by Antonio Magi
14 DIC –
Dear director,
last December 2 at the headquarters of the National Federation of Orders of Surgeons and Dentists, the General Secretaries and the Presidents of the most representative trade unions of all the medical categories of the NHS, Hospitallers, General Practitioners and internal Outpatient Specialists, together with the management of the FNOMCeO, presenting the “Invisible” video, denounced in no uncertain terms how the doctors of the NHS have now become “invisible” due to politics.
If in itself this is a serious fact for politics, it seems that not all doctors are equally invisible. We are in fact discovering that among the white coats there are those who are even more invisible than the others.
We are talking about the 14,424 specialist surgeons who work every day in the Local Health Authorities, in the Local Health Units, in Polyclinics, in Consultations, in the Prevention Departments, in the Districts, in the Mental Health Departments, in the Mental Health Protection and Developmental Rehabilitation (TSMREE), in the Penal Institutes, in Ports and Airports for the Ministry of Health in the Marine Health Assistance Service (SASN), in disadvantaged areas such as mountain areas and islands, guaranteeing specialist assistance to all Italian citizens.
They are the ones who have so far prevented, throughout Italy, the closure of hospitals and emergency rooms by filling the gaps in the staffing of specialized medical personnel due to the famous turnover block, wanted by the Monti government in 2012, which imposed a ceiling on the cost for personnel equal to 2004 minus 1.5%. Lockdown still in effect today after 10 years.
They are those who with their 19,017,134 annual working hours of specialist medicine (totally insufficient for the purpose, in fact at least double that would be needed) try with difficulty to guarantee specialist medical visits (first visits and check-ups) and instrumental diagnostic tests ( X-rays, ultrasounds, mammograms, spirometry, ECG, etc.) in the public outpatient clinics of the NHS, the few that are still open (they are today about half compared to those in 1992) excluding laboratory facilities as many as 76 million services every year .
“Invisible among the invisible” are these non-hospital public contracted specialists – cardiologists, diabetologists, orthopaedists, gynecologists, radiologists, neurologists, angiologists, general surgeons, internists, dermatologists, gastroenterologists, pulmonologists, oncologists, psychiatrists, etc. – who have always, even before the establishment of the NHS in 1978, been the first specialist contact that citizens have, often trustee, proximity, to treat and take care of patients in the area as well as in public polyclinics, even at home , and who do not require hospitalization but also those patients who are discharged from hospitals after hospitalization.
They are those “invisible among the invisible” doctors, whose serious numerical shortage, even more evident for citizens who see increasingly empty public polyclinics, created by incomprehensible political choices, are the real and main reason for the current long waiting lists.
These choices have led patients to book exams and be examined even after many months, forcing those who do not have the financial resources to be able to pay for specialist visits or those who cannot wait too long for a specialist service for health reasons, to crowd the Emergency Department or even worse to give up treatment.
I would like to remind those with government responsibilities that these “invisible among the invisible” are fully-fledged NHS specialists who, together with general medicine, paediatricians of free choice and pharmacies, form an integral part of that local proximity agreement which today everyone fills their mouths but which we continue to forget, it was not mentioned in the previous government and it is not even mentioned in the public statements of the representatives of the new government.
Without these specialist surgeons it will not be possible to organize an effective and efficient territorial medicine, applying or not the DM 77, as they are an integral part of that multi-professional and multi-disciplinary team which together with the health professions should fill the 1,430 houses of the Community both Hub and Spoke but also the 435 community hospitals and which should use the health equipment provided for in the PNRR in the Community Houses such as ultrasounds, mammography, CT scans and Magnetic Resonances and so on and which are those specialists who should also use that technology provided for Telemedicine activities mainly dedicated to home care as indicated by the PNRR as public specialist doctors are the only ones who have been going to the homes of ADI patients for over 50 years.
Despite this, when the topic is territorial medicine, primary and proximity care, politics, today as in the past, once again indicates only General Medicine, with the very recent novelty of Pharmacies, certainly essential principals especially after the experience of the pandemic , but you will all agree neither general medicine nor pharmacies can affect the management of waiting lists and be substitutes for internal outpatient specialists.
Yet the chronically ill in the area, especially the complex ones, need specialist outpatient assistance that works together with General Medicine and Pharmacies just as they need hospital specialists when they need hospitalisation.
Some speak, evidently inappropriately, of hospital specialists to be used in the area when these are not sufficient in the hospitals and neither can new ones be found available to work there.
During the 54th National Congress of SUMAI Assoprof with the publication of the work “Doctors Specialists situation in 2021 forecast in 2030” we wanted to highlight the failure of the health planning policies implemented so far by previous governments by highlighting the lack of 30,000 doctors in Italy in 2022 specialists in the NHS of which 20,000 are hospitalized.
The remaining 10,000 missing doctors are the internal outpatient specialists (invisible among the invisible) who are absolutely necessary in order to guarantee territorial specialist assistance.
If we add another 10,000 colleagues to the current 14,000 outpatient specialists in service, we could reduce the current waiting lists and excessive improper access to the Emergency Department. In recent years, however, instead of investing, as would have been natural to do, in internal outpatient specialists, it has been preferred to desertify the territory, hospitals, general practitioners, increasing waiting lists, creating an important out-of-pocket expense but also unfortunately causing many patients to give up treatment.
To calm the waiting lists, instead of going to look for specialists elsewhere, it would have been enough to gradually bring the average hourly rate of specialists in service over the years from the current 25 hours a week to the 38 hours a week provided for as a contractual ceiling. In this way we would have given access to all those specialists who have been waiting on the list for a long time and who, unfortunately, in the absence of a call or a sufficient number of hours of assignment to be able to live, have rightly chosen private or abroad .
In addition to doctors, we must also include other non-medical outpatient specialists in the invisible category, i.e. the 1,567 psychologists (with 4 million annual services), the 1,176 veterinarians (with 3.2 million annual services), the 391 biologists and the 18 Chemists (with over 2 million services per year).
In conclusion, all doctors (hospital specialists, general practitioners and paediatricians of free choice) have unfortunately become invisible. In addition to these, however, there is a category of “invisible” to politics but not to citizens: outpatient specialists, who are now more fundamental than ever in solving specialist-type care problems in the area, thus guaranteeing optimal hospital activity, taking into account loading into the territory the chronicities that can be treated on an outpatient basis and optimizing hospitalizations and improper access to the Emergency Department.
Antonio MagiSecretary General SUMAI Assoprof
December 14, 2022
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