According to the National Association of Hospital Support Services (ANAAO) and the Association of Medical Directors (ASSOMED) in 2023 there will be 10,173 fewer specialist physicians. How could this happen?
Up till two years ago there were 6,000 postgraduate scholarships, in addition to the 1,000 scholarships for medical school, and between 9,000 and 10,000 students graduated in medicine. The difference of 3,000 students that could not manage to complete their medical training gave rise to what we call the “training funnel”, a sort of limbo where medical graduates wait for a solution to their postgraduate training situation, as this is required by our National Healthcare System. The training is consistent with the quality of service provision and our National Healthcare System is only able to deliver these services thanks to the high level education that physicians receive. Over time this system increased the amount of students that do not have the chance to become specialists and today there are more than 15,000 physicians who are waiting for their training. In the last competition for scholarships the Ministry of Health added 14,500 more scholarships and 23,000 medical graduates applied. This means that today there are almost 10,000 people that, despite the increase in scholarships, cannot manage to get to the end of their education.
Should we change the training system of healthcare workers?
What needs to be done is firstly to change the planned schedule and then to change the training program. The plan should be ten year long because that is how long the educational journey of physicians takes; to be precise it actually goes on between nine and eleven years. What we decide today in 2020 will indeed take place in 2030 and this type of long term planning is not easy to do. In addition to this, access to medical school and access to postgraduate specialisation courses should be linked: we ask that by law there is a guarantees space at postgraduate courses, including general medicine, for every medical graduate. It is only this way that we will manage to make a thorough assessment of the specialists available in our society and to organise a good level of assistance without causing any harm. Nowadays we definitively have a serious shortage of physicians because the exponential increase of retiring doctors is not followed by a greater number of new contracts that would compensate the loss. However, we should also remember that if we excessively increase the numbers we will risk having too many postgraduates in 2030 and, based on the amount of healthcare jobs currently available- which we think is lower than the European average- we will not know where to place them.
Nowadays we have a serious shortage of physicians because the exponential increase in retirements is not followed by a greater number of new contracts.
Once they completed their studies many young people choose to continue their education abroad. What is the reason for this? How could we keep them in Italy?
First of all this means that our training is sound. The fact that our young people are welcomed abroad with enthusiasm is confirmation of this. Between 15 and 20% of graduates choose to leave because in Italy they do not find a place in postgraduate courses and because the salaries are lower. In fact, in Italy today the salaries are lower than the European average.
What specialties struggle the most due to the shortage of doctors?
We did not have a postgraduate course in Emergency Medicine for a long time, which resulted in a great deficiency, especially this summer when the Presidents of the Regions had to frantically search for operators to cover the Accident and Emergency department and eventually asked new graduates to work there. We think that, in this case as well, there is a need for specialist training because those who work in the Accident and Emergency department have to make fast paced life or death decisions on patient care. There is also another evident shortage in anaesthetists. The Government currently decided to bring ICU beds to 110% but we do not have a magic want to also double the anaesthetists’ jobs. The training spaces were increased in the last competition for scholarships but unfortunately this is still pending due to appeals. It is a worrying situation and I believe that all 23,000 participants should be admitted in order to compensate the shortage predicted by the ANAAO estimates. If they were all admitted we would be emptying the training funnel and would tackle the shortage expected for 2023.
Saving in healthcare means compromising our health.
What does the shortage of physicians mean during a pandemic such as the Covid-19 one?
Any type of support service must take place with the appropriate number of physicians and healthcare workers in order to avoid clinical risks, the risk of making mistakes and the risk of not having the time needed to think thoroughly about what to do next. The dramatic images recorded in March and April at the hospitals of Cremona, Piacenza, Parma, Bergamo and Lodi show physicians and nurses working on shifts that at times exceeded 24 hours. This means counting only on people’s passion and self-sacrifice, but tiredness results in a reduction of the service quality and of the support provided. Those nurses who need to be ready to support patients that feel alone and cannot speak to anyone else are an example of this. I believe that at the end of the pandemic we will all acknowledge that perhaps saving in healthcare means compromising our health and that such a fragmented management amongst regions does not guarantee the right to equality outlined by the Constitution.
Written by Rebecca De Fiore