The last Sos arrived from San Camillo in Rome and from Cardarelli in Naples where chaos reigns due to a lack of doctors. For years there has been an escape from the emergency room of hospitals that has worsened with Covid and is now being felt more by the mass return of patients after two years of treatment with a dropper: at least 4,500 doctors are missing here. But the shortage alarm more generally concerns hospitals where there are 10 thousand vacancies: it is impossible to forget the hunt for anesthesiologists and pulmonologists in the hardest months of the pandemic. With the bleeding that also affects the offices of family doctors: about 4 thousand white coats are missing with millions of Italians who risk being left without or are forced to register with doctors already in “over booking”.
The alarm in the emergency room
The situation that is most evident at the moment concerns the emergency room where after two years under stress due to Covid, the long wave of patients who have postponed treatment precisely because of the pandemic must now be managed: «Here there are 4,500 doctors missing. To this is added a vicious circle linked to the exhausting shifts of those who work on the front line today, often with all working weekends and difficulties even in taking holidays “, he explains. Carlo Palermo, national secretary Anaao Assomed, the union of hospital doctors. Not only that: according to the estimates of Mario Balzenelli, president of Sis 118, “the doctors on board the ambulance have decreased by more than 50% in the last 10 years”: they have escaped from a “tiring and poorly paid” job. In the last maneuver, 90 million were allocated to pay an ancillary allowance for those who work in the emergency room. But it might not be enough. Also because as the president of Fiaso denounces, John Best“More and more competitions banned by healthcare companies and hospitals fail to be attractive and go deserted, and more and more professionals leave the public to work in the private sector, emergency legislation is needed, on the model of the one that allowed us to overcome the pandemic , which makes it possible to hire in the emergency room both specialists from other disciplines, as well as graduates in Medicine and Surgery and qualified for the medical profession even if without specialization “.
Chronic deficiency in hospitals
How can we forget the hunt for medical specialists in the hardest months of the pandemic? Then we ran for cover with retirees or young trainees. But the problem remains all: the shortage is at least 10 thousand doctors, but according to Carlo Palermo “the figure is destined to worsen because the exits from the health service, including retirements and layoffs, can be estimated at about 7 thousand every year. The new specialists who are trained are currently about 6000 every year, of which only about half / two thirds accept a job in the NHS. So 7 thousand come out, the replacement capacity is limited to 3000-4000 every year. The chasm – explains Palermo – therefore expands by 3000-4000 every year without counting the increase in personnel necessary to cover the intensive and sub-intensive beds activated during the pandemic ». What to do? “The first thing is to take on all the precariousness that developed in the sector during the pandemic and then go beyond the limits imposed on personnel spending. But – concludes the secretary of Anaao – even more must be done: to extend the recruitments in the NHS to medical specialists starting from the third year. It is the only weapon we have ».
The reasons for the shortage of white coats
There are two main causes of the shortage of doctors: the first is the expenditure ceiling for recruitment in force for over 15 years and which provides that the Regions cannot spend more than they did in 2004, then removing the 1.4 per one hundred. A big cap that was momentarily removed during the pandemic with extraordinary recruitments (over 30 thousand, many on a temporary basis) which, however, were almost all precarious. The second cause was the absence of programming of the training system which in fact caused a training funnel for which for many medical graduates there were not enough grants to specialize and therefore too few young doctors were trained. In recent years alone there has been a reversal of the trend and it has gone from 6-7 thousand scholarships a year to 13,400 in 2020 and over 18 thousand in 2021. In the future, the NRR foresees an average of 12 thousand scholarships a year for graduates in Medicine. But to make them work you have to wait for them to specialize and therefore 4-5 years from the start of the course. “There will still be a few years not easy to manage – explained the Minister of Health Roberto Speranza – but today the lesson of Covid was very clear: we must reverse the season of cuts, as we are doing, and we must open a new great season of investments in healthcare as a whole and, in particular, in healthcare personnel. We have already started to do it and the numbers say so ».
More and more Italians without a family doctor
But the crux of the shortage of white coats also concerns the category closest to Italians: that of family doctors. Here there are 3-4 thousand vacant seats in a category that has about 40 thousand. Among other things, the shortcomings are not only in rural areas but also in large cities such as Milan and Florence. At least 1.5 million Italians are without their own doctor. Some are forced to rely on studios that already have a full number of clients (the maximum is 1500). And the shortage alarm for family doctors may be just beginning. After losing 3 thousand family doctors between 2013 and 2019, the race to retirements has now begun: 35,200 are expected by 2027. Probably there will not be enough to replace them even if a first real sign of countertrend comes from the NRP: in the National Recovery and Resilience Plan, in fact, the resources are allocated to add 900 more scholarships to train in general medicine for the next three years.