Doctors in revolt against Schillaci's reform, what changes for citizens

It is a practically unanimous chorus that raised by the white-collar workers against the proposed reform of general medicine presented by Health Minister Orazio Schillaci to the Regions. The reform of the practices does not please the doctors, who have raised criticisms both on the contents and on the way the measure was drafted, also calling for the intervention of the Prime Minister Giorgia Meloni. "It is a reform made without the doctors and without the citizens: ineffective, useless and harmful," said the president of the Federation of Doctors' Associations (Fnomceo), Filippo Anelli, according to whom the measure "calls into question a fundamental principle for this type of assistance: today the family doctor is the citizen's doctor" who "has the aim of protecting his health. Otherwise, he would become the company doctor protecting the corporate interest'. Politics, on the other hand, are also divided within the majority, particularly within Forza Italia.

The proposal that could soon become a decree law - the text will first have to be shared with the regions - envisages a dual channel for primary care medicine. On the one hand, there will be family doctors who will work according to the 'reformed' convention relationship with the Regions: this is an evolution of the current form, which will also provide for hourly constraints with respect to Community Homes. On the other hand, there will be doctors who will choose to become employees of the health service for all intents and purposes and therefore will work directly within the new structures on the territory financed by the NRP with 2 billion lire. The reaction of the Fimmg, the main trade union of family doctors, is harsh. It speaks of a measure "that will destroy the family doctor" "never discussed with the categories, unworkable and dangerous for patients", and therefore appeals to the President of the Council asking her to "intervene directly to suspend the decree process". According to Fimmg, the reform is likely to encourage the flight of young doctors from general medicine causing "improper access to emergency rooms, unmanaged chronicity, worsening of territorial inequalities". For the Fimp paediatricians, 'strengthening territorial healthcare and Community Homes is a shareable objective, but it cannot be pursued through models imposed from above'. On the other hand, according to the Cimo-Fesmed Federation, the reform could trigger a 'competition' between doctors capable of 'destabilising the entire health service'.

For the 5 Star Movement senator Mariolina Castellone, the proposal 'contains some ideas that, at least in intention, could go in the right direction'. Criticism for the method, on the other hand, came from the PD deputy Gian Antonio Girelli: "every intervention on the subject must be the result of a serious, frank and in-depth discussion with those who are called upon to implement that reform every day". Openness, on the other hand, from the centre-right governors, starting with the president of the Lazio Region, Francesco Rocca: 'The oral illustration in principle convinced me. We are waiting for the text'. Forza Italia is divided: contrary to Minister Schillaci's proposal is the president of the Forza Italia senators, Stefania Craxi. Who, after emphasising how "periodically in the dialogue between State and Regions the illusion of improving the efficiency of family doctors by making them dependent on the regional health services" re-emerges, reiterated how it is necessary "on the contrary, to lead them to associated practices between contracted professionals so as to guarantee the proximity, trustworthiness and availability of their service". On the other hand, the governor of Calabria Roberto Occhiuto, also of Forza Italia, was positive, for whom Schillaci's reform represents "a good starting point" and "with a clear liberal imprint" by giving doctors the opportunity "on a voluntary basis" to become employees: "A choice that, in addition to strengthening the organisation of territorial assistance, offers a concrete opportunity especially for young doctors, allowing them to start their professional career more quickly without having to bear particularly onerous initial costs, such as opening a medical practice.

But what could be the effects for the citizens-servants? The reform, which - it must be remembered - still has to be written in detail, has more of an impact on the legal status of family doctors than on patients. The current convention remains the ordinary model of general medicine and paediatrics of free choice and therefore the fiduciary relationship with the patient is not abolished, although the way in which they will be remunerated is being reformed: today they are paid for the so-called quota capitaria, that is, the number of patients they follow (up to a maximum of 1500-1800 patients), with the reform they will be paid on the basis of objectives (the guidelines give examples: from the chronic patients assisted to the number of hours spent in community homes). For the patients of these doctors who will remain in their practices as a priority, practically nothing will change. Instead, the new salaried family doctors will be employed where there are most shortages, for example in those areas where there is a shortage of family doctors, and above all within the new Community Homes, the maxi clinics where examinations and also first diagnostic examinations as well as prevention will be carried out. The detractors of the reform point out that for these doctors the fiduciary relationship with their patients is loosened: in the new facilities the doctors take turns and therefore not all of them may know the patient well. On the other hand, the benefit is that there is always a doctor available in the facility and the possibility - where there is diagnostic equipment - of being able to do an examination such as a spirometry or an Ecg.