In Italy, family doctors are complaining about being overloaded with patients and paperwork, patients can't find a primary care pediatrician, and areas are left abandoned every time the town's doctor retires. In spring 2020, we thought we had learned our lesson from COVID-19: the focus must be turned to general medicine and primary care services must be improved.
Three years on, the picture given in the Report on General Practitioners drafted by the Italian National Agency for Regional Health Services is not the most reassuring, nor does it show a concrete effort to respond to the shortfalls highlighted by COVID-19, which were already well established.
In 2021, there were around 40,250 general practitioners working in Italy: almost 1460 fewer than the previous year and 2178 fewer than in 2019. In addition to those who passed away during the attack of the virus (around one per day in March 2020, when they faced the still-unknown virus not only unarmed, but also without even the slightest level of protection given by a mask), many discouraged doctors have changed jobs, left the profession, or decided to retire. On the other hand, almost three quarters of general practitioners still working in 2021 had more than 27 years of experience.
It is difficult to imagine the situation improving soon, considering that by 2025, almost 13,800 general practitioners will celebrate their 70th birthday, while there is still an insufficient number of young people entering general medicine. The observed increase in grants for general practitioner training, from 1765 in 2019 to 3675 in 2022, is still not enough. Even if 100% of the places were filled and all candidates completed the course on time, fewer than 10,150 doctors would enter the profession by 2025, leaving more than 3600 unfilled positions throughout the country.
Only the smallest regions will manage. They include Val d'Aosta, the Autonomous Province of Trento (each of which has only a few active units), and Molise, with a shortage of only four professionals. The worst situation is anticipated in the regions of Lazio and Sicily, which will each face a lack of more than 500 family doctors, followed by Campania and Puglia (almost 400 each), Tuscany (around 250), and Piedmont and Emilia Romagna, around 200. In Veneto and Lombardy, general medicine faces an estimated shortage of around 150 and 135 units. For Abruzzo and Sardinia, the shortages will be 127 and 116, respectively. Other less populated regions will consequently need fewer doctors, generally less than a hundred.
However, we should not forget about how the population varies. In 2021, each family doctor had an average of 1237 adults to care for. This is a relatively stable number, compared with 2020, and sits below the maximum of 1500 indicated by their contracts, with exceptions. The number of doctors per 10,000 inhabitants at a national level is 6.81, from a minimum of 5.47 in the Autonomous Province of Bolzano to a maximum of 8.34 in Umbria. If we consider that difficulty attracting doctors in Alto Adige is also fueled by the requirement to speak German fluently, then immediately after the minimum comes Lombardy, due to a shortage of doctors, with 5.8 general practitioners per 10,000 inhabitants, which is on a par with Calabria.
According to data from Eurostat, Italian numbers are much lower than those in Portugal and Ireland, where this ratio reaches 30 and 20 general practitioners per 10,000 inhabitants, respectively. They also are lower than those of France and Germany, where the total number of family doctors is also much higher than in Italy, with 94,000 and 85,000 units, respectively.
Finally, when looking at continuity of care services in place overnight and on the weekends, in 2021, there were fewer than 3000 emergency medical units in Italy, with 10,344 appointed doctors, equal to 18 doctors for every 100,000 inhabitants. There are also large regional differences in these services: from 3 appointed doctors in Valle d'Aosta to 47 in Basilicata, and from 5 in Emilia Romagna to 39 in Calabria, evidently reflecting the different healthcare organization models in place for citizens. Even the law states that these differ depending on the needs of the region. The most important thing is that citizens feel cared for in one way or another and know whom to contact in times of need, without having to bang on the doors of the emergency room for problems that could be resolved through a different healthcare service.
This article was translated from Univadis Italy, which is part of the Medscape Professional Network.
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Cite this: Shortfalls in General Medicine Persist in Italy - Medscape - May 30, 2023.