by Federico Di Renzo
05 OTT – Dear Director,
after 4 years the training funnel seems to be at sunset: over 18,000 SSM contracts (schools of specializations in medicine) for 19,500 participants and 1,300 contracts with CFSMG scholarship (specific training course in general medicine) for 6420 participants. At the first phase of SSM assignment, over 1,300 scholarships are advanced and, it is estimated, there will also be many lost ones in general medicine. Are we really at the end of the training funnel?
It was 2017 when I began to familiarize myself with this concept: thousands of doctors were imprisoned in post-graduate limbo without finding a future in specialization or in general medicine, employed in the most disparate and precarious jobs. Instead, in the last year of the pandemic, many colleagues who remained in limbo have held work positions, even in the absence of training, in some cases resulting in a stabilization. Having thus reached this goal, they gave up competing for a specialist training qualification or in general medicine (MG).
This happens because the choice to undertake a post-graduate training course obliges the resignation from previous work assignments as anachronistic work incompatibilities still exist despite the serious shortage of doctors.
Do we really want to continue to lose funding in specialized training and general practitioners, and on the other hand continue to feed the shortage of hospital and local doctors by persevering with counterproductive job incompatibilities ?!
A further mechanism causing the loss of grants is that of the eternal undecided who try the competition again because they are dissatisfied with the choice made the previous year: a rampant phenomenon both in terms of specializations and in general medicine. From the testimonies that we have collected from colleagues in specific training or with a certificate in GM who have decided to try the specialist path, the criticalities of the territorial health system emerge that scare young colleagues away from the territory.
Increasing workloads, difficulty in maintaining the doctor-patient bond of trust, bureaucratization of the activity of a doctor, poor support from the ASL and work isolation, are just some of the complaints that have emerged which are flanked by the shadows cast by the PNRR generating contractual uncertainty, logistics and organization. This difficult current reality, coupled with nebulous future prospects, generates mistrust in young general practitioners (GPs) who prefer to rethink their choice in the hope that hospital specialization will give more satisfying realities.
The problem, indeed the emergency, of the shortage of doctors in the territory caused by early retirements, the lack of investments in the territory, the definitive financing of past years, the abandonment of training grants, the shortage of doctors willing to operate in the more rural territories could force policy makers to protect health care by undertaking emergency compensatory strategies. Among these the most inflated at the moment are the family nurse and task shifting, the equalization of titles, or the increases in the ceiling that could slow down, if not even block, our union proposals to improve the working conditions of local doctors. .
We must reverse the course by aiming for drastic and decisive solutions.
First of all, it is necessary to permanently eliminate the job incompatibilities for doctors in CFSMG and in specialization, thus resolving a legislative Byzantineism that would allow for over 4000 doctors able to train and at the same time to provide their work in the sectors of the most serious shortage.
It is also necessary to overcome the concept of achieving eligibility for the competition for access to the CFSMG, that is the minimum threshold of 60 correct answers out of 100 questions: exceeding this limit would be able to guarantee the scrolling to the end of the ranking avoiding the non-assignment of contracts. for exhaustion of those eligible for the competition. This scenario could already become a reality this year in some regions, even those with a greater shortage of local doctors such as Lombardy, and should be avoided prematurely in order not to frustrate the union goals achieved in with the allocation of approximately 900 additional scholarships.
It is essential to abrogate the minimum score to access the CFSMG because the access tests cannot and must not become a tool for cutting the completion of the training of each individual doctor, but must establish a ranking that can be used in its entirety so as to guarantee everyone the access to an educational and professional future.
These objectives are nothing more than small steps towards achieving the final goal or the creation of a specialized university course for general medicine with requirements and quality standards established at national level with a single competition for access to all post-graduate training for to stem the phenomenon of the loss of scholarships and to guarantee free educational choice for everyone.
Only in this way will we really put the point on the end of the training funnel, and it is only in this way that we will be able to really plan the number of professionals needed by our NHS and to ensure access to healthcare for our citizens. “
Dr. Federico Di Renzo
SNAMI National Youth, Training and Precarious Responsible
SNAMI Molise Regional Secretary
05 October 2021
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