Increasingly rare general practitioners and an increasingly urgent “generational relay”.. According to data from Enpam, the social security institution of the white coats, they would be 18,757 thousand general practitioners ready for retirement. Exits that risk not being compensated by entries into the health sector. Just think about that in the first 6 months of 2022, only 226 new family doctors entered service against 2,173 retirements. The theme is therefore the transfer of new white coats into a professional field, general medicine, which is less and less attractive for the new generations.
Few young people
Mathematics leaves no room for doubt: Italy is experiencing and will experience an emergency on the territorial medicine front in the coming years. The turnover of general practitioners and pediatricians of free choice is in fact guaranteed by the general practitionersa three-year postgraduate course which is not formally a specialization, to which are added the pediatric specialists, a real specialization that engages young people for 5 years. For the former, 9,000 scholarships have been activated in the last three years: 3,000 graduates leave the training schools every year. It’s no better in the case of pediatricians. Currently 2,500 trainees are enrolled in the five-year course, but only half will go to work in the studio, the other 50% will go to hospital. Of the approximately 500 specialists this year, therefore, only 250 will become paediatricians of free choice. In the next three years we will therefore have less than 10,000 general practitioners and paediatricians operating.
The shortage of doctors means reduction of services in the area. According to the National Agency for Regional Health Services (Agenas), in Italy from 2019 to 2021 their number decreased by 2,178 units while that of pediatricians decreased by 386 units. For 2021 throughout Italy they were therefore counted 40,250 general practitioners and 7,022 pediatricians. The survey by the Interregional Conventional Healthcare Structure speaks of closed clinics at the rate of about a thousand a year starting from 2019, leaving three million Italians without a general practitioner.
The intervention in the Milleproroghe: retired at 72 years old
To delay the exit of seniors, the “Milleproroghe” decree introduced the possibility for medical personnel under an agreement with the National Health Service to retire later in time with the maximum limit moved from 70 years to 72 years.
Interventions according to Enpam
However, this is a short-term solution given that the employment abyss must be resolved in a structural way. According to Enpam it can be done in different ways, working on several fronts. The first is to encourage doctors to retire later with discounts or ad hoc tools such as the «App», the advance on social security benefits. The mechanism devised by Enpam allows those who join to reduce activity by shadowing a young colleague. The senior doctor who remains active reduces his work by 30-70% receiving compensation from the local health authority for the percentage of work carried out while the remainder is transformed into a proportional portion of the pension paid by the Cassa. With the younger doctor covering the activity discovered by the senior in a logic of generational relay and training.
The other necessary intervention is upstream: immediately increase the places in training for general practitioners and pediatricians of free choice. In addition to making young people aware of the advantages of the general practitioner profession: from the economic advantage to more sustainable life-work times.