, such as having a sufficient number of trained doctors and dentists or working at the level of subquotas, which has been achieved.

Moreover, it is necessary that the universities - and as such, the last figure in 2018 was, by the way, extremely positive - respect the subquotas fixed for general physicians and that they also work on the attractiveness of general physicians and specialists (giaters, pediatricians, etc.) through the nomenclature, promotion at the establishment but also through the entire organization of the guards.

I also find it interesting, dear colleagues, to get out of the fairly sterile game of ping-pong and to try to get out of the top of the debates we have witnessed in recent years, to organize a common entrance exam, each in their own language, of course. This would allow us to no longer accuse ourselves, often wrongly, of a laxist examination. Let us recognize him! It is true that the figure can interpell for the return in the first year of bachelor 2018 from the French-speaking side. At the same time, we also rationally recognize that only 20% of students have passed this entrance exam, which corresponds to a similar percentage to that of the Flemish Community.

Finally, you will not bother me to support our young students in medicine and dentistry who will graduate in June. An interministerial conference recently discussed this issue. A solution must be found quickly. These young people cannot be victims of politics or political decisions. It is between policies that solutions must be found and it is not these young people who have to pay the cost.

I hope that this proposal will be implemented very soon through the Royal Execution Orders. I thank you.

Mr. Speaker, colleagues, my group will support this bill because we are also facing a large influx of foreign doctors on our side of the language border. It is therefore logical that the quota and the quota take into account that influx.

To be clear, I would like to point out that this is already the case. The Planning Committee has already taken into account this influx in its calculation of the number. It is better and more logical to start limiting the inflow in the same way so that there will not be a curved relationship in the future.

I would like to add that on the other side of the language boundary this is actually a somewhat cynical or even hypocritical discussion. I am pleased with this bill and will also support it, but it is still funny to hear that it is being introduced mainly on a French-language question. As a major reason, it is again cited that the quota is a huge deficit. I don’t know how many times I have to argue against this, but it can be hard to struggle with shortcomings because of something you’ve never followed.

You have never followed the contingent. You have never had a limited number of outflowers. You never followed the number of RIZIV numbers. If you today have problems in certain sub-specialities and certain areas, it is because your French community government has never pursued a policy to ensure that doctors go to those particular areas as well, as they did in Flanders, and choose those particular sub-specialities, as they have successfully done in Flanders.

The first version of the bill included an article stipulating that the quota should be abolished. Fortunately, this article was removed from the committee. I see that the PS is now trying to reintroduce this again through an amendment. I cannot emphasize enough how much I find this to be witness to an arrogance that is truly beyond all proportions.

You helped approve the contingent twenty years ago. Then for twenty years you have done everything to ensure that Flanders did its job well, while you have approved all kinds of constructions to ensure that this didn’t have to happen on your part. You are now with students in tremendous uncertainty and they are there just because you haven’t done your job. You continue to shift the responsibility to the federal level and to the people who did their job.

I am very pleased that this article has been rejected in the committee. We will be happy to immediately re-vot your amendment. If we succeed, we will support this proposal.

I would like to add one thing to that, which will be explained by colleague Yoleen Van Camp. If we look at the conditions that must apply for doctors to obtain a certificate, I think that the language requirement is also one. Colleague Van Camp has been working on this for years. Unfortunately, she has seen an amendment to the WUG law die. This may be an opportunity to repair it. I leave it to her to explain this further.

In order to facilitate this amendment, I now give the word to Mrs. Van Camp.

It is especially unfortunate and quite incomprehensible that other parties do not participate in this. We are really alone in that. When one looks at communication between people, it is already very important to speak the same language. This is especially true when we talk about medical interventions. When people are in need, they don’t always have the opportunity to choose a healthcare provider. Thus, from the beginning of the discussions on the requirements for the exercise of care professions, we emphasize that there must be language skills. We have repeatedly accused this, and we have handed a handset to the government, of which we were part at the time, in order to get it included in the law on the exercise of the health care professions. This has not succeeded, several parties have blocked it.

