Internal medicine, general surgery, emergency room. According to the estimates of the experts of the Italian Society of Internal Medicine (SIMI), in the future it could become increasingly difficult cover the needs of the National Health Service. All this while Doctor burnout is rising who find themselves increasingly exposed to the excesses (let’s call them that) of users.
Predictions arrive from the SIMI Congress that cause dark clouds to gather over healthcare, considering that the departments of internal medicine and of general surgery they are the backbone of even the smallest hospitals. This year, internal medicine has not done its best inawarding of specialization scholarships (only 79% of those available were covered) and while doctor turnover decreases (those who retire are not replaced), their burn out increases at the same time. Also because the public shows growing hostility towards white coats and healthcare personnel, especially in the emergency room and in the wards.
Because healthcare suffers
On the one hand, the difficulty of those who work in the Health Service. On the other increasingly less attractive prospects for new recruits. These are the coordinates of a combination that creates anxiety for the future.
“The causes of this phenomenon – explains Gerardo Mancuso, vice-president of SIMI – are many and must be sought in the excessive workloadsin inadequate salaries to the cost of living but above all to the type of responsibility and commitment that the work of a doctor and nurse entails, in career difficulties. Working in a hospital in Italy today means a life of great sacrifices for one salary which is up to 40-50% lower than in other European countrieslike France. But important differences are also found between the North and the South of Italy; those who work in a hospital in the North-East work much more than in those in the South and this generates a migration of medical and nursing staff which is increasingly impoverishing the South.”
It therefore happens that new doctors are increasingly oriented towardsfreelance activity. In short, healthcare is increasingly oriented towards the private sector, with a predilection for specialties with a greater outlet in the private sector, while others seem destined to suffer. This is the case of microbiology, biochemistry, clinical pathology, radiotherapy, medicine and palliative care, nuclear medicine, emergency medicine, just to name a few examples.
“THE young doctors – Mancuso reports – they are less attracted to public health and this is demonstrated by two facts above all: the reduction in the number of specialists in internal medicine (this year only 79% of specialization positions were filled) and in general surgery (only 51% of specialization places assigned). These two specialties, highly coveted and considered prestigious in the past, are today less and less attractive for young people. But if we continue like this, in the near future we will no longer be able to manage the hospitals dedicated to these activities. The 1,050 internal medicine departments in Italy must be managed by internal medicine specialists; but if turnover is missing because young people no longer want to be interns, in the future we will see a further contraction in the provision of care. And maybe we won’t even have to wait for the next few years. An analysis from a few years ago already highlighted one contraction of 22-23% of human resources within internal medicines”.
Can the trend be reversed?
What to do, then? The recipe to increase salaries would be very easy, but it is not enough because the evident disorganization of work would also have to be addressed, also due to the fact that the hospital continues to take on activities that should be managed by the territory. Therefore it is necessary to rethink many aspects, remembering, as SIMI president Giorgio Sesti points out, that “there is no hospital, even the smallest one, that does not have a medical department and a surgery department; this is provided for by the current legislation, but also by the new reform of the NHS designed by the Pnrr.”
In short, the internist is a specialist present in every hospital. But Internal medicine is in crisisas are all the specialties that require ward and department work, not to mention urgent emergencies. It is no longer possible not to address the problems underlying this leak: inadequate salaries, burn out, increasing complaints of negligence or compensation for damages, assaults. And politics must intervene in this: they are needed greater investments on personnel, an even more adequate law with respect to requests for compensation for damages for medical activities, which includes the complete decriminalization (except for willful misconduct and gross negligence); a greater surveillance, security and prevention of attacks, placing law enforcement personnel in all emergency rooms. In short, we need to restore dignity and adequate economic recognition to those who carry out such a heavy and responsible activity. It is the only way to make internal and emergency medicine appealing again. What we ask is to be put 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 need to say enough to violence
Doctors and nurses are increasingly the first and most vulnerable interface of a healthcare system which, moreover, sometimes fails to offer the expected answers. But this is not an entirely new phenomenon.
“In 2022 the Ministry of Health established a ‘National Observatory on the safety of healthcare professionals’ – recalls Mancuso – with the aim of monitoring the phenomenon and promoting guarantees”. Based on this activity, in 2023 they were registered 16 thousand cases of violence (2/3 verbal, 26% physical) to the detriment of healthcare workers. Those most affected by episodes of violence were the nursesfollowed by doctors and social-health workers and in two out of three cases the violence was perpetrated against women (but in the South cases of violence against males prevail). The age of the people attacked is under 50 and the environments most at risk are the emergency room, psychiatric departments and services. In 70% of cases it was a patient who attacked, in 28% it was relatives.”
Contrary to what one might think, the regions most affected are those in the North (especially Lombardy). The consequences of these acts of violence, in addition to those of a physical nature, are the appearance of depressive symptoms, burnout and loss of serenity at workwhich can impact medical-nursing performance.
“The most obvious triggers (i.e. triggering elements) of this wave of violence against healthcare workers – concludes Mancuso – are the overcrowding in the emergency roomwhich increasingly leads to irrelevant activities and the reduction of healthcare personnel. In the last 8 years there has been one contraction of approximately 15 thousand doctors and 20 thousand nurses, and this contributes to determining the lengthening of the waiting lists and triggering the impatience of those who come to the ED, demanding an immediate clinical evaluation, regardless of the triage code”.
