France's audit court urges mandatory primary care role as 6.3 million lack doctors

Evaluation of the primary care model

France's Cour des comptes presented a report on 30 September 2026 to the National Assembly reviewing two decades of the primary care physician model. The mechanism, known as the médecin traitant, was established during the 2004 health insurance reform to replace the voluntary médecin référent framework introduced in 1997. The system was designed to serve as the initial contact point for patients, directing them through the healthcare network and reducing unnecessary specialist consultations. Official figures show that 89% of the French population is registered with a designated doctor, but 6.3 million insured individuals lacked one in 2025. Among those without a doctor, one-third are elderly or suffer from long-term chronic conditions requiring regular medical monitoring. The audit also recorded that one in five people visits a practitioner less than once a year, yielding poor preventive outcomes.

Financial penalties and growing patient rosters

Under the French health system, patients receive a 70% reimbursement rate from statutory health insurance when consulting their designated doctor, compared to 30% when seeing another generalist outside the coordinated care pathway. Direct access without financial reimbursement penalties remains restricted to specific disciplines, including gynecology, ophthalmology, psychiatry, and stomatology. The workload for participating doctors has increased over recent years. General practitioners acting as primary doctors managed an average of 1,130 adult patients in 2024, climbing from 919 adult patients in 2016.

Physician participation and urban deficits

The audit revealed that 15% of independent general practitioners, representing 8,500 doctors, do not take on the role of primary care physicians. These practitioners often focus on fee-for-service activities such as aesthetic medicine or allergology, which offer higher remuneration per medical act. Out of the 100,000 general practitioners registered across France, approximately half do not fulfill primary care coordination duties. The audit noted that the most severe shortages of primary care doctors occur in urban areas with younger populations, where doctors are less inclined to take on long-term patient panels.

Proposed reforms and practitioner reactions

To close the coverage gap, the Cour des comptes recommended requiring general practitioners to participate in the scheme and rebalancing their remuneration toward patient follow-up rather than individual medical acts. General practitioners in France currently earn a median income of 171,000 euros per year. Dr. Jean-Dominique Fayard, president of the Fédération des médecins de France for Gironde, manages a panel of 800 patients in suburban Bordeaux and restricts his practice to three consultations per hour.

Most colleagues have around 1,200, but others push up to 2,000. I advocate artisanal medicine: no more than three patients per hour. I prefer that to slaughterhouse pace. I now refuse to take new patients as a primary doctor to preserve the quality of my work, but I sometimes yield for a relative of a family I follow. I find this system entirely appropriate to follow, support, and above all do prevention work.