We have also tried to provide a solution in the form of our own bill, which was not accepted. Once again we submitted this as an amendment during the discussion of the WUG law, but again we have to establish that other parties do not want to participate in this. Thus they are absolutely not worthy of the V in their name, because they put people in danger. The fact that a patient in an emergency situation does not have a free choice regarding the healthcare provider and is not sure that the healthcare provider speaks his language is in itself a danger to Public Health. For this reason, we re-present the proposal to register the speaking of the language of the language area in which the healthcare provider is established.

Specifically, a healthcare provider who settles in Flanders must prove that he speaks Dutch before he can start working. The same applies to regions where other languages are spoken. In Wallonia, a doctor must first prove that he is able to speak French before he can continue as a healthcare provider.

I will speak to you because I will be brief. We abstained and we will abstain in the plenary.

Without entering into the controversies, I hear the usual retournals with regard to French speakers. As far as I am concerned, I will try to take a little more height in this debate that is important and indicate in what it is in our view.

I would like to remind you that more than six out of ten municipalities in Wallonia and 33 districts in Brussels are currently in a shortage of general practitioners. Of the 253 Walloon municipalities, only 103 have a sufficient density of physicians. This shortage also affects certain specialties such as emergency medicine, geriatrics or psychiatry, with direct consequences for patients who struggle to find a generalist or who have to wait abnormally long to get an appointment.

All studies agree that this shortage will only increase in the coming years. Many doctors are approaching retirement age and most of the workforce in general medicine is currently provided by doctors entering the 54-64 year age group.

Nevertheless, we continue to restrict access to the practice of medicine and dentistry in a quite aberrant way to us — I don’t ask you to share our point of view. Worse than that, in recent years, the Minister of Health, who does not please us with her presence, supported by the partners of her former majority, has made the system even more disastrous, ignoring the needs of patients, ignoring the quality and accessibility of our medicine.

Do I have to recall, dear colleagues, that the State Council itself, regarding the changes made to the contingent system, spoke of "an incoherent system, infringinging the right to health protection and constituting a decline in the medical supply in one or another community"?

We are not the only ones who make this observation. I have heard our excellent colleague, the current president of the Senate, the doctor himself, Jacques Brotchi, declare recently - and I support our eminent colleague - that he was personally opposed to the principle of quotas.

Mr. Fonck, I recently heard Minister Mrs. Greoli, estimate for her part that "to crampon on the 60-40 distribution between Dutch-speaking and French-speaking students, while the shortage is much stronger in Wallonia than in Flanders and that the realities are very different between the north and south of the country, is a total inepty".

Finally, the Federation of Francophone Students declares that "it is a good thing that many young people want to become doctors to treat their fellow citizens, because it meets a collective need; but they are prevented from doing it and it is deeply absurd."

It is indeed an absurd reality when we see that we must recruit foreign doctors to work in our hospitals, simply because the needs are felt and there is a shortage of labor. As you indicated, those doctors who graduated abroad are not affected by the contingent.

While, for my group, it is obviously incomprehensible that a Belgian student is not treated equally with a foreign student in terms of the conditions for access to a specialization, we consider it essential to address this problem of shortage in a more comprehensive way. This is the very essence of the motivation for our abstention. Yes, this text removes a discrimination that we also denounce; but no, in our view, it does not provide any solution to the problem of shortage that concerns us.

So, Mr. Speaker, I and my group have submitted two amendments, which we have just mentioned. The first aims to enable to guarantee the obtaining of an INAMI number to all students currently undergoing training in medicine or dentistry, at the end of their training, crowned with success.

