[en] Since the 1980s, the evolution of the French medical demography has led to an uneven distribution through the national territory. These imbalances are partially due to practitioners' deficits in the hospitals of secondary urban centers and to strategies of avoidance of certain disadvantaged or rural urban areas by the new generations of doctors. This problematic situation has created a possibility for foreign practitioners, qualified outside the European Union to come and work in France in order to alleviate the dramatic deficits within hospitals. The objective of our research is to study the situation of these particular doctors within the region of Poitou-Charentes, one of the areas affected by the "partial medical shortage". At the crossroads between the academic fields of international migrations and geography of health, this study analyzes the presence and role of these doctors within the French health system, their geographical distribution as well as their particular conditions of exercise. The specific context is examined by looking through the trajectory and migratory projects of these foreign practitioners qualified outside the European Union working in the public hospitals of the region Poitou-Charentes. The methodology used in this present research combines quantitative and qualitative data. The qualitative data was provided through the conduct of 80 interviews with doctors and with the administrative personnel (direction / human resources). The public hospitals of the region Poitou-Charentes has offered a privileged entry for the study of the particular situation of the foreign doctors qualified outside the European Union practicing in France. The conduct of an inventory listing all current practitioners within the public hospitals as of January 1st, 2011 brings new data including all doctors (number, distribution, etc.) and specific to the foreign practitioners qualified outside the European Union. Representing a proportion of about 10% of all doctors working in the public sector, these highly qualified migrants play a real role of adjustment and balance within a healthcare system that has been submitted to national and regional disparities in the distribution of the medical staff. For the past several years, these doctors have gradually come to enlarge the staff of hospitals that were the most abandoned by medical graduates in France. By doing so, they have been compensating the negative impacts on medical demography caused by the numerus clausus and the reforms of the medical schools. Furthermore, the analysis of the assigned departments of these practitioners through the inventory illustrates how they have been filling the least attractive medical specialties and the most in need of personnel, thus highlighting the original and essential role they play in the functioning of the French healthcare system. The study of the countries where doctors obtained their medical qualifications reveals that these particular practitioners are mainly qualified in old French colonies and protectorates, making France a privileged destination due to the language, the strong historic links and because of the reputation of the French healthcare system. The analysis of the migratory projects of these doctors has showed that economic motivations are not a fundamental factor in this migration. The majority of these doctors are initially motivated by the offer of diplomas in specific specializations proposed by France to foreign practitioners. Other subsequent factors and events (personal, family-related, etc.) often lead to the abandonment of the initial project, which usually includes an eventual return to the country of origin. The original student mobility is gradually transformed into a long-term international migration. The two main elements usually refraining from the initial project of return are the entitlement to practice and the French nationality, since their acquisition is a much complicated process. Many doctors have recognized that these elements, combined with a greater job security and higher income, have put a definite stop in their project to return. These doctors are however subjected to a specific and unstable legislation generating numerous obstacles in their professional paths, which makes it difficult for them to fully incorporate the French medical community. Through their discourses and trajectory, we come to reveal the surprising complexity of their careers and their strategies of adaptation that we have coined under the notion of itinerant career allowing us to understand the steps undertaken by these doctors to fully integrate the corporate association. Whether they become mobile or temporarily change professions, these doctors demonstrate a constant capacity of adaptation that is forged by opportunities and strategies. Although often seen and referred to as "the invisible people of the hospital", these doctors have been essential in the French healthcare system for almost half a century.

[fr] Depuis les années 1980, l'évolution de la démographie médicale française engendre une inégale distribution des praticiens sur le territoire national. Ces déséquilibres sont en partie liés à des déficits de praticiens dans les hôpitaux de pôles urbains secondaires et à des stratégies d'évitement de certaines zones urbaines défavorisées ou rurales par les nouvelles générations de médecins. Cette problématique a ainsi créé une possibilité pour les praticiens à diplôme hors Union Européenne de venir travailler en France, pour pallier à des déficits dramatiques au sein de structures hospitalières. L'objectif de cette recherche est d'étudier la situation des PADHUE au sein de la région Poitou-Charentes, région touchée par la " pénurie médicale partielle ". Elle s'interroge sur la répartition géographique et les conditions d'exercice de ces médecins ainsi que sur les parcours et les projets migratoires de ces migrants hautement qualifiés qui exercent dans un secteur-clé: celui de l'hôpital.