by Matteo Maria Macrì
Just a few lines to try to put together two very different genres: the farce and the tragedy. The increasingly widespread use of “Tokenists” in public hospitals. A token operator, a figure already present in most European countries, is a doctor employed instead of staff in the workforce, to fill the uncovered shifts in the hospital. The Italian alternative has always been extra and unpaid hours.
For the sake of clarity, a series of considerations must be made starting from afar.
Although still a young doctor, I can report that during the years of studies, among the most exciting subjects for most students, there are those considered more demanding: surgery, emergencies, resuscitation, etc. Access to such specializations was once considered elitist. I remember with what admiration I looked at the specialists of these departments, they seemed like heroes in my novice eyes. But already during my studies things were starting to change; these large branches they were no longer seductiveon the contrary, it seemed that dermatology had become the most interesting subject that ever existed. But why this epochal change? Why did we go from ambition to do a triple coronary bypass to learn how to do a mapping of the moles? Without detracting from the importance of the latter, the change was quite clear.
Looking at the wishes of aspiring specialists, we can see what the trend has been in recent years: choosing a specialization that can be spent in the private sector and that allows a lifestyle decent in terms of stress and working hours. Ambition of the whole legitimate. Therefore, it is not surprising that in the last competition to access specializations, 50% of the emergency medicine grants and about 20% of the surgical ones remained vacations. But to better explain the phenomenon, it is enough to look at the changes in the health sector over the last 20 years:
– Massive reduction of medical personnel
– Net loss of training quality in surgical areas
– Worsening working conditions in hospitals
– Salaries inadequate with often precarious contracts
It is no wonder that, as in any other sector, workers try to improve their conditions. Historically, various professional figures (usually sector specialists such as dermatologists, ophthalmologists, etc.), for structural reasons, have been able to practice in freelancerin fact guaranteeing health care in private form, where the public did not provide it in a capillary way, as it is mainly non-urgent services and therefore procrastinable up to infinity in a system without resources. There have never been street riots or newspaper articles about this phenomenon. But since the shortages in the hospital have become so striking and some places so unappealing that they even risk interrupting essential services, the logic of the market also involves those who have been left alone, forgotten, ignored for years, transforming from silent servants to unlikely mercenaries. And finally here is the indignation, which, however, was not valid as long as only a few professionals, the “noble” ones, gained from the inefficiency of public health.
Here is the farce. Unfortunately within a tragedy: the gradual and inexorable dismantling of public health. How nice it would be to be able to work in the public service without feeling exploited, humiliated, degraded. Perhaps the wishes of aspiring specialists would change, they would be dictated by their own attitudes rather than by convenience. In the meantime, if the choice is between being a well-paid and appreciated professional or an underpaid employee, exposed to the highest risks of the job and increasingly intolerable daily stress, then the choice remains easy: dermatology.