Since 2014, this government has actually exercised a real blackmail against the Wallonia-Brussels Federation. He imposed the establishment of a filter at the entrance of medical and dentistry studies, with the penalty of not granting an INAMI number to students currently in training. Therefore, the Federation has implemented this filter. Today, the Minister of Public Health plans to set up an additional lock at the end of the training. Some students, despite having successfully completed their training, would therefore no longer have access to internships and would not receive their INAMI number.

For my group, it is no longer tolerable that hundreds of students continue to be held hostage by the federal government, which still threatens them not to be able to exercise their profession at the end of their studies, because they cannot have an INAMI number. While it is true that excess INAMI numbers have been issued in the past, it turns out that the shortage is a reality and that the quotas currently set will be insufficient to meet the health needs of our population, specifically in the South of the country.

In this same logic, we submitted a second amendment, joining the original proposal of Ms Fonck, which she amended at the last minute, which earned her the support of the N-VA alone. We have re-submitted this amendment by which we propose to eliminate purely and simply the system contingenting access to the practice of medicine and dentistry. My group hopes that everyone can have an objective and non-electoral view of the situation, with the sole objective the health of our fellow citizens.

The truth has its rights. It is not since today that I have been engaged in this matter. This is not the first time I am trying to put it on the vote. Mr. Frédéric, on 14 March 2018, you had submitted the same amendment that I had previously submitted and which provided for the removal of the exemption from contingent for foreign graduates. I will not go back into the discussion, but I thought it was important to recall the previous ones.

I respect the work of my colleagues. I never said that Ms. Fonck had never worked on this matter. I just said that today, in 2019, it is a false good idea and I just justify why.

Per ⁇ Ms. Fonck should ask herself the essential question. To know why, being the only one supporting this text at the outset, she was joined only and exclusively by the N-VA. If I were her, I would ask myself this question.

Mr. Frédéric, I would like to come back on two points, if you allow me to.

First, I find that what you found smart in 2018 is no longer so-called in 2019. of which act. As for me, I have a consistency on issues as important as these.

What you present as something ridiculous is the daily life of many young people and above all, it is an unacceptable reverse discrimination. On this point, the Planning Commission, which is nevertheless not a handcuff and which does not run for the N-VA – neither for me, I specify it, nor for you, I hope it –, fully supports me since it issued a report in which it explicitly said that it was absolutely necessary to do so.

Secondly, as far as the N-VA is concerned, I have a big deal of politicians who, on this file, have only invectified themselves for years and are constantly sending back the ping-pong ball, without any result! What is important is that problems can be solved one after another. I have recently presented orally a series of complementary proposals for a comprehensive approach. I dare hope that instead of polemic, we will eventually be able to advance this text. This is the first step; there are other steps needed. On these other things, it is not of today that I also invest!

We are fully aware of the problem posed by the influx of foreign doctors. We are absolutely in favor of the establishment of a contingent for them. Let things be clear from the beginning! However, a number of elements need to be recaptured. This is what I will try to do quickly now.

The first element is to say that the migration of health professionals and, in particular, doctors, is a growing phenomenon worldwide and, in particular, in Europe since the recognition of the equivalence of degrees implemented in 2007. This first observation regarding the increase in the number of foreign doctors in recent years is a consequence of the positive evolution of European legislation: recognition of diplomas, simplification of procedures, free movement. Any initiative that will be taken must therefore imperatively be incorporated into this European legislation. It seems to me that we did not take this into consideration sufficiently during the debate.

The second element, the fact that the mobility of foreign doctors is manifested at several times in the health care career path, complicates the understanding of the phenomenon. You know, international mobility allows foreigners to enter the Belgian healthcare system at three times: the first, at the entry of studies; the second, at the time of specialization; the third, at the time of entry into the labour market, that is, at the time of obtaining the approval. The entrance to studies is the competence of Education and, therefore, the Communities, while the other two moments are the competence of Public Health and, therefore, of the federal.

In terms of numbers, Mrs. Fonck, I have read you. We had a small discussion on this in the committee. In addition, you said and wrote that in 2015, there were more INAMI numbers assigned to doctors and dentists trained abroad than to doctors and dentists trained in French-speaking universities. You spoke of 489 abroad against 473 in French-speaking universities.

I can see that you do not confirm my words.

The [...]

So we agree: that’s what you said. Unfortunately, Ms. Fonck, this number is not correct. Of course, I consulted those that were transmitted by the contingent commission. In conclusion, I can tell you that, for the French Community, we are talking about 473 INAMI numbers for doctors and dentists – so that’s true. On the other hand, for non-Belgians, it is 364, not 489, as you said.

Mr. Thiéry, I did not say that foreign doctors settled only on the French-speaking side, but that this was true for the whole of Belgium. So, in the table of the Planning Commission, you must add the figures relating to the French Community and the Flemish Community. You will then get a total of 489. Are you following me, Mr. Thiery?

I am very happy with you, especially since I have the figures of the Planning Commission in sight. You have your own interpretation. I go a little further in reasoning. You took the figures of 2015, but there are also those of 2016 and 2017.

and 2018.

Okay, but I would just like to develop the following reflection. You said that in 2015, 51% of foreign dentists had received their INAMI number. However, you forgot to mention the 2016 and 2017 rates. The numbers are extremely important here. In 2015, we actually reached a peak in the number of foreign doctors and dentists who received their number. However, if we look at the next two years, we find that doctors fell from 41% to 35% in 2016 and to 30% in 2107. Furthermore, in 2011 the rate for dentists reached 45%, while for doctors it was 28%. In short, we are more or less coming back to that norm.

It is important to understand that the figures you gave in commission are those of 2015, and that in 2016 and 2017 the figures no longer corresponded to the examples you provided to support your bill. However, the problem of the influx of foreign doctors remains. We are fully agreed.

I would also like to point out one point that should not leave us without question. The text does not make a distinction between the contingent of doctors coming from the European Union and those coming from other countries, even though, in the figures we received from the planning committee, this difference is well present. It is the doctors from the European Union who make up the largest percentage. What is more right in view of the free movement and the equivalence of diplomas? Together with my colleague Nathalie Muylle, we will discuss next week, in the Health Commission, a very concrete contingent arrangement for doctors from countries outside the European Union.

I also recall that it is inaccurate to assert that the assignment of INAMI numbers to doctors trained abroad would reduce the number of INAMI numbers assigned to doctors trained in Belgium. This should be taken into account in this calculation. The influx of doctors trained abroad, on the other hand, helps to fill the shortage in some specialties unfortunately considered less attractive, such as emergency doctors and hospital geriatrics.

Finally, we must relativize the assertion that Belgian students would leave to train abroad hoping to have an INAMI number when they return. I demonstrated in a commission that the number of Belgian doctors who will be trained in Romania, and return to Belgium afterwards, was one in 2015 and two in 2016. These figures have been transmitted to me by the Romanian Parliament.

Here are the comments I would like to bring to the debate. As in the committee, our group will abstain.

Mr. Thiéry, I have here a document from the Romanian Embassy in Belgium, which was requested by my colleague Georges Dallemagne. In 2017, in the first year, there are 20 registered; in the second year, 12 registered; in the third year, 6 registered; in the fourth year, 2 registered. It’s not just one or two students, as you say. I can give you a copy of this document.

In addition, you return to doctors and dentists outside the European Union. This is a very small number, but it should be treated in the same way. There are much stricter rules for them in Belgium. And given the larger numbers at the European Union level, this is really where this reverse discrimination needs to be corrected and also work to contingent them in order to be able to organize health care in Belgium.

Mr. Speaker, Mrs. Fonck, I thank you for these clarifications. You cite the 2017 figures. I gave the 2015 and 2016 figures that were in my possession and that come from the Romanian Senate. We will compare them. You also forget to say that it is not because some future Belgian doctors will do their studies in Romania that they intend to return to have an INAMI number here. Most of them will remain in place. There is a lot of exchange at many levels and ⁇ at the level of medicine.

This is not the first time that we address this topic and it will not be the last time. I will come up with the presentation of colleague Frédéric, because he almost touched me. When one hears his story, it’s always about that someone else is to blame.

According to colleague Frédéric, it is someone else’s fault that there has been no entrance exam in French-speaking Belgium for years. It is also someone else’s fault that there are so many surpluses today, for them deficits but surpluses for the rest of the country. It is also the fault of someone else that when there is an entrance exam that is not effective and there are more students admitted than there are RIZIV numbers to be distributed. It is also someone else’s fault that there is no good distribution today and that there is a shortage of general physicians while subquotas today fall under the responsibility of the Communities. Also, it is someone else’s fault that the federal medical planning instruments don’t work while the PS has delivered the three previous legislatures to the Minister of Health who installed these instruments. I can continue this way for a while.

Colleagues of the PS, I think you have a crushing responsibility. I now look at the colleagues Fonck and Thiéry who have always held their line here and who have led the debate in a much more nuanced way. I do not have the habit of taking up the defense of colleague Fonck, but now I will do so. If you say that colleague Fonck never spoke about this in the past, I must point out that she has done nothing else in recent years. In the debate over the numbers, she has always stated that they should be nuanced for her because foreign doctors were in no way taken into account.

I think we can find ourselves in that, colleague.

However, CD&V will abstain from this. We understand what you say about foreign doctors. We also wonder whether we should not make a distinction between doctors within and outside the EU. Mr. Thiéry has already said that this Tuesday will be again on the agenda. We will be able to conduct the discussion there.

The proposal in its original form, with the possibility, if we did not introduce it, to abolish the full quota after two years, would not have gone on for us. This is taken from the text, which makes it better and more plausible for us.

Mrs. Fonck, our abstinence today is based on our sympathy for what you do today. The French-speaking colleagues have a crushing responsibility in this file that they do not include. We will not support this. I know that it doesn’t make much sense to keep repeating this, but we hope that some common sense comes from across here, so that we can conduct the conversation with some reason.

Mr. Speaker, Mrs. Fonck, I would like to thank you for putting a fundamental topic on the agenda. Today we can put back on the carpet the problem of shortages that endanger our public health in Belgium. It has been recalled the figures: 144 Walloon municipalities are in scarcity. The Observatoire de la Santé et du Social (Observatoire de la Santé et du Social) says there will be a shortage of 480 general physicians within ten years if nothing changes.

In this debate, one realizes that the shortage would be even greater if these foreign doctors did not come to complete the ranks. Today they are 12% and this figure is only increasing.

I also see that this subject makes the costs of community guegueras. He suffered the failures of successive majorities in different governments. Students and patients suffer from this.

One could therefore be tempted to vote for this text for several reasons, for example to highlight the real figures of the shortage. I am pleased to hear today that the N-VA recognizes the shortage of doctors in Belgium. At least that is what I have heard. We get together and that’s very good.

Mr. Speaker, I have a simple question for Mrs. Schlitz. Whose responsibility is this assignment to the sub-specialisms? Can you give a clear answer to this?

I was referring to the response of Mrs. ...

Whose responsibility is the assignment of people to the sub-specialities?

You just don’t know the case! You stand there but out your neck you lullen. I ask you a simple question. Which bevoegdheid is the people to sub-specialists lead you? (Samenspraak is)

Mrs. Schlitz, you make your speech as you want.

This is what I intend to do.

There is no obligation to respond.

Mr. Speaker, we cannot constantly suffer the provocations of the N-VA on a case like this.

Then you answer. Do you know the answer? Whose competence is the assignment to the sub-specialities?

Mr. Speaker, we are not here to constantly hear the provocations of the N-VA.

I don’t understand what is provocative about this.

