DENOYEL-JAUMARD Alice, BOCHATON Audrey

DES PRATIQUES ET ESPACES MEDICAUX EN TRANSFORMATION : EFFET
GENERATIONNEL OU CONSEQUENCE DE LA FEMINISATION DE LA
PROFESSION ?

21/12/2015

Résumé

La féminisation de la profession médicale est un phénomène croissant, de plus en plus
étudié par les historiens, sociologues ou médecins qui analysent son impact sur les évolutions du métier dans un contexte d’augmentation des inégalités en matière de santé. Mais alors que les inégalités de répartition des médecins vont croissantes, les géographes se sont peu penchés sur le lien entre féminisation et organisation territoriale de l’offre de soins. De nombreux rapports officiels et travaux scientifiques montrent que les écarts de répartition de médecins augmentent sur le territoire français et à différentes échelles (Maurey, 2013). La tendance actuelle est à la concentration des médecins en zone urbaine et par conséquent un délaissement des zones rurales désignées généralement par l’expression de « déserts médicaux ». L’objectif de cet article est d’explorer les facteurs couramment évoqués et perçus pour expliquer ce phénomène. Parmi ces derniers, nous verrons comment la féminisation de la profession médicale est souvent désignée comme un déterminant central des évolutions actuelles de la médecine et de la distribution inégale des médecins sur le territoire français. Outre la féminisation de la profession de médecins, il convient d’avoir à l’esprit que le secteur médical traverse également de nombreux changements liés au contexte actuel de départ massif à la retraite, à l’application du numerus clausus pendant de longues années et aux attentes de la nouvelle génération de médecins. Face à la diversité des facteurs démographiques, économiques, sociaux et territoriaux qui sont au coeur des changements de la profession, nous déterminerons la manière dont les représentations et les discours associés à la féminisation du métier perdurent et tendent à simplifier les évolutions complexes du métier.

Texte intégral :Denoyel_bochaton_rfst_2015_GST


Abstract

CHANGING MEDICAL SPACES AND PRACTICES : GENERATIONAL OR FEMINIZATION EFFECT ?

The feminization of the physician workforce is a growing phenomenon, increasingly studied by historians, sociologists and physicians who examine the consequences of this shift on the medical profession in a context of increasing health inequalities. While inequality in health worker distribution is also increasing in France, geographers have little studied the relation between feminization and the territorial organization of healthcare provision.

Many official reports and scientific studies show that disparities in the distribution of physicians increase over France and at different spatial levels (Maurey, 2013). Considering the workforces of physicians in relation to the French population, the situation of France is quite good but their distribution reveals clear spatial inequalities. Major disparities can be observed between administrative areas, for example “les régions”. As shown in the map below, medical coverage is significantly higher in the French southern regions (particularly Provence-Alpes-Côte-d’Azur with one doctor for 244.77 inhabitants) and also the capital region called Ile-de-France (which one doctor for 252.22 inhabitants). On the contrary, the region called Picardie displays the lowest medical service (one doctor for 388.13 inhabitants) followed by the region Centre (one doctor for 375.43 inhabitants). Inequalities are even stronger within regions at a local level. Medical doctors concentrate mainly in urban areas and therefore neglect rural areas which appear and are described as « medical deserts ». In 2012, 20% of general physicians work in rural areas whereas 27% of French people live there.

map 1 denoyel.gif

The objective of this article is to explore the factors commonly discussed and perceived to explain this phenomenon. Among these, the feminization of the medical profession is often designated as a central determinant of the ongoing developments of the medical sector and the increasing spatial disparities among the French territory. We wanted to test the idea that medical deserts exist because of the feminization of the medical profession with local data, collected across the Burgundy region.

In Burgundy, the under-representation of female doctors in rural areas is real but the differences observed between the physical locations of male and female doctors are relatively moderate and not significantly different. However, some discourses from the medical sector, political sphere and media tend to associate closely the current increase of the spatial inequalities of medical care and the feminization of medical profession. The tweet from Senator Mayet « medical deserts, the fault of the women? » of 27 July 2015 can certainly appear anecdotal but it still shows an overview of current thinking that can circulate on the effects of the feminization of the medical workforce.

To understand the rationales behind medical deserts, it appeared that we should go beyond gendered explanations in order to address the broader social and economic determinants which contribute to this phenomenon. Some recent studies show that young medical practitioners, both women and men, wish to preserve time for family or for social activities leading them to reconsider their relationships to work (Deriaz et al. 2010). In 2003, Robert Herin already stated about the liberal healthcare provision in Normandy that the new generations of physicians (regardless of gender) were seriously concerned by living environment, educating children, the range of jobs for spouses, the qualities of cultural and social environment, etc. All these determinants tend therefore to lead young doctors towards urban environments more than rural areas. As a consequence, we must consider the spatial disparities observed among the medical physicians in France more as a generational issue than a simple gendered issue.

Full text : Denoyel_bochaton_rfst_2015_GST