Family paediatricians: more than 500 are missing, three out of four in Lombardy, Piedmont and Veneto

At least 502 family paediatricians are missing and most of the shortages are concentrated in three large northern regions: Lombardy, Piedmont and Veneto. In some areas, the ceiling of 1,000 patients per paediatrician is exceeded, while 2,598 will retire by 2028. This was noted by the Gimbe Foