In association with Dr Gentili's comments  about Vickers' article  on the role of non-physician anaesthetists I should like to express my concern as a French consultant anaesthesiologist working in the public sector.
In France, a quarter of all emergencies, and 39% of night-time and obstetric emergencies, are treated in our non-university hospitals  where the lack of physician anaesthetists is acute. Most of these hospitals require the help of affiliated foreign physicians. The role of the non-physician anaesthetists (nurse anaesthetists) who are under our direction is important: a recent strike by these nurses demonstrated their value.
I do not agree with the idea of setting out to introduce and enhance nurse anaesthetists in our public hospitals. In my view it was a lack of anticipation and policy of the state administration and of the French Council of Medicine that instituted two tenets into medical and specialized training.
First, and this goes back a long time, a numerus clausus diminished the opportunity for French candidates to gain admission to medical schools with the unrealistic objective of reducing the cost of providing public health. The second tenet for admission of medical students to all medical specialities took place in the 1990s for the same reasons. The French State became aware of the problem for the first time last year and then allowed 300 non-European affiliated and less well-paid physicians to take the French examination; if they were successful they could progress to become anaesthetic consultants and be permitted to remain in France with decent career prospects. If the scientific knowledge of the candidates is adequate, this will be the first step to improve medical anaesthesiology in our public hospitals.
We realize this solution represents a brain drain from countries that may ill-afford such losses. Moreover, it is unfair to our own French students, because the policy to deliberately restrict the number of places that are available (numerus clausus) results in intense competition for entry to the second year of the medical schools (the success rate is 12–15% usually, and only two attempts are permitted). To become a specialist, the students (usually during the 5th or 6th year of medical school) have to pass a second competitive examination, the ‘internat’ (with a success rate of approximately 50%): this provides about 1700 specialists every year – for every specialty! However, if the State and the Medical Council persist in this lack of anticipation, will France be able to attract enough French-speaking foreign colleagues?
1 Gentili M. Anaesthesia and non-physician anaesthetists: what are the real needs for which kind of health policy? Eur J Anaesthesiol
2001; 18: 336–337.
2 Vickers MD. Non-physician anaesthetists. Can we agree their role in Europe? Eur J Anaesthesiol
2000; 17: 537–541.
3 Auroy Y, Laxenaire MC, Clergue F, Péquignot F, Jougla E, Lienhart A. L'anesthésie en France en. Anesthésies selon les caractéristiques des patients, des établissements et de la procédure associée. Ann Fr Anesth Réanim
1998; 17: 1311–1316.