THE WAY I SEE IT...
April in Paris
Authors: Jessica Wilson
Publication date: 22 Apr 2006
Jessica Wilson on the pleasures of working in the French capital
I had always been keen to work abroad but had found the prospect of working on the other side of the world a little daunting, so I was delighted to be offered a place on the European residents exchange scheme as part of my medical rotation as a senior house officer (SHO).
I worked as an “interne” (the equivalent of an SHO) in a major Parisian cardiology teaching hospital and was responsible for the management of the 15 patients on the ward as well as being encouraged to learn to echo, assist in electrophysiological testing, and see all my patients in the cath lab. My professor and registrar gave me good support throughout and I was expected to lead the ward round and present in weekly departmental meetings and in journal clubs.
Compared to working in the United Kingdom, I found I had more time to devote to my patients and to learning; nurses help by referring patients, taking bloods, and helping with paperwork. I was provided with a portable laptop on rounds so had access to all lab results and used electronic drug charts; medical students (“externes” in France) also help internes in the morning (in return for a small salary) before their afternoon lectures.
European directive ignored
On-call shifts were challenging and rewarding. I was expected to cover the wards, admissions, and also the 10 bed coronary care unit. Before arriving I had been interested to see how the European Working Time Directive affected French doctors, and I was surprised to see that it was completely ignored. There was no set rota but the internes were expected to provide 24 hour cover, and so with five internes (with the occasional assistance of more experienced externes) the result was working a 24 hour shift one day in five. The lack of a set rota led to some heated discussions when dividing up the shifts but this is in the nature of French organisation.
Saturday mornings were seen as part of the normal working week, if with a slightly more relaxed atmosphere, such as being allowed to wear more casual clothes. French doctors take one week of leave during the winter, and the traditional month during the summer with study leave being discretional. This can make for a long haul through the winter.
The basic salary of a French interne is a fraction of the UK equivalent, but with the additional supplements that you are paid for the on-call shifts, your salary is almost doubled. This is still less than the United Kingdom, but is a good wage as living costs are much cheaper, even in Paris.
The role of GPs in hospital
I was impressed that rationing was not a concept I encountered in France, nor was ageism, with the average age on a ward commonly being more than 90. French GPs take an active role in hospital medicine and were often present on ward rounds and expected to be contacted on their mobiles to discuss management plans and discharge summaries. Health care is financed by a combination of state contributions and personal insurance policies, which translates to patients being aware of the cost implications and doctors striving to achieve good value.
Having arrived with no more than GCSE French and five French lessons, I resorted to reading Tricolore and the dictionary on the metro and found myself making some sizeable faux pas in my early days. Nevertheless, as I became more confident in my role, my language skills developed and I was reasonably fluent in medical French by the end of my six months.
Overall, my time in France was extremely rewarding and I would unreservedly recommend the experience to anyone else. There are enough obvious similarities with the British system to allow you to make a real contribution from the start but there is also much to be learnt from the considerable differences as well. ■
Jessica Wilson senior house officer in medicine London firstname.lastname@example.org