“I share the government’s idea of putting a squeeze on the phenomenon of token doctorsbut there has to be an’alternative and at the moment it is not there”. fabio de iaconational president of the Italian Society of Emergency Medicine (Simeu), has just read the amendments definitive at Bills Decree. The provision, approved by the Council of Ministers on March 28, will arrive in the Chamber on May 17. There are many sanitary measures inside. Among these, also the intervention desired by the Minister of Health, Horace Schillacito curb the use of outsourcing by the National Health Service. In the first draft, the decree provided that i token doctors could continue to operate only in emergency room and for a maximum of one year, with no possibility of extension. But the government’s tough fist risked causing many problems for other departments, suddenly deprived of the only available workforce. By closing cooperatives and private companies to doctors, without offering alternatives that can replace them, hospitals risk remaining deserts, without staff. And that is why the majority decided to back down with the amendments. Without, however, finding some real solutions to the problem.
In many regions, the SSn he is unable to stand without token holders. “They are called when there are no other resources available. When the other possibilities have all been examined, without success”, explains De Iaco a ilfattoquotidiano.it. Italian hospitals have been suffering from a serious shortage of staff for years. Thus, healthcare companies are forced to rely on private third party bodies, to guarantee shifts that would otherwise remain uncovered. But these outsourcing they cost a lot to the NHS. In fact, the token doctor, working less, enjoys wages that exceed up to three times those received by the professional civil servant. This disparity of economic treatmentflanked by the difficult working conditions of those employed in hospitals, especially in pronto rescuehas caused a continuous over the years doctors bleedingfrom public to private. The result is that i contests they go deserts and in rankings there are no white coats to hire instead of those who come from private companies.
To this is added the short circuit for which the same resources before in service in the SSnonce they resign, they re-enter the audience through the back door, like VAT numbers. After signing a contract with a cooperative or one society, in fact, the token holders go to cover the same positions left uncovered by their resignation. Only this time they will be able to decide when to work and will be able to enjoy a much higher hourly wage. In this way, in the Regions concerned, the outsourcing lead to a significant increase in costs. Expenses which, moreover, do not always guarantee adequate quality levels of healthcare services, sometimes even provided by non-specialist professionals.
“The decree introduces important innovations – explains De Iaco -, such as thepay equity for token holders andincrease in the hourly rate from the additional performance of emergency medical personnel. They are measures that have a economic value in itself, but also symbolic, of recognition”. The economic aspect, in fact, is not the priority for the category. “We have to tackle the problem at a systemic level, thinking structurally about work in the emergency room”, explains the president of Simeu. The white coats of the emergency departments hope that the value of their specialization is recognized. It is necessary to return to being attractive in the eyes of new graduates and to solve the personnel shortage. Young university graduates, in fact, do not want to work in emergency rooms. This is demonstrated by the fact that, in the last year, over 60% from the specialization scholarships for emergency medicine has not been assigned or has been abandoned.
Right on interns the Bills Decree has intervened: until 31 December 2025, regardless of the school they are attending, they will be able to assume, on a voluntary basis and outside the hours dedicated to training, freelance positions in the hospital emergency services of the NHS, for up to 8 hours per week. For this extra activity, a fee will be paid hourly wageyou seem to 40 euros gross, which supplements the remuneration envisaged for specialist training. “The idea of involving the residents in the emergency room was a good one – agrees De Iaco -, but 8 hours is too little, it is madness. We don’t cover ourselves not even a night shift from 12 hours. I had personally requested to audition in Social Affairs Commission in the House that they be extended at least 18 hours a week”. But the request, initially implemented by an amendment by the deputy of Brothers of Italy and Vice-President of the Commission, Luciano Ciocchettiremained unheard in the end and was eliminated from the final text.
For the president of Simeu, giving trainees the opportunity to work as a freelancer in emergency rooms was vital for the survival of the system: “Hospitallers like us are killing themselves to carry on the service. I I don’t know how to guarantee holidays to colleagues this summer. Every month I have new resignation requests and it won’t be some extra cash to change the situation”, complains De Iaco. “Despite this – he continues – the universities (with which postgraduates stipulate training contracts, ndr) didn’t come to meet us and now we don’t have the possibility to insert new resources “. For this Simeu has requested a meeting with the Minister of University and Research, Anna Maria Bernini. “We want to understand why this decision was made – explains De Iaco – The postgraduates already work outside their hours. Even much more than the 18 hours we asked for. Both in the schools themselves and in other activities, such as continuity of care, the medical guardssubstitutions for general medicine, blood samples or vaccines”.
Every day, many emergency rooms, even important ones, risk closing due to staff shortages. The only place where resources can be found is graduate schools. “From a quality point of view, the residents are incomparable to the doctors who come to us from cooperatives – explains De Iaco -, they have a much higher level. If we modulate their responsibilities according to the year they are attending and we support them with structured doctors, they can be very useful. The emergency room is not made up only of emergencies”.
The end result is that without the input of new resources in the system, the grip on token holders must necessarily be loosened, for avoid the collapse of the NHS. Therefore, the doctors of the cooperatives will be allowed to continue working in all sectors of the hospital where they register staff shortagesand no longer only inemergency-urgency, as initially envisaged by the decree. The risk for some departments of running out of white coats was too high. Until new specialists can be supplied to the local health authorities, public health will be forced to take refuge in outsourcing to survive. A short circuit that can only be overcome by a systemic and structural reform, aimed at making the NHS more attractive. Schillaci, commenting on the publication of the Bollette Decree in the Official Gazette, promised it. But, for the moment, the majority is only trying to plug the holes caused by the decree itself.