Stress and assaults, the escape of doctors from hospitals. Boom of “coin holders”

ROME – Every day ten doctors quit Italian hospitals. Those who can go abroad, others prefer the private sector, there are even those who apply for a general practitioner competition because they believe they have a more peaceful life. And then there are the “tokenists”: those who go to work for cooperatives to which the health companies turn to fill the gaps in the workforce. Except that a “token” doctor earns 110 euros an hour, working less he collects much more than when he was on the ward as an employee. The numbers were collected by Anaao Assomed, the association of managing doctors. Pierino Di Silverio, national secretary, says: «The terrible years of the pandemic had accentuated this phenomenon, but now the outflow seems unstoppable. If in 2022 we calculated seven doctors who quit every day, this year the figure is close to ten. Attention, I’m talking about those who leave by choice, not because they retire”.

SCENARIO

The consolidated numbers show that “the great escape”, which is actually a phenomenon that also affects other sectors and not only in Italy, has much more marked characteristics in hospitals. Between 2019 and 2021, 21,000 doctors left Italian hospitals. That figure processed by Anaao Assomed included 12,645 retirements, including early retirements. However, the study pointed out that 8,000 had left by choice, had quit, especially in the health facilities of southern regions, such as Calabria, Sicily and Liguria, but also in Lazio, Lombardy and Liguria.
But who quits what is he going to do? Di Silverio observes: «Some of them accept offers abroad, where they can earn more and have better career opportunities». But there’s more: there are those who accept offers from the private sector, especially in those regions where the presence of this type of healthcare facility is stronger. The Minister of Health, Orazio Schillaci, has promised the little virtuous phenomenon of “token holders” that a brake will be given: “Is it possible that I should arrive to realize that this type of hospital management is unacceptable?”. Schillaci has decided to place a limit on the number of assignments and in any case before resorting to external assignments it is necessary to check the availability of internal personnel. There will also be much more attention to checks on the possession of the professional requirements of “token holders”. They tell the Ministry of Health: when we ordered inspections by the Nas, cases emerged of token doctors sent to departments for which they did not have the necessary qualifications. In summary: the “great escape” from Italian hospitals was aggravated by the stress caused by the difficult years of Covid, but it is also caused by wages deemed low (the Ministry is intervening on this for those employed in emergency rooms); from the “deficiencies in the workforce that force us to work exhausting shifts” says Di Silverio; by the temptation of higher salaries in the private sector and the “token holder” job. Then there are a number of contributing factors. The first: the frequency of attacks suffered, especially for those who work on the front lines. “And let’s not forget the constant lawsuits of those who believe they have been wronged in hospital, which almost always end up in filing because they are unjustified, but nonetheless fuel stress among doctors,” observes the leader of Anaao Assomed. On this the government has set up a commission that will reform the crime of medical error to counter complaints presented without a real reason. All these elements are at the basis of the “great escape”, but also of a situation of widespread burnout syndrome, denounced by a study by Fadoi (scientific society of internal medicine).

CHOICES
Massimo Magnanti, who has been on the front line for many years, head physician in a Roman emergency room and leader of the Spes union, recounts: «Unfortunately we are facing the effects of twenty years of cuts in health care. The first to suffer are those who work in emergency rooms, but internal medicine departments are also suffering now. This is agony, let’s not be surprised if hospital doctors quit. Either the national health system is retrained, or we might as well declare that we are no longer able to afford a universal, fair and basically free system. But this second option would be unacceptable.”

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in Il Gazzettino