Italy's healthcare system is on the brink of significant transformation as the government proposes to change the employment status of family doctors, transitioning them from independent practitioners to employees of the National Health Service (SSN). This major reform, described by Corriere della Sera as "un cambiamento epocale", is aimed at improving primary care efficiency and accessibility throughout the country.
The reform is backed by Health Minister Orazio Schillaci and promises to alter the current relationship between family doctors and the SSN, updating practices established since 1992, wherein family doctors, as independent contractors, have managed their schedules and workloads autonomously. If enacted, the reform will necessitate new contracts under which family doctors will be required to work structured hours.
Currently, family doctors enjoy flexibility, with their workloads varying significantly based on patient numbers. The proposed reform would impose a standard 38-hour work week, divided between patient consultations and community health services. For those doctors serving up to 400 patients, this means allocating specific hours to direct patient care, alongside fulfilling duties at community health centers, known as Case della Comunità, which are being funded as part of Italy's national recovery plan with €2 billion set aside for their establishment.
According to the outline of the reform, doctors would not only see their work hours mandated but would also be compelled to operate within the community health framework, enhancing prime services available from 8 AM to 8 PM. This model is expected to support advanced diagnostic capabilities, such as ECGs and ultrasounds, directly within community facilities. The intent is to assure adequate healthcare availability across Italy, including rural areas.
Distinctly voiced concerns have emerged from various medical unions about the potential fallout of restructuring the healthcare workforce. The Sindacato Nazionale Autonomo Medici Italiani (Snami) recently announced its decision to exit joint union discussions, citing irreconcilable differences over the future of general medicine. "Without concrete solutions," warns Snami President Angelo Testa, “doctors will leave the profession, and the results will be disastrous for citizens.” The sentiment echoes louder among healthcare professionals, who fear the impending reform could exacerbate existing shortages, particularly as many practitioners are nearing retirement.
Feedback from the Sindacato Medici Italiani (SMI) brings to light additional weaknesses of the reform proposal. Pina Onotri, SMI's Secretary General, has cautioned against compromises to professional autonomy and the potential for increased workloads, compromising quality of care. The SMI also highlights the inadequacies of the current proposal, questioning how it could fortify support for women doctors, the predominant gender within the profession.
Reports suggest alternatives to the proposed methodology could include retaining the benefits of mixed contracts, allowing for paid hourly work alongside private practices. Such flexibility might alleviate the burden placed on doctors and allow them to balance numerous patient needs effectively.
Critically, the ramifications of the reform could reshape the career outlook for young medical professionals. Surveys indicate dissatisfaction among existing practitioners, with 44% expressing willingness to resign if reforms are instituted as currently proposed. Grave doubts linger about how the restructuring will handle practical day-to-day operations, particularly with regards to hospital admissions, home visits, and myriad tasks performed outside the standard patient visit.
Corriere della Sera noted the urgent need for the proposed reforms, as the existing framework is deemed insufficient to meet modern healthcare demands. Critics argue, though, without improved compensation structures or substantial administrative support components embedded within the proposal, the shift will present insurmountable hurdles for the current workforce.
Italy’s healthcare reforms aim to modernize services as they strive for greater efficiency and coverage; yet, the myriad of advertisements within the proposed changes suggests many practitioners venturing forward under the new model may not be equipped to bear the weight of additional responsibilities without adequate support.
The path forward appears fraught with challenges, indicating the pressing need for dialogue between the government and medical professionals to forge solutions addressing mutual concerns. Only through collaborative negotiations can Italy hope to avoid compromising the integrity of its healthcare systems and the services offered to its citizens.