by Lorenzo Spadotto
16 NOV –
Dear Director,
For the last year, I have held an interim general practice position. No colleague a year ago wanted to take on this job and no one wanted to do it this year. In fact, in Noventa di Piave, the country where I work, there was (and is) a deficient area and therefore over 1,500 people would have been left without assistance or transferred to doctors in neighboring countries, therefore, despite not having the specific training diploma in general medicine, I chose in November 2021 to take up the position.
In short, despite the willingness to continue the service, the Local Health Authority has detected the incompatibility between the number of hours of free practice declared by me and the assignment of general medicine, by virtue – indeed, to blame – of the art. 21 of the ACN. I will therefore complete the assignment at the end of November and this prompts me to make some considerations.
Let us first of all consider that:
- in Veneto there are a lack of 640 general practitioners,
- over 40 in Eastern Veneto,
- in the three-year period 2023-2025 we will see a number of retirements equal to 462 doctors,
- in the same period, 700 general practitioners will graduate,
- of these around 210 (30%, according to data from the SSP Foundation) will not do this job;
- in the next three years 700 doctors will not arrive, but only 500 colleagues;
Then the shortages will be those already present (640) in addition to the new ones (462) for a total of 1,100 and in the end we will still have a lack of over 600 professionals, a lack that will most likely have a greater impact in smaller urban centres.
An inexorable drip that has led us today to the lack of doctors, to the retirement curve of which we had the first alarms in 2010 and after more than a decade we have realized a fact: basic medicine is no longer an attractive profession for young doctors. Surely there are many factors – many also reported in this magazine, but trying to find one of them all: it is not normal for a general practitioner to stay behind the computer more than he actually visits the patient on the couch or the sick at home, and I understand hard to think it could be a stimulating career prospect for a young doctor.
Although there are already few young doctors willing to do this job, everything is done to entice them to do something else! One example, among others, is the countless incompatibilities present, a topic on which I wrote a year ago in this publication, which push colleagues to choose other paths. It is not appropriate to go back to it, having already said a lot in the past, but in this regard it is important to remember the work of the Gray Shirts Association and all the appeals they have presented regarding the incompatibility between the training course in general medicine and the free profession, reached a favorable term for the applicant doctors, even up to the coherent ruling of the Council of State (n. 310/2022).
Far from making a sterile controversy, I think it is appropriate to ask ourselves whether in the years to come we will continue to chase the numbers waiting for the deficient areas to become saturated in the next decade and whether, in the meantime, we will continue to get by with doctors to whom we assign 1,800-2,000 patients l ‘one, in defiance of the poorest sense of quality of care.
And it is at this point that a passage from Cavicchi’s writing in this journal comes to mind “family doctors will be less and less freelance professionals and will be more and more “para subordinates”, so I’m starting to think that there is probably no intention to solve current problems by removing anachronistic limits to say the least. In other words, with all due respect to citizens and patients’ health: “who cares”!
It would be good if it were said, in fact, that it does not concern the current problem. And even if the start of the training course in general medicine has almost always been delayed, not least this year – a condition which already largely makes us understand the consideration given to the problem, there are political needs to follow, the regions must agree, the elephantine machine of bureaucracy must move at its own pace.
On closer inspection, if 30% of colleagues who graduate as General Practitioners don’t do this job, they’re going too far.
Dr. Lorenzo Spadotto
Medico
November 16, 2022
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