of Als (Carmine Cecola et al.)
19 NOV – Dear Director,
The theme of the shortage of emergency-urgency doctors in hospitals is sadly back in vogue: emergency rooms are increasingly lacking specialists, with the predictable result of having one of the fundamental services of our national health system, namely patient management who go to emergency rooms with acute illnesses, not at levels worthy of a Western country.
This shortage has multiple culprits. The doctor who chooses to undertake the path of emergency-urgency medicine is a doctor who knows well that he must be “a doctor on the front line” with the constant relationship with the patient, with the perennial threat of complaints, with the awareness that his medical choice is fundamental in the subsequent clinical management and in the follow-up.
As the most representative Italian association of doctors in specialist training, including emergency-emergency specialists, we have analyzed the amount of funding to train the “urgent specialists” of tomorrow: a substantial funding. We can only give credit to Minister Speranza and the Government for the effort to finance 1152 state contracts, which are equivalent to 147 million euros since each contract corresponds to 128 thousand euros spread over 5 years.
Finally, we calculated the amount of emergency-urgency medicine contracts not assigned during the last specialization competition. The data shown in the table below are pitiless: over half of the financed contracts (54.3%) are currently unassigned and almost all of them will not be awarded in the future. There is no north-south regional gradient or a university efficiency gradient: the bleeding affects all university realities at all latitudes. With these figures, we will not only have a “chronicization” of the shortage of emergency-urgency doctors but we will see a real emptying of the emergency rooms and already in the coming months in many regions the emergency-urgency specialists in the first year will be counted on the fingers of one hand: in Friuli-Venezia Giulia, the region in which there is currently a peak of infections, you will be able to count on only 3 new postgraduates out of the 49 planned. Of the 147 million euros financed, 80 million will not be used for non-allocation.
Strangely and paradoxically, there is no “funding problem” or scheduling admissions to medicine: the real problem in our opinion is the framing of the medical training contract which creates a huge disaffection towards the specialization school in emergency medicine – urgency, together with other realities such as clinical pathology or anesthesia-resuscitation.
The current resident in emergency-urgency medicine (MEU) is a young doctor, winner of a national competition, who does not sign a full-fledged employment contract, that is, based on the CCNL, but a university scholarship contract based on in a law, the 368 of 1999, which in 22 years has not undergone substantial changes. The MEU trainee receives a monthly scholarship allowance of € 1650 for the first two years and € 1710 for the last three years, gross of annual university fees that can be quantified on average of € 200 per month. As he is “a doctor who has won a university training scholarship”, unlike medical executives
· He is not entitled to overtime, despite almost all of them exceeding the monthly number of hours.
· He is not entitled to exclusivity indemnity, although he has in practice only incompatibility except for medical guards and mmg replacements.
· It has practically no equivalence, although other schools that last 1 year less, such as geriatrics, are equivalent to MEU. In practice, a geriatrics can work in the ED but not the other way around.
· Like medical managers, he can and is systematically denounced and beaten up by patients.
If we do not put our hand to the classification of doctors in specialist training, we will see a real extinction of the figure of the urgent emergency specialist. In our opinion, the urgent initiatives to be undertaken are the following:
· Change of position of the doctor in specialist training, evolving his figure from winner of a post-graduate university scholarship to a doctor in training hired with an ad hoc contract based on the CCNL.
· Guarantee, on a par with the medical director, of the most basic labor rights such as holidays, illnesses, hours, overtime, inter-school transfers, family reunification, leave.
· Trainee’s allowance equivalent to fellow European doctors in training.
· Optimization of incompatibilities and equivalences.
· Increased protection for doctors against aggression and “judicial crusades”.
· Promote training also in non-university DPs.
· Encourage entry into the world of work with permanent contracts and not “atypical contracts” for newly graduated specialists.
Financing specialization contracts without changing the position of the doctor in specialist training will not lead to any improvement in the already serious situation. Not only we representatives of ALS are asking for it, but 4,000 young doctors who have signed up to our proposal for the reform of medical training.
The economic coverage, if ever needed, is largely covered by the 80 million already allocated which will not be used. Now we need the political will to reform the system of specializations.
Carmine Cecola, Andrea Costantino, Demetrio Crea, Antimo Di Martino, Nicola Guareschi, Alberto Guarnaccia, Rinaldo Miceli, Federico Moro, Antonio Libonati, Giammaria Liuzzi, Massimo Minerva, Alexia Quaranta, Ermelinda Pagliaro, Gian Marco Petrianni, Giorgio Robuffo, Santo Simone Rustica , Angela Rita Bianco, Livio Tarchi, Lucrezia Trozzi, Guido Santini, Daniela Atzeni, Manuel Santu, Marco Tarroni, Roberto Tozzi
Representatives of the ALS Association
November 19, 2021
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