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They are increasingly difficult to find, so much so that in twenty years there are 10,000 fewer, forcing Italians to go through difficult gymkhanas to get one. During the pandemic they were overwhelmed by bringing out the limits of their studies: too isolated from hospitals. This is why the reform of family doctors can no longer be postponed as Europe is also asking in view of the take-off of the new territorial health system in which the Pnrr invests 7 billion. The Government is reflecting on it and there are two paths on the table that could be followed together: on the one hand, hiring young general practitioners in the new Community Houses and on the other, enhancing studies with equipment and instruments to allow family doctors to also prescribe hospitalizations by reducing the crowding of emergency rooms.
The shortage alarm is getting heavier and heavier
The great haemorrhage of family doctors will continue at least until 2025 when – according to Agenas estimates – there will be only 36628 available to Italians (there were over 46 thousand in 2002 and 40 thousand in 2021). These numbers well explain the difficulties of many Italians in finding their trusted doctor who is often forced to overbook, i.e. to exceed the ceiling of 1,500 patients set by the roofs. We are dealing with a real desertification that began some time ago and which has exacerbated in recent years due to the maxi exodus of white coats who retire en masse with “spare parts” that are not sufficient to fill the holes left by those he’s out. A shot in the arm to reverse this trend is expected with the formation of new recruits who will be able to take advantage of the 900 additional grants a year approved by the previous Government with the funds of the Pnrr which are added to the ordinary funding: for three years, i.e. up to 2025 the scholarships go from 1,879 to a total of 2,779. The competition started last March (very late) and may not have filled all the places.
The new Territorial Healthcare and the personnel node
In the Pnrr, more than 15 billion are allocated for Healthcare, of which about half for the territory and in particular 3 billion to build over 1350 Community Houses by 2026 – a sort of maxi outpatient clinic in the area for first aid and diagnosis to stem overcrowding emergency departments – and around 400 community hospitals, facilities for hospitalizing chronic patients who do not need the high-intensity care of a normal hospital. Among the main issues that immediately emerged is that of the personnel to be employed in the new structures: in addition to a few specialists and nurses – who are also very difficult to find – the idea is to also have family doctors work in the Community Houses. But how? the previous Draghi government had thought of binding them a certain number of hours to work in the new structures, but the project foundered with the fall of the Executive. Now the idea being worked on by the Ministry of Health is to allow young generalists who have just specialized to be hired as employees while whoever wants to remain under an agreement (today the relationship is in fact freelance) both by working in the new spaces of the community houses and by staying in the own studies as is the case today.
Family doctors as an alternative to the emergency room
The other way is to try to make family doctors also an important hub for emergency rooms and arrive at providing an academic path for their training, in order to make this profession more attractive, moving from the current training course in General Medicine after a three-year degree managed by the Regions to a university specialization with a minimum duration of 4 years. The revision of the study model would instead aim to allow the doctor to be able to prescribe hospitalization where necessary, so that the citizen can skip waiting in the emergency room and immediately enter the ward. An experiment in this sense was carried out in Lombardy with the establishment of a ‘blue code’ but the problem is that in order to do this, the doctor should be able to carry out complete diagnostic tests, starting from electrocardiograms and cardiological tests, but to date – notes the secretary of the Italian Federation of family doctors (Fimmg), Silvestro Scotti – our studies still do not have the necessary diagnostic equipment. The funds for the diagnostic equipment are foreseen from 2019, but the Regions have not started the necessary procedures ».