by Enzo Bozza
21 NOV – Dear Director,
a simple and concrete narrative for uninformed people to know what their family doctor’s job is, before extinction. Before the panda bear, the monk seal and the family doctor succumb to the dramatic evolution of the species. If nothing else, because then no one is surprised and falls from the clouds, because such is the disinformation and dramatic is the general lack of interest in a professional figure so important in the public care system that for decades no one has cared about him, as is typical of politics Italian government, and then shouted for emergency.
The family doctor is the first healthcare professional to be called into question in local medicine. For any health problem of the citizen, he should be the first to intervene with a clinic and timetables at hand. The first interlocutor who can provide many answers to many health questions. Of all kinds. Obviously, he has and opens all the resources of the public health service: exams, hospitalizations, specialist advice, screening, certifications and any information concerning the citizen’s state of health. But he works alone, he is not a civil servant but only a freelance professional who works for the State with an agreement contract, with a salary of just 3 euros per client per month and with all expenses at his expense: from the telephone, to computer, toilet paper. Being a freelancer with a VAT number, holidays and sickness are his responsibility: if he has to be absent for any reason, he has to pay for a substitute doctor.
His compensation depends on the number of clients, which cannot exceed 1500 choices, for a total of 5,000 euros per month, from which to deduct: rent, heating, water, electricity, telephone, car, cleaning, medical equipment, insurance and taxes with a 43% IRPEF tax cut on gross income received. If there are no unforeseen events, the family doctor will bring home around 2,700 euros net for working hours which, far from being only outpatient, are between eight and ten hours a day, where a good 60% is work bureaucratic: repetitive, demanding prescriptions, certificates, requests for principals, Svama, disability, Inail, Inps, medical records and the daily struggle with the management software for updates and the thousands of IT hitches every day. And then there’s the phone that rings two hundred times a day and interrupts a doctor’s visit on average every 7 minutes.
This is the normal routine of the family doctor who tries to respond with the means and time he has to every need of as many as 1500 patients. Alone. It would be legitimate to ask why she doesn’t get help from a secretary and a nurse: soon said, what does she pay them with, with the 2,700 euro monthly salary? The State should intervene, with concrete help and make this now archaic and anachronistic figure a true protagonist of public health care. Never done. Not even in intentions.
The family doctor is truly absent from any public assistance project. No genuine reforms, no salary reviews, no recognized university education, no state dependencies and no rewards or career opportunities. So why should a young doctor choose to be a family doctor, pure and simple vocational crisis or abandonment by everyone? And why do so many family doctors flee to retirement as soon as they see a glimmer of salvation? Ingratitude? Lack of courage? Little attachment to the Mission? Why don’t citizens ask these questions to the State? Starting from the simple consideration that public health is a right enshrined in the Constitution?
Enzo Bozza
General practitioner in Vodo and Borca di Cadore (BL)
November 21, 2022
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