by Matteo Maria Macrì
Recently in Italy, due to the pandemic disaster, it was “discovered” that he had a big one shortage of doctors and as typically happens in our country, attempts have been made to run for cover only after years of guilty negligence.
The government took action and after “accurate” analysis agreed to increase places for admission to the medical degree course and medical specialization courses. To give an idea of the phenomenon, there has been an increase in 21% of places in the last 2 years for the degree course in medicine (reaching over 14 thousand places in 2021) and above all in the last 5 years there has been an increase of over 150% of places for medical specializations (from 5000 scholarships in 2016 to 17400 in 2021).
Public opinion may think that this is only good and that as praised by Minister Roberto Speranza “lays the foundations of the NHS of the future”. The minister also added: “thanks to a strong, adequate university network”. Just this last statement leaves some perplexity to those like me who work in university hospitals to become a specialist. At present, almost all of the Italian university hospitals it is absolutely not capable to satisfy the training need of the ever increasing number of new trainees.
To solve the problem of the shortage of doctors, it would have had to first of all strengthen the training network and the ability of universities to offer real quality training. Instead, we proceeded in a short-sighted and obtuse way, ignoring the numerous problems that accompanied a hasty and simplistic increase in the grants available. Among the main reasons, there is the fact that non-university hospitals have not yet been permanently integrated into the training network, and university structures are often unable to guarantee teaching even under normal conditions. To give a practical example, if it is already very difficult for a surgical resident to practice in the operating room when, for example, he is 20, how much do you think he will do now that there will be 60? This obviously applies to all medical branches.
Ultimately, the overcrowding in which the hospital structures responsible for the training of students are and will increasingly be found, will make even more miserable the already often lacking quality of the training offered. As if that were not enough, it will introduce an anomalous and disproportionate number of specialists into the world of work, which will contribute to further devalue the already debased professionalism of doctors in Italy, generating a race to the bottom of employment contracts as typically happens in our country in many sectors.
Many trade associations have always fought against the training funnel that prevented many young doctors (so-called gray coats) from continuing their training and becoming specialists. Undoubtedly commendable battles, which they sought to protect both the right to training and work for doctors and the right to treatment for the population. Unfortunately, increasing the number of specialization posts does not make it obvious to absorb a similar number of specialists in the NHS at the same time. This involves the creation of a new funnel, this time not training but work, effectively canceling all the efforts put in place.
More medical personnel in hospitals does not only mean improving public service, but also making doctors less burdened and thus allowing them to devote more quality time to the training of trainees. I hope these same associations now shift their gaze to a problem much bigger, but that it will make less noise, because it will only involve our category, but only apparently. Because a lowering of the educational quality of new doctors is destined to soon become a problem for the community. Let’s not let that happen.