26 APR –
Dear Director,
last week President Fnomceo Anelli presented a study by the Piepoli Institute during the first meeting on the “Medical Question” which testifies to the great moment of difficulty of Italian doctors and the distrust of health institutions. On the same occasion, Anaao Assomed presented a study entitled “The Great Resignation of doctors: 21,000 on the run in 3 years”, equally worrying and alarming.
The two studies report a trend already known in the pre-covid period and that the pandemic has accelerated, exacerbating the criticality of a public health that has begun to be systematically defined for at least 10 years. Fnomceo did well to focus attention on the medical question again. But the real question is: do national and regional health institutions want to understand, address and resolve the medical question and great resignation?
According to a study by the company “Visual Capitalist” on the trend of world economies, Italy will come out of the ranking of the 10 richest economies in the world within ten years, going from the current 8th place to a probable 13th place in 2030.
The trend of world economies cannot be separated from an analysis of the health of our NHS because sometimes one gets the impression that the Italian political decision-maker is defining Italian public health in order to be able to face the phase of economic impoverishment of the coming decades which will have repercussions. also on our social security system.
To this data must be added the particular sensitivity of many political decision-makers, especially regional ones, to the needs of private healthcare. The so-called Giorgetti Boy’s (from the minister who in 2019 declared that family medicine was a finite world) – are politically transversal and are present in parliament, in regional councils, among the managers of health departments and health companies. And I am not referring only to the regional councilors Moratti and Donini.
The Giorgetti Boy’s are those who, with the political support of entrepreneurial and editorial groups with interests in private health care, are involved in shifting the center of gravity of Italian health from the public to the private sector through forms of weakening and impoverishment of the NHS.
To achieve this, the health profession is made less and less attractive among the public through shortages of personnel, unsustainable workloads, murderous bureaucracy, low salaries, medico-legal assaults, pre- and post-graduate training deficiencies, poor personal gratification, loss of social authority and, in the case of the family doctor, also cultural delegitimization through the systematic use of the manipulation of reality. The witch hunt for the public family doctor, due to its systematic and scientific nature, responds to a typical model already described in 1982 by Renè Girard in his “The scapegoat” and is not seen only by those who do not want to see it or who he has no interest in seeing it. The end result is a medical escape in private and television / online commercials of insurance groups which, sensing the great prairie in front of them, offer health services in exchange for an annual subscription.
The risk is to arrive within a few years to a breaking point such as to justify in the eyes of the Italian public opinion a slow but substantial reform of the health system, conceived in 1978 as a solidarity with universal coverage – Beveridge model, with a different type of system mutualistic-Bismarck model or entirely entrusted to private American-model insurance companies. This is why no institution really wants to tackle the medical question and stop the Great Resignation, because they are two tools to legitimize a slow but progressively inevitable reform of the universal SSN in front of Italian citizens.
In my opinion, the medical profession has two divergent paths in front of this scenario.
1) Recognize that the universal health system is an integral and non-replaceable part of Italian medical ethics and therefore initiate a series of extraordinary actions to stem the dangerous drift that the NHS is taking at the cost of a bitter and not necessarily decisive political battle with the national and regional institutions.
2) Claim your autonomy with respect to political choices in health matters and therefore no longer accept that in order to save a universal but not sufficiently funded NHS, the authority, professionalism, decorum, serenity and health of professionals are questioned, accepting in fact a new health model that is no longer universal as long as it is implemented respecting the principles of the profession and is shared with Italian citizens honestly and transparently.
I don’t think I have the right experience to indicate which of the two roads is in the interest of the Italian population. However, I believe that I affirm that the age of half measures, of procrastinations, of mitigating, is over and we have already entered the age in which every action committed or omitted causes consequences.
Roberto Bellacicco
Trainee in general medicine, Taranto
April 26, 2022
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