This morning’s phone call from a young colleague: “Give me some advice, not as a doctor or trade unionist, but as a mother (he is my son’s school friend). Do you think he will change something in our work of family doctors? Because I can’t take it anymore. I’m thinking about resigning, but I feel terrible. I invested a lot in the profession, but under these conditions I’m not there anymore“.
Once upon a time I would have been amazed at a conversation like this. A doctor who terminates the contract with the NHS? Unthinkable. Now no longer. I am a tutor doctor who welcomes many young colleagues into his practice who are internships for the training course in general medicine. Many of them don’t even complete the course. “If this is the job that awaits us, even if it isn’t, precarious work is better”.
We are faced with a vocational crisis, how did many title? I would say no: there are many students who undertake or would like to pursue a career as a doctor and family doctor in particular. But it is the figure of the current “family” doctor, unrelated to the training path undertaken, a path that lasts approximately 10 years and that it cost time, money, sacrifices, which is rejected.
Because we are clinicians, not administrators, as they have reduced us over time, with an unprecedented decline. We are tired of Asl appropriateness commissions that judge us, to justify their existence in life, for how many pills for stomach ache we have prescribed and not for how many hospital admissions we have avoided. We are tired of INPS certificates that we have to draw up for non-objectifiable diseases, but only on the narration of the patient who is denied the right to self-certify the first days of illness as is the case in many European countries.
We are fed up with Inail certifications and certifications in general, just think of the certificates for non-competitive sports activities that are no longer mandatory since 2013, but which are continuously requested. And what about the renewal of treatment plans for drugs of particular use, on behalf of third parties, on digital platforms, even different from region to region and which often do not communicate with the system health insurance cardjust to name a few examples.
We live in an IT babel and in all of this Covid, new diseases and old diseases that did not miraculously disappear, rather. Diseases that we try to treat to the best of our ability, given the appalling contraction of the public health supply throughout the country. Until recently we were, together with the continuity of care stations, the only capillary and easily accessible garrison of the NHS; today more than three million citizens are without a family doctor and many emergency medical posts have been closed. The courageous who remain on duty are in burnout, accused of being the cause of the overcrowding of the emergency rooms, not to mention the decennial cuts to structures and personnel. Emergency rooms are crowded simply because they are few and understaffed: they are less than 60% compared to those of 10 years ago.
Today’s young doctors rightly have a more Anglo-Saxon approach to the profession. They take off the role of the missionary that doctors of my generation have cloaked themselves in (or that they have forced us to wear as a straitjacket), claiming a professional role, fair pay, time for private life and not feeling the least bit guilty, rightly so I say, if they don’t answer the phone at 10 pm or on Saturdays and Sundays, when they are in operation, or there should be, alternative services to replace them. In defiance of those who said on TV that a family doctor who doesn’t respond in the evening must be fired.
Today there is much debate about the legal role of general practitioners: affiliated or employees? As if the restructuring of the company depended on the type of contract local medicine. Restructuring that certainly does not pass through Community Houses, a reality that Report has disclosed to the general public but which insiders know very well. Pnrr money is being used for a building restyling devoid of content and human resources.
Over time we have moved from social and health districts, to health houses, already rejected by Agenas in 2012, to the current community houses, with a clear quantitative and qualitative worsening of the services provided. The privatization of the healthcare system is now rampant. When will the squares full of citizens in defense of a fair, universal and public health service as in other countries?
We believe in it and for this reason we resist. But for how much longer?