We understand that you supported this text, it joins your ideology and your anti-Franco-speaking obsession.

This is a very simple, substantive question. Whose competence is the assignment to the sub-specialities?

The [...]

I will give the word to those who ask.

Mr. Frédéric, you might know? Whose competence is the assignment to the sub-specialities?

You have already asked that question. Who asks the word?

Mr. Speaker, the speaker did not ask who was responsible or not for the shortage. She simply asked the question of whether the project in discussion today was aimed precisely at solving the problems or rather to serve as an alibi to your anti-francophone obsession. This is what she said!

Mr. Speaker, Ms. Schlitz, who will resume the speech because she has prepared her speech and is ⁇ familiar with the case, called: first, not to communityize a debate that is a public health debate, which we must all pay attention to; second, to try to work on convergences by positively emphasizing that Ms. Van Peel and therefore the N-VA recognized the existence of difficulties related to the shortage of doctors, and, as is also the case in Flanders, to engage doctors trained abroad, a topic put on the agenda by Ms. Fonmeck.

I simply propose to allow Ms. Schlitz to continue her speech.

Mr. Speaker, I was therefore saying that the debate that we are dealing with today may allow us to shed light on the figures of the shortage we currently know in Belgium. This may also be an opportunity to put an end to the organized brain leak that is currently in Europe.

In fact, what we know at home has an impact on health care in other countries, such as Romania where entire populations suffer from a severe shortage of doctors, a shortage that is the source of serious health problems, or even mortality in some remote areas where there is no doctor. This could be a gesture towards these populations.

It is also a question of fairness with respect to our students and doctors who are in a ⁇ difficult situation. Indeed, with the system as it is organized, they are subject to a competition that, in some way, is not fair.

This could also force the European Union to rework the subject, since it is known that part of the case has a European tone. The desire to travel and settle elsewhere is undermined by the systems of limiting access to these studies, especially in France, which have significant impacts on neighboring countries.

We consider that the risks of this text weigh too heavily on the balance sheet to implement it. This could lead to an increase in the shortage.

It is foreign doctors who perform functions like those of emergency practitioners and other essential functions in our health system, because they are deserted by our doctors. If their number continued to decrease, we would face a serious problem. However, a doctor can only be trained in eight to ten years, or even more. I do not see very well how, through training, one could manage to compensate for this decrease in foreign doctors, at least in the short term.

Another element disturbs us in this text: it continues to extend a quota system that is not specifically proven in Europe. We believe that we should look at the problem from another angle: no longer addressing the consequences but looking at the causes of the shortage.

Finally, we have a vision of openness towards the European peoples and we believe that through this text, we limit ourselves to the Belgian territory. This is not the way we want to consider the European construction.

We will therefore abstain from voting on this text. On the one hand, asking that the contingent of foreign doctors be settled by a royal decree seems complicated in the sense that one constitutes the lack of will in the head of the minister to advance on this theme. We believe that a blockage could occur. On the other hand, in view of the removal of Article 3 through the amendments, one risks to find himself in a complicated situation due to an aggravation of the shortage.

I will reiterate once again that we want this Parliament and this government to have a comprehensive political vision of Public Health. We want to objectivize the shortage, organize the territorial planning that, for the public health and the health of our fellow citizens.

Mr. Speaker, Mrs. Schlitz, I will not ask you any more questions, I will not embarrass you. However, I would like to say the following.

The proposal of colleague Fonck presented today, which will allow more students to be planned and more doctors to be in the field through contingentation, will not resolve the spread in rural areas and will not provide incentives to have more doctors in the Wallish rural areas. This is not a federal authority. One must first key to the subquota for the general physicians and to the incentives. It is then about Impulseo 1, Impulseo 2 and Impulseo 3, introduced by colleague Onkelinx and today all community competence. The Communities are competent, and Wallonia is competent. This will not change the situation. I wanted to give it a moment. Think about it well.

