“We are in an absurd situation: we have funding available, but we are unable to recruit staff.” A few words are enough for Romana Bacchi, health sub commissioner of the Ausl, to make the problem understood: there are fewer and fewer family doctors, but above all there are no substitutes.
The uncovered places
Last year in Parma and its province there were 275 general practitioners (133 in the Parma district); now they are 270, but their number is destined to drop further, also due to the funnel that has been created at the educational level.
The lack of adequate turnover, even in light of future retirements, risks causing a shortage of doctors that will inevitably create inconvenience to patients. «At this moment – explains Bacchi – the whole health system is suffering from a lack of professional resources. We continually have to deal with retirements and consequent vacancies. In the Parma district there are 125 general practitioners and there are 12 deficient areas. The problem, which until some time ago was limited to mountain areas, is now spreading throughout the territory ».
On a formative level, some positive glimmers are beginning to be seen, but it is still not enough. “There is a training course and we have the possibility to use the doctors in training, even if limited – the sub-commissioner of health points out -, but it is not enough. We would need more professionals ».
News for the mountains
Bacchi then announces that the Ausl is about to present a project «for the mountains, to facilitate the recruitment of doctors even in areas with a smaller population and greater distances to travel. We are promoting associative forms and new remuneration methods to make these areas more attractive ».
Integrated approach
The general practitioner is called to have a complete view of the patient. «In this sense the health houses – explains Romana Bacchi – play a fundamental role. Before, the family doctor was a professional who managed himself completely autonomously. Now, instead, contracts are envisaged that favor associative forms such as group or network medicines ”.
The numbers speak for themselves about 270 general practitioners, 220 work in association forms (one hundred of these in health care homes). “This modus operandi – he continues – offers a great advantage to doctors, but above all to citizens, who find a place to receive answers to multiple needs”.
How much do you earn?
At the moment, GPs are freelancers who have a gross salary paid by the Ausl (their employer) with which they are affiliated. A fixed fee of approximately 43 euros per client per year is envisaged (for those reaching 1,500 clients this is 64,500 euros gross per year), with increases for clients over 75 years of age. To this must be added a variable portion depending on the achievement of the objectives set by the regional and company activity programs.
Associated medicine, computer collaboration allowance, medical office collaborator allowance and nursing staff allowance fall within this scope. For example, doctors who work in group medicine are paid 7 euros per patient per year. A further variable portion is foreseen according to the services and activities agreed at regional and company level (additional services, programmed assistance, integrated home assistance, programmed assistance in protected residences and communities, services and activities in community hospitals or alternative structures to hospitalization). However, for general practitioners there is no change in remuneration in relation to career advancement, but they vary in relation to the number of patients, the projects activated and any associations. The list of expenses incurred, however, is long: 20 percent withholding tax, the rent of the clinic and utilities (for those who work in the health houses this is a lump sum), the integration of expenses for the salaries of nurses and administrative study collaborators, the integration of social security.
The possible reform
Just in these days, also in light of the funding provided by the NRP, the regional health councilors have signed a document that traces the lines of a reform of the system. The legal profile of the general practitioner, a freelance professional with agreement, “is not suitable for facing the change taking place”. There are four possible paths to follow: the most extreme one involves the farewell to the “convention” to transform family doctors into employees of the National Health Service, the second and third proposals provide for more stringent forms of accreditation with the NHS and the fourth to a mixed dependency-accreditation form. The solution that seems most convincing is that of an integrated system.
Luca Molinari
.