Hospitals, doctors that are missing. That’s why the closed number in Medicine is not the problem | Milena Gabanelli

Whenever there is talk of doctors who are missing, the limited number of Medicine is brought up as the cause of the problem. At a time when staff shortages are the real emergency of the Healthbecause they affect the waiting lists and do not assure us of being assisted quickly and in the best possible way, the eternal question returns: why don’t we abolish the closed number to Medicine? Deputy Prime Minister Matteo Salvini is also convinced that it is better to eliminate him, who reiterated during the election campaign: Let’s cancel it to make up for the shortage of doctors (here). a position that mirrors the thought of most of the students which collide with it barragealso considered an obstacle to expectations about your future. Let’s see how things really are.

Because the closed number was born

The limited number is established by law 264 of 1999 by the then Minister of Education Hortensius Zecchino which links the number of places in Medicine to the availability of classrooms, teachers, laboratoriespossibility of internships and student participation in mandatory training activities. The reasons for the choice are mainly two: to guarantee future doctors the best training possible – who has to deal with the availability of teachers who teach and patients to visit – e don’t churn out too many unemployed. Thus, every year the universities notify the university ministry of the number of places available. Simultaneously the State-Regions Conference collects data on the need for doctors who will be ready to enter hospitals in 10 years. At this point a program table is opened between the ministry and the State-Regions Conference in which they are defined university places per university.

Candidates and number of places

How has it been in the last 10 years in the 42 public universities and in the 7 private ones how did they come about? Until the 2018 on 60 thousand candidates it just goes in 1 on 7 which means up and down 15%. From the 2019 enter a candidate on 4i.e. the 25%because the places increase from 9 thousand about a 14,740 in the 2022.


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There State of Milan passes by 410 places in 2013 to 515 in the 2022; there Wisdom And Tor Vergata from Rome respectively from 908 to 1.156 and from 240 to 290; Bologna from 400 to 614; Florence from 330 to 378; there Frederick II from Naples from 413 to 623. If instead there hadn’t been the limited number and if today it was eliminated, Would the situation be different and could we have the doctors we need? No. That’s why.

Training funnel

The problem is not the limited number in Medicine, but what happens afterwards. Between 2013 and the 2018 on 51,369 new graduates in Medicine alone 43,748 were able to complete the course of study entering the Graduate schools (36,733) or by attending i courses from training triennial for family doctors (7.015): it means that at least 7,621 they have not had the opportunity to do either.

The number of places made available is undersized for economic reasons both with respect to the future need for doctors and with respect to the number of recent graduates

The training of a specialist costs the state from 102 thousand to 128 thousand euros and weighs on the budgets of the moment. In a document of the State-Regions Conference of the 21 June 2018 reads: For the 2017-2018 academic year the need estimated of doctors equal to 8,569 unitswhile the resources available for the same year allow for funding from the State budget of 6,200 specialist training contractswith a difference of 2,369 units. The significant negative gap between the needs of doctors and what can be concretely satisfied with state resources was also recorded in previous academic years. The phenomenon destined to produce a shortage of doctors specialized for the NHS. Thus far, therefore, the problem is the so-called training funnel.


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Poor programming

Then things change: as we have seen since 2019 the rectors of universities are committed to guaranteeing more places to Medicine (4,961 more in 2022 compared to 2018i.e. the 50% more). And at the same time the places in the Specialty schools (7.091 more between the 2018 and the 2022i.e. more than doubled) and in the three-year courses for family doctors (1.313 more from 2018 to the 2022more 60%). But, as we have already denounced in a recent Datarooms (here), faced with the possibility of a wide choice, the places in the Specialties that are most needed are not filled: to 7 November the 58% of places in Emergency Medicine-Urgency discoveredin Anesthesia And Resuscitation the 21.5%; in Radiotherapy the 73.5%. Now, therefore, one of the main problems is being able to make the doer programming (the Ministry of Health) and who bans i places in graduate schools (the Miur) balances the offer by reducing, for example, the places in the specialties that are not needed and which are often the most in demand. It is urgent to correctly calculate how many doctors and for which specialties will be needed 4-5 years that the time it takes to form new specialists.

Quality selection

Therefore, eliminating the limited number would not solve the problem of the lack of doctors. Stay, for, there anger of the students who can’t get over the Entry test and that they see theirs broken dream to enter the lane. this is the reason why it is essential that the selection criteria for those entering Medicine are the best possible: the entrance test cannot be a lottery. In the 1999 proof of 90 questionsthen from 2000 to the 2012 from 80 and from 2013 to today of 60. Every correct answer counts 1.5 pointsthe wrong ones -0.4those in white 0.

The test has been modified almost every year: the understanding and logic part has decreased and the one concerning the questions of scientific disciplines has grown

But there has been no shortage of ridiculous questions over the years that have nothing to do with identifying the skills you need to become a good doctor.

How does the entrance exam change?

From 2023 the test changes again on the decision of the Draghi government: decree 1107 of 24 September 2022 (here) double the test sessions – which will be two a year and no longer one – and will be held to April And July 2023. In addition, not only those who are doing the can participate maturity or has already done it, but all subscribers at last or penultimate year of high school that they will be able to enter their own best score in the platform where it will be drawn up there ranking.


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The goal is to make sure that the entrance test is no longer a lottery. Also because the more the number of places in Medicine is increased, the more it is destined to decrease the quality of the candidates who will then be our doctors from tomorrow. The new government will have the task of implementing the reform.

November 24, 2022 | 07:07

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Hospitals, doctors that are missing. That’s why the closed number in Medicine is not the problem | Milena Gabanelli


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