of Walter De Caro
06 SET –
Dear Director,
I thank you for the extensive publication in Quotidiano Sanità of the politicians’ statements on the subject of scheduled access for the degree course in medicine and the shortage of doctors.
In all its drama, the abysmal gap between the health and training system that the candidates in the elections are talking about, the real health service in which nurses and other health professionals work and from which patients and women are treated how to deliver health and meet the needs of citizens now and in the near future. And in particular the lack of in-depth analysis and attention to data.
A series of candidates from different camps all agreed in the abolition of the “limited number” in Medicine and, above all, in remembering the medical shortage, forgetting the real shortage: the dramatic one of nurses.
Among these I highlight:
– Silvio Berlusconi (Forza Italia), in a medical-centric video release stated that “there are too many doctors missing”;
– Matteo Salvini (Lega) declared “we are in a medical emergency” and “here (in the Marche) there are no doctors as in all of Italy”;
– Luciano Ciocchetti (Brothers of Italy) declared “the national health system is in desperate need of doctors”;
– Alessio D’Amato, Lazio Regional Councilor for Health (Democratic Party) who declared “There are no doctors and we prevent young people from enrolling”;
– At the same time, there was no lack of a long plethora of candidates in political elections, as well as deputies and regional presidents of many parties, including Toti, Musumeci, Zaia, Mastella, the councilor for health Luca Coletto (Lega) in Umbria for to mention just a few, who have insistently asked for the abolition of the limited number, obviously citing the shortage of doctors.
Regarding the medical shortage, what is the real situation?
“In terms of the number of doctors, our country is at the top of the European rankings”, the Court of Auditors announced in the 2020 report. Any statistic (EU, World Bank, OECD, WHO) agrees on this data. By choosing that of the World Bank, in which the G7 countries are selected, it is visible that Italian doctors are also more than twice as many as other nations.
Specifically, the President of FNOMCEO Anelli also dismissed the issue by declaring “We risk going from deficiency to specialist plethora”.
The medical union ANAAO Lombardia with Stefano Magnone in an interesting analysis reiterated that “doctors are no longer needed in Italy” and that “the data currently available show that Italy has a strong shortage of nurses also compared to the number of doctors”
The real cause of the shortage, existing in some specializations, in some area of general medicine or geographical area is fundamentally linked to the organization model of health services that is still too medical-centric and to the consequent failure to develop the potential (with advanced skills and prescription , for example in all primary care activities) of nurses
In the same ANAAO analysis, it is recalled that according to the OECD an indicator of the modernity of the systems is the composition of the different health professions in Italy: in Italy there are too many doctors compared to other professions. In many countries, in fact, many interventions are not the exclusive prerogative of doctors but of other health professionals with particular regard to nurses. This did not lead to user dissatisfaction or problems in managing problems, facilitating access to treatment and reducing waiting lists, especially for those with chronic diseases.
The Court of Auditors (2020) also already indicated the need for investments in nursing staff “The case of nursing staff is different, where, on the contrary, in our country the number of graduated operators is much lower than the European average and the margins are more limited of their use, despite the growing role they can play in a context of an increasingly elderly population “.
In fact, according to World Bank / WHO data, Italian nurses are less than half of other nations (about 6/1000 inhabitants) compared to other countries starting from European countries and the United States which have well over 12/1000 inhabitants.
The minimum estimated shortage is equal to at least 60,000 units and can reach over 200,000 units.
It is also worth remembering that we have about 9,000 nurses abroad (and as many doctors) trained in Italy who went to work abroad (in particular the United Kingdom and Germany), whose return should be facilitated with an incentive plan. in Italy. At the same time, the use of foreign health personnel must be reviewed in an “ethical” recruitment mode in order not to aggravate the situation of low-medium income countries as indicated in the document linked to the global strategy for nursing.
What should politics and institutional decision-makers deal with then? The desperate need for nurses and nurses and how to offer health services in line with the needs of citizens.
What did the politicians talk about yesterday? The shortage of doctors, which has been de facto declassified even by the Orders and Trade Unions of Doctors.
And what has been done to resolve this over the past few years? What have the Ministry of Health, the Ministry of University, the Regions, the other institutional decision makers done to increase the attractiveness of the profession? What plan has been put in place? What has been done to attract new nursing students?
Little or nothing.
For the positions available for Medicine, there are about 4 candidates for each position; for Nursing much less as always. Even if the data are not all known yet, he hopes to at least be able to fill all the places on the call. In several universities, however, the data show (for example the Insubria University and the University of Siena) that there are fewer candidates for nursing than the available positions.
And last but not least, it is worth remembering that the number of medical graduates has been growing steadily in recent years while that of nurses unfortunately has not. Last year, the most unique case in the world, we had more medical graduates than nurses.
It is very urgent to act on the attractiveness of the nursing profession right from the start with planning and investments starting from training: reduction or zeroing of university fees for nurses, bridging models towards nursing, diversification of the programmed access model, job placement, radical revision of the relationships between universities and regional health services and health companies, also in terms of allocation of resources, as well as intervening with innovative teaching and professionalization models.
In addition to this, a substantial increase in salaries, a homogeneous bargaining system between the various public and private realities, with increasing incentive systems, professional and career development with specialized and advanced skills, the free profession and the strategic inclusion of nurses in different contexts.
Thirty years after the entry of degree courses at the University (and over 55 years from the DAI University School), the time has come to review the architecture of the Courses and for the Presidency to be attributed to the nursing staff to allow for directing future training without obstacles or constraints. Nursing training in recent years, also by virtue of the “dependence” on Presidents of other professions, has unfortunately been partially distorted.
It seems natural, if the current mixed University-NHS model is to be maintained, to allow the immediate establishment of university nursing sciences departmental structures, to proceed with the extraordinary recruitment plan of the Universities (at the moment there are only about 50 nursing professors) and to allow transitory to NHS Nursing Professors (over 5000), a different positioning and integration in university positions also with the functions of Course Presidency.
There is a desperate lack of nurses. It is time to act and to mobilize.
Walter De Caro
National President of the National Association of Nursing Associations (CNAI)
06 September 2022
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