Mr. Speaker, I just listened to Mr. Frédéric’s speech with increasing surprise. I will not repeat the history of the file, because there has already been enough reference that no arrangement on the French-speaking side concerning the organization of entrance exams and so on has been fulfilled. This has already been sufficiently understood by our colleagues. If one knows that years-long history, then I would, in your place, Mr. Frédéric, at least dare to speak with much scorn, and ⁇ not at all, let alone with a content and a tone that I found hallucinating today.

It is not my habit to repeat what has already been said. I would therefore like to agree with all that colleagues Van Peel, Van Camp and Muylle have already said on this subject: the proposal is a step in the right direction and it is very good that the passage stating that in the event of non-introduction the quota would be completely abolished after two years has been deleted. This was, of course, absolutely absurd, and in that case we would have very much voted against. We will therefore with great conviction reject the amendments of the PS in that sense.

However, I heard colleague Van Camp point out a point that is not correct. She just broke a lance for the language knowledge, but said that she is alone in it. This is not the case, Mr. Van Camp. We have always supported all proposals in the sense you have referred to in the past. We are very aware of the importance of language and of communication between a patient and his doctor, because that is of fundamental and often vital importance. You are not the only one who has submitted an amendment. We had already submitted an amendment on this subject because language knowledge is so important. We will ⁇ support your amendment, I also count on your support for my amendment.

Madame Fonck, we are very uncomfortable with your proposal. We share your findings and concerns, but we believe that this proposal has the merit of existing to show how absurd the situation is.

For DéFI, establishing a contingent of doctors and dentists trained in a foreign university is really not the right solution. It is absurd in itself to maintain a contingent while the existence of medical shortages has been demonstrated and alarm bells have been regularly sounded, both by experts and by the relevant circles. It is not by reinforcing an absurd mechanism with an additional quota for young people studying abroad that we will solve the problem of shortages.

We also know that young Belgians will study abroad to escape the absurdity of contingentism. Training in French is also offered in Romania. In addition, we are committed to the European principle of free movement. This is a fundamental principle. We do not want to restrict this right, especially since we believe that this approach would be contrary to European legislation.

Mr. Speaker, I cannot let it go. Will we keep that discourse here again?

The case saves everything, that is Belgium at its best. The French-speaking colleagues here again and again say things that shoot the Flamings, across the party boundaries, with turmoil.

For all clarity, Mrs. Caprasse, you are once again claiming that there is a shortage in Wallonia. Since the introduction of the contingent there has been a surplus of 1,500 doctors. Only you do not get them assigned to the right specialties and to the right areas, but that is because the French Community does nothing.

I hear you now say that the proposed solution, which I support because it is needed in Flanders, will solve the problem of all those poor students in Wallonia who had to go to study elsewhere, because they could not all graduate because of the contingent.

You have never suffered from the contingent in those twenty years. You graduated who wanted to graduate. There has never been a brake on the number of doctors that have flown out from you, and yet you are with shortages in certain specialties because the French Community does not do its job.

Never have you done what we did in Vlaanderen in the twentieth year with very much success do. Stop by Ermee. There is no shortage. You just don’t do your job. The point.

Mrs. Van Peel, you are simply sitting on the planning committee. You do not respect what is happening in Belgium. That is all! Can I continue, Mr President?

Madame Fonck, you are probably well aware of this, since in your original version, you had envisaged an article 3 stipulating that, if within a period of two years from the entry into force of your law, it was not possible to implement it, the numerus clausus must be abandoned. I preferred this first version, but given the opposition of the Flemish parties, N-VA at the head, you removed this article.

It is obvious that given this position in this file, we fully support the amendments introduced by our colleague Mr. André Frédéric, which aim, on the one hand, to eliminate the numerus clausus, and, on the other hand, to guarantee the obtaining of an INAMI number to all students currently in training when they have graduated. This is the most basic thing today.