The national health system built around the number one unit: general practitioners. They have to assist patients as much as possible at home, and every citizen has to go there to access everything from specialist visits to prescriptions for drugs. As we have documented during the long months of the Covid-19 epidemic, their role will become increasingly crucial: in 10 years there will be almost 800,000 more than 80 year-olds, or 5.2 million (almost 9% of the population). chronically ill patients are on the rise (23 million) and we must avoid filling the emergency rooms unnecessarily with white and green codes. Each year there are 16 million accesses (out of a total of 21 million), and 87% do not result in hospitalization. With the budget law of 2020, 235 million euros have been allocated to equip the family doctors with ultrasound scanners, spirometers and electrocardiographs, so that they can finally perform first-level examinations in their clinics, thus avoiding painful lists of patients. wait. It means new tasks and skills. Hence the need to better prepare those who undertake the profession of general practitioner.
How are they formed?
Throughout Europe, after graduating in Medicine, you have to do a three-year course between theory and practice in the clinic and hospital. This internship is very different from one country to another: in Bavaria governed by the Bayerische Landesrztekammer, the Bavarian Medical Association, and doctors are paid as employees at around 5,000 euros a month. In England the courses and hands-on activity are coordinated by Health Education England, the National Government Agency, and the salary is £ 4,166 per month. In Italy, a specific training diploma in general medicine is required, which is obtained through a three-year postgraduate course consisting of 1,600 hours of theory and 3,200 hours of practice in hospital and in the clinics of family doctors. They are paid with a scholarship (therefore classified as students) of 11 thousand euros per year, that is 966 euros per month, subject to Irpef, with contributions paid, and disbursed by the Ministry of Health. Quite different from the scholarship for hospital trainees, which of 26 thousand euros a year, contributions included and without personal income tax. This already indicates upstream the poor consideration for the general practitioner.
The unions train doctors
The funding entrusted to the Regions (Legislative Decree No. 368 of 17 August 1999) and each decides how to organize the courses: through regional primary care training centers (Friuli Venezia Giulia), regional bodies (Lombardy), foundations (Veneto), health authorities Asl / Usl (Emilia-Romagna, Lazio, Liguria, Piedmont, Sardinia, Aosta Valley), regional laboratories for health training (Tuscany). Each training course then has a direction, a technical-scientific committee and territorial coordinators for theoretical and practical activities. The criterion in choosing who trains future family doctors should only be that of competence, ability and experience.
If you go to see who manages the courses, name by name, it turns out that in almost all cases they are subjects with an important role in medical unions. Unique case in Europe
The main corporation the Fimmg that with 23,800 subscribers represents 63% of general practitioners, according to it With us with 19%, but the long and surprising list. In addition to the trade unions, the course coordinators also belong in significant numbers to the SItalian ociet of general medicine and primary care (Simg), founded in 1982 in Florence to enhance the role of general practitioners. At its top there has been haematologist Claudio Cricelli, 71, president since 1998, without interruption for 30 years. after having been vice president from 1996 to 1998 and general secretary from 1990 to 1996. In 2017 Simg was recognized as a scientific company. National Vice President Ovidio Brignoli which also coordinator of the Lombard course and councilor of the Brescia Medical Association. But what is this society doing scientific?
Public role and private interest
Simg organizes congresses and refresher courses sponsored by pharmaceutical companies: in 2020 it receives 80 thousand euros gives Bayer, 42 thousand from the Grunenthale 452 thousand from the GlaxoSmithKline, of which 309 thousandby way of donation and liberality. In April 2020 he signs with Sanofi e Fimmg (the most important union) a memorandum of understanding for an innovative 40-hour medical training program, valid for credits Ecm, those that must be compulsorily acquired during the three-year period. After a thousand controversies for conflicts of interest, the parties have taken a step back. For the bulk of the activity on collecting and managing patient health data. As a scientific company since 2013, Cricelli has successfully promoted software to family doctors for the clinical government, with which thousands of patient health data are collected. Today 17,000 general practitioners use them. These software are developed by two closely related companies. One the Millennium, controlled by Dedalus, international leader in clinical software, of which Cricelli himself between 2004 and 2013 chairman of the board of directors and today chairman from Italian Dedalus. The other there Genomedics, formerly a company of softwarefrom Cricelli e Brignoli, from 19 April 2011 to 85% of Iacopo Cricelli (son of Claudio) and 15% of Silvia Tronci, at the same time responsible for customer care of Dedalus. To supervise the activity of doctors there is an independent body: the Order of Doctors. Carlo Roberto Rossi for example both president of the Order of Doctors of Milan that president of the Snami Lombardia union. And at the same time he holds the three-year training courses.
From courses to contracts
After the internship, general practitioners become self-employed, and it is the same unions that formed them and collected the memberships of their trade union association during the course, to then negotiate collective agreements with the government. The agreement in force provides that the clinic must be open (depending on the number of patients) from 5 hours per week (up to 500 patients) to 15 hours (for 1,500 patients). Each additional service must be contracted and paid for, unlike what happens for hospital doctors, because in the contracts it has never been defined in detail which primary care is to be guaranteed.
In between are the patients, who know how much they see their family doctor. The Lombardy Region, which paid heavily for the errors of its health policy, decided to change everything last July: paid apprenticeships are carried out in the uncovered general medicine clinics as in Bavaria and England. The future family doctor while doing three-year training, also keeps his clinic open (obviously under close supervision of the tutors), and a salary of 2,400 euros per month for 500 patients is added to the scholarship. Carlo Roberto Rossi and Fimmg come out with indignant press releases. The measure is currently blocked.
Who commands?
If in Italy the family doctors in training students remain underpaid and almost completely in the hands of the unions, the consequence that the profession of family doctor destined to remain a second-class profession, often used as a fallback by those who do not enter specialized schools to become a cardiologist, heart surgeon, gynecologist, orthopedist, etc.
A gray area for years now where on one side there are family doctors that only the compilers of papers do, and on the other hand those who try to assist patients to the best of their ability, but are damaged by a system that is not very transparent and full of conflicts of interest.
A power lobby that often manages to keep politics in check while having difficulty making decisions that uproot the system
Meanwhile, the 7 billion euros of the Recovery Fund available to improve local assistance risk being thrown away if the family doctors are not convinced to go to work in the 1,288 new homes of the community planned within 2026.
19 September 2021 | 22:29
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