Context
France faces significant and persistent geographical disparities in physician supply. Underserved medical areas remain a longstanding challenge, despite multiple reforms, including financial incentives to encourage physicians to establish practices in these areas.
Impetus and purpose of the reform
Approved by the French National Assembly in May 2025, the “Garot Law” aims to tackle the issue of underserved medical areas – affecting around 9 000 000 people in France – by regulating where self-employed physicians can establish their practices and by mandating their participation in on-call duties. This marks a major shift in a country where physicians have traditionally enjoyed total freedom regarding where and when they practice.
Main content of the reform
The proposal requires all newly qualified physicians to obtain authorization from Regional Health Agencies (ARS) to open a new practice in well-served areas. Authorization is only granted if a physician of the same specialty simultaneously leaves the area. In contrast, the establishment of new practices in underserved areas will be automatically approved. A territorial indicator of healthcare provision for each medical specialty, which remains to defined, will be used to classify areas.
Stakeholder positions
While patient advocacy groups support the “Garot Law”, physician unions and medical students and residents are strongly opposed, perceiving it as a strong constraint on professional freedom and a disincentive to enter medical studies. Nevertheless, similar territorial restrictions are already used for regulating the local supply of other health professionals, such as nurses and community pharmacists, without sparking comparable controversy. The bill is currently under review by the Senate, but its prospects of adoption appear limited given the strong influence of the medical profession on the Senate.
Moreover, the government stated its opposition to the “Garot Law” and has supported an alternative proposition, the “Mouiller Law”, for which it has initiated a fast-track legislative procedure. The text was approved by the Senate in May 2025 and is currently under review in the National Assembly. While this law also aims to regulate the establishment of physicians’ practice, it gives more discretionary power to local authorities in defining the rules for establishment and is seen as less coercive for physicians. The law proposes to maintain free establishment for general practitioners, with the condition that they must participate in mandatory consultations in underserved areas for a few days each month. In contrast, as in the “Garot Law”, specialists would only be allowed to set up practice in well-served areas if replacing a departing specialist, with some possible exemptions. Local authorities (départements) will identify healthcare needs in their areas and define under-served zones where access is difficult as well as over-served zones where the level of healthcare provision is particularly high, after consulting with local and municipal elected officials. Regional health agencies (ARS) will have to take their opinion into account when determining these areas which risk introducing some heterogeneity in decision rules.
Other recent reforms to tackle underserved medical areas
In April 2025, a reform of the nursing profession was adopted to expand the autonomy of nurses. It introduced nurse-led consultations, the right for nurses to make diagnostics, and limited prescribing rights. This legislation highlights a parallel change towards enhanced task-shifting and the expanded role of nurses as additional levers to address geographical healthcare disparities.