Internal Medicine, General Surgery, Emergency Room. According to the estimates of the experts of the Italian Society of Internal Medicine (SIMI), it may become in the future. increasingly difficult Meet the requirements of the National Health Service. All this while Doctors are worried. Who find themselves increasingly exposed to consumer abuses (let’s call them).
Similar predictions come from Congress that cast a dark cloud over health care, considering that departments Internal medicine e di General surgery They are the backbone of even the smallest hospitals. This year, internal medicine did not perform at its bestProvision of specialized scholarships (only 79% of those available were covered) and when The turnover of doctors decreases. (Those who retire are not replaced), their burnout increases at the same time. Also because the public shows increasing hostility towards white coats and healthcare personnel, especially in emergency rooms and wards.
Because health care is damaged.
On the one hand, the difficulty Among those who work in the health service. On the other hand Increasingly less attractive prospects For new recruits. These are the coordinates of a combination that creates anxiety for the future.
“The reasons for this trend – explains Gerardo Mancuso, Vice President of SIMI – are many and must be explored. Excessive workloadi Inadequate salary At the cost of living but above all of kind Responsibility and commitment that is involved in the work of a doctor and nurse. Career difficulties. Working in a hospital in Italy today means a life of great sacrifice for one. Salary which is 40-50% lower than other European countries.Like France. But there are also important differences between the north and the south of Italy. People who work in hospitals in the Northeast work much more than those in hospitals in the South and so on Displacement of medical and nursing staff which is increasingly impoverishing the South.”
So it happens that there is a rapid trend towards new doctors.Independent activity. In short, healthcare is becoming increasingly concentrated in the private sector, with greater outlets in the private sector predicted for specialties, while others suffer. This is the case in microbiology, biochemistry, clinical pathology, radiotherapy, medicine and palliative care, nuclear medicine, emergency medicine, to name just a few examples.
“I Young doctors – Mancuso reports – they are. Less attracted to public health And this is shown above all by two facts. Reduction in the number of specialists in Internal Medicine (only 79% specialty vacancies were filled this year) and In general surgery (Only 51% specialization places are assigned). These two traits, which were considered highly coveted and prestigious in the past, are the least attractive to young people today. But if we continue like this, in the near future we will not be able to manage dedicated hospitals for these activities. Mandatory management of 1,050 internal medicine departments in Italy. Internal medicine specialists; And a Business is missing Because young people no longer want to be interns, we will see further declines in care provision in the future. And we may not even have to wait for the next few years. An analysis a few years ago already highlighted a 22-23% contraction of human resources within internal medicine.”
Can the trend be reversed?
Then what to do? The composition of the salary increase would be very simple, but it is not enough because the obvious disorganization of the work must also be addressed, also due to the fact that the hospital is carrying on activities that should be managed by the region. Many aspects therefore need to be reconsidered, remembering, as SIMI President Giorgio Cesti points out, that “there is no hospital, even the smallest, that has a medical department and a surgical department. No. It is provided by existing legislation, but also by New NHS reforms designed by Pnrr“
In short, an internist is a specialist present in every hospital. But Internal medicine is in crisis.As are all specialties that require ward and department work, not to mention immediate emergencies. It is no longer possible not to solve the problems in it. Leak: Inadequate pay, burnout, increase in negligence complaints or compensation for damages, assaults. And politics must intervene: they are needed. More investment On personnel, a more appropriate statute in relation to claims for compensation for medical activity losses, in which Complete criminalization (except willful misconduct and gross negligence); a Greater surveillance, security and prevention Placing law enforcement personnel in all emergency rooms, related to attacks. In short, we need to restore dignity and proper economic recognition to those who perform such a heavy and responsible activity. This is the only way to make internal and emergency medicine attractive again. What we say is to be in a position to best interpret the true mission of the doctor, which is to help those who need them find answers to their problems.”
We must say enough to violence.
Doctors and nurses are the first and most vulnerable interface of the health care system which, moreover, sometimes fails to provide the expected answers. But this is not a new phenomenon.
“In 2022 the Ministry of Health established ‘a national observatory on the safety of health care professionals’ – recalls Mancuso – with the aim of monitoring this phenomenon and promoting guarantees”. Based on this activity, they were enrolled in 2023. 16 thousand incidents of violence (2/3 verbal, 26% physical) to the detriment of health care workers. were the most affected by episodes of violence. Nursesfollowed by doctors and social health workers, and violence against women in two out of three cases (but violence against men predominates in southern cases). Those attacked are under the age of 50 and in the most vulnerable environments. Emergency room, psychiatric departments and services. In 70 percent of cases, the attackers were patients, 28 percent were relatives.
Contrary to what one might think, the most affected regions are in the north (especially Lombardy). The consequences of these acts of violence, in addition to the physical nature, are visible. Symptoms of depression, loss of peace and tranquility in the workplacewhich may affect medical nursing performance.
“The most obvious triggers (i.e., triggering factors) of this wave of violence against health care workers – Mancuso concludes – are Emergency room overcrowdingwhich leads to increasingly irrelevant activities and shortage of health care personnel. There has been one in the last 8 years. Shrinkage of about 15,000 doctors and 20,000 nurses. And this contributes to determining the length of waiting lists and triggering the impatience of visitors to the ED, regardless of triage code, demanding urgent medical evaluation.”