GENERAL AND GASTROINTESTINAL-TRACT SURGERY IN FRANCE

Forty-three state-run medical schools admit 30 000 students per year b ut only 3500 receive their diploma after 6 years of studies. After pas sing a special examination, 480 of 2000 residents choose surgery and t rain during twelve 6-month rotations. Surgical research is organized t hrough government agencies, individual units, or volunteer groups. In 1992, of 8 268 114 procedures, appendectomy represented 4.15%; hernia, 4.09%; varicose veins, 3.61%; and cholecystectomy, 1.82%. Appendectom y has decreased from 306 500 per year in 1980 (34% of all gastrointest inal surgical procedures) to 159 900 (15%) in 1996, whereas cholecyste ctomy has increased from 64 700 to 95 300. Emergency gastrointestinal procedures represented 15% of all surgical procedures in 1996, doublin g in the last 4 years (essentially for labor and endoscopic procedures ). Ambulatory procedures have increased 12-fold since 1980, essentiall y (75%) in private practice. About 27% of 160 000 appendectomies and 7 7% of 95 300 cholecystectomies were performed laparoscopically in 1997 . One person of 4 in France has or has had cancer, mainly due to tobac co abuse. In 1993, 32 000 surgical procedures were performed for gastr ointestinal cancer. Of 532 000 deaths (1992), about 150 000 were due t o cancer, 10 000 to alcohol-related disease, and 22 000 to trauma. Tra nsplantation in France increased from 3180 procedures in 1993 to 2807 in 1996, essentially lungs and heart and lungs. Between 60% and 100% o f health expenditures are reimbursed by the government, the remaining being covered by private insurances. Approximately 60% of 4500 French surgeons are in private practice; 25% also have part-time hospital emp loyment. Almost 40% of surgeons work full-time in hospitals.