Restore dignity to the postgraduate training of doctors

by Davide Boarato

23 DEC –

Dear Director,
I am a Doctor in specialist training in anesthesia-resuscitation, intensive care and pain. For three years now we have read and heard in all the hackneyed sauces that there is a huge problem of shortage of medical personnel, both employees and contracted ones, and that it is difficult to keep essential services open to guarantee the LEAs required by law.

Here, in this scenario, many young specialists today live in a terrible limbo. In fact, all of us doctors are called in the years of specialization to sacrifice almost any form of extra work activity for training only thanks to the countless anachronistic incompatibilities regulated by a 1999 law (DLGS 368/99) which mentions:

“For the duration of the full-time training of the doctor, the exercise of freelance activity outside the healthcare structures in which the training is carried out and any conventional or precarious relationship with the national health service or public bodies and institutions is prohibited and private. The commitment required for specialist training is equal to that envisaged for full-time medical personnel of the National Health Service, ensuring the right to exercise the intramural free profession.”

We currently live in this ‘third dimension’ where we are neither fish nor fowl; in fact, we are considered students when it is convenient for us to pay university fees but at the same time we are low-wage laborers (we receive a small scholarship with minimal social security contributions) when it comes to filling staff shortages structured hospital without obviously having all those rights that typically belong to an employee doctor or even a contracted one.

It must be said that only recently, with the introduction of the 2019 DL Calabria and with the various emergency derogations that have occurred in the covid period, has a slow change begun which has given us trainees the opportunity to work in the Health Service National with freelance contracts, cococo, in convention and in some cases to participate in competitions for medical management.

It is thanks to this decree that essential services have continued and citizens have continued to receive assistance, because each of us has made himself available to help the system when it is in difficulty (see, for example, the possibility of having tasks in family medicine , in 1 18, in emergency rooms, internal medicine wards, covid wards, etc.).

This has demonstrated (finally!) the feasibility of having a path that is both training on the one hand and work on the other, both jointly and separately, with the possibility of making us even more independent from an economic point of view, last but not least especially now that inflation and the economic crisis are starting to weigh more than ever on Italian families.

Could everything remain like this and regulate this indefinitely? Obviously not.

It is clear to all that a system made up of scholarships cannot go ahead and, given the current difficulties, we honestly would have expected the promises of a revision of the postgraduate figure to be kept, making him a freer pol, perhaps to hire stable part-time assignments in the field of general medicine (family doctor, 1 1 8, penitentiary medicine) or to see one’s contract transformed into real training-work, having a decent contract with the right economic legal framework, exactly as happens in all states of the world.

It is a pity that none of this has happened and it seems that there is no real desire for change even in the short term. As always, we are left with many beautiful words of petty rhetoric.

We understand that someone, especially at the university level, does not want to contribute to redesigning the figure of the resident, leading him to be a free and independent professional in the National Health Service with the risk of losing unskilled workers who carry out orders like the best soldiers.

Pretending to apply the job incompatibilities typical of public employment to doctors who are not employees of the National Health Service, preventing them from taking on stable job assignments (and therefore not precarious as is the case now) on behalf of the National Health Service itself outside the The training schedule is completely out of logic at a time like this.

We see Emergency Departments closing, family doctors missing, 118 shifts and penitentiary medicine uncovered, is it ethical to block the possibility of those who would be available to help?

Should we imagine a future in which the shortage and flight of doctors were intended to make room for other figures? Should we continue to feel like second-class doctors compared to their European counterparts who can operate free from silly and old-fashioned prohibitions? And above all, why can a shift on medical duty be done while a shift in the emergency room isn’t? Or why is a MMG replacement yes and an assistance at a football match no? Why can’t we (except in some rare Italian situations) take assignments with the 1 1 8 for those who are trained to do so, during the specialty?

the same, as well as many of my colleagues, would gladly lend a hand in the emergency room or on the 1 18 if we were given permission to work there but instead NO, because after the covid period the law has returned which inhibits the possibility of carrying out any type of work beyond the scheduled training hours even in the absence of real conflicts.

The part-time training envisaged by the European Directive is in fact implemented only for DL ​​Calabria doctors.

The exceptions were made only by the DL Calabria for the recruitment of trainees and for general medicine agreements for MMG students. And in the meantime, the services close or are handed over to others.

Meanwhile, time passes and all the proposals made in recent years to try to improve the system that benefits everyone, especially citizens, continue to remain castles in the clouds with enormous risks for the maintenance of national health itself.

We believe the time has come for the institutions to take the necessary steps to restore dignity to the post-graduate training of doctors and towards citizens, allowing us trainees to be an integral part of our National Health Service.

Dr. Davide Boarato
Physician in specialist training

December 23, 2022
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