Demography of psychiatrists and attractiveness factors: the example of Franche-Comte

Introduction: In France, the challenges of replacing departing psychiatrists with a new generation are compounded by an increased demand for psychiatric care, which threatens the accessibility of health care, particularly in rural and semi-rural areas. The objective of this study was to describe the location of psychiatrists trained in the Franche-Comte region, and to analyze the factors associated with establishing their practice in the region, particularly in the most understaffed areas. Methods: We conducted a retrospective observational study, completed by a qualitative investigation with semi-directive interviews with psychiatrists and psychiatry residents. Results: Between 1994 and 2013, 160 students entered psychiatry residencies in Franche-Comte. As of October 2013, 87 of them were full-time psychiatry practitioners and, 57% of them worked in Franche-Comte. The region of practice was associated with their birthplace (p=0.03). The qualitative investigation showed that, apart from family- and quality of life-related factors (work opportunities for the spouse, family closeness, desire to live in urban areas), opportunities to work in a team, implementation of dynamic and innovative projects and values of the establishment were also considered when choosing a site of practice. Conclusion: While the current increase in the number of psychiatry residents may respond, in the long run, to health care demographic problems in Franche-Comte, more specific interventions also seem necessary. Creation of time-shared jobs, facilitating the establishment of psychiatric practices within multidisciplinary clinics, task shifting and telemedicine may allow improvement of the psychiatric care offered in Franche-Comte.