Doctors: the legal and organisational mess on working until the age of 72

Three different bills and a continuous jumble of draft legislation make up the scenario of health legislation in its current confused approximation, and this scenario was repeated in the conversion of the Milleproroghe 2026 decree with amendment 5.138, presented directly by the government, on retention up to 72 years of age and on six-monthly assignments to pensioners.

However, in this instance, the usual regulatory asymmetry has been compounded by a singular lack of attention, if that is what it is about. The vicissitudes of the two conjunctural measures are now rooted in time: the assignments to pensioners date back to the 'Simplification' decree law of 2022 and, before that, to the first decree on COVID (Art. 2-bis, paragraph 5, of DL 18/2020), while the recourse to withholdings and readmissions began with the Budget Law 2024. These interventions were defined above as 'conjunctural', but can now be considered structural. For the assignments to retirees, all healthcare executives are concerned, as well as staff in the healthcare sector and OSS. For retention and readmission to service, only health managers, including those of the Ministry of Health, are affected, but with the amendment, academics are excluded.

But what had happened at the end of December? It was simply that in DL 200/2025, Article 5 with its 10 paragraphs extended numerous health-related regulations, but not those we are dealing with. The reasons for this could have been a simple oversight, although it is more plausible that the use of pensioners was deliberately eliminated because in recent years many questions had arisen - especially from the INPS and the Court of Auditors - regarding the problem of the cumulability of pension and self-employment income. It all stemmed from the difficult coordination of the special pension rules (such as quota 100 or the women's option) with the cyclical rules for health personnel.

The disconcertment of all the health agencies over the concrete risk of interruption of services was followed by the formal protest of a medical trade union and this was evidently enough to open the eyes of the technicians or to overcome the perplexities of the Court of Auditors and INPS. Thus, the disruption of the two organisational instruments was averted, but the operation, taken as a whole, raises many perplexities.

Let us start with the reasons. Originally, reference was made to the extraordinary needs caused by COVID and the need to guarantee LEAs. With regard to retention beyond the age limit, the purpose was to 'meet the training and mentoring needs of recruited staff' but also, and more credibly, 'to cope with the serious staff shortage'. The situation at present has not changed, on the contrary; the above-mentioned motivations appear to be rather cosmetic and the real purposes involve very complex evaluations of political and trade union strategies, category interests, and personal opportunism. It should not be forgotten that the events surrounding the retention of doctors began with the famous open letter four years ago from six eminent chiefs to remain in service beyond the then current 70-year limit.