Exclusions: Practicing Prejudice in French Law and Medicine, 1920-1945

3. The Art of Medicine: Access and Status

Chapter 3 The Art of Medicine Access and Status Although the movement to exclude foreigners during the interwar years was the most important manifestation of medical protectionism,doctors pursued other strategies for professional survival that call into question the notion that the anti-foreigner movement arose simply from xenophobia. Merging protectionism with professionalization, doctors strove to reduce the number of medical graduates by raising qualification standards. Three main proposals were advanced:a return to the classical baccalaureate,quotas on medical students, and more rigorous exams. This strategy was aimed at reducing the number of French citizens, not foreigners, entering the profession. Because educational trajectories were strongly determined by social origins, controversy emerged over the discriminatory effect of this strategy on the lower and middle classes. The medical profession also sought to protect itself through distinction. By clearly defining and staking out their professional terrain, doctors hoped to elevate their status by distancing themselves from other health care providers . Manifestations of this strategy included the repression of charlatanism and illegal medical practice by non-doctors, protection of the title of “doctor,” and campaigns against dentists, pharmacists, nurses, and midwives to preserve doctors ’ professional domain. Turf protection also led to battles among doctors themselves. Evidence of competition between private practitioners and statesalaried doctors,and between generalists and specialists,especially when the field of medicine was being altered by the institutionalization of medical welfare, 70 Chapter 3 demonstrates that the family of doctors was not immune to internecine feuds. Finally, two specific categories of French citizens were blamed for dragging down the profession and were targeted for exclusion: women and elderly doctors . Like foreigners, Frenchwomen were especially singled out as scapegoats whose legitimate presence in French medicine could be challenged when professional survival seemed to be at stake. These proposals to restrict the access of French people to the medical profession attest to the existence of larger protectionist mechanisms beyond the scope of mere xenophobia. By providing a more complete picture of exclusionary practices in the medical profession in interwar France, they add nuance to the arguments presented in chapter 2 without diminishing the primacy of the antiforeigner movement. Before analyzing these various strategies, I first examine the opinion of a small minority of doctors who rejected the myth of overcrowding altogether. there Is No plethora A handful of medical professionals responded to the widespread panic over the supposed glut of doctors with detachment, believing that there was no plethora of doctors at all, given the infinite possibilities of scientific discoveries for improving health care and the democratic value of providing an excellent education to the maximum number of citizens. Several medical professionals acknowledged that more doctors were needed in rural areas of the country . These points of view effectively undermined all the premises behind the anti-foreigner mobilization, although they had little actual impact on it. A few French doctors and students even took an actively pro-foreigner stance and publicly criticized the exclusionary movement. Such resistance to the predominant thinking in the medical profession thus took three forms: rejection of the plethora myth, recognition of a professional distribution problem, and a welcoming acceptance of foreigners. Determining the appropriate number of health care providers for a society was, of course, a subjective undertaking.1 In response to the Malthusian stance embraced by most medical unions, which maintained that excessive competition led to the commercialization of medicine,with nefarious effects on patients, progressives argued that there could never be too many doctors. In favor of both social mobility and patient rights, such thinkers promoted accommodation of the maximum number of doctors. One doctor ironically lamented doctors ’ “financial situation, already compromised by the decrease in sick people. The medical profession is the only one, to our knowledge, that works against its direct interests and we are proud of it.”2 For the successful implementation of Jules Ferry’s educational principles, laïque, gratuite, et obligatoire, such thinkers the art of MedICINe 71 advocated for increased government funding to expand the infrastructure of the university system in order to serve the largest possible student body.3 The preceding chapter revealed that France did not have too many medical practitioners but,in fact,needed more of them in rural areas. Drastic differences in the doctor-per-inhabitant ratios between urban and rural regions attested to a sufficient number of doctors in Paris and other large cities but to a real and occasionally dangerous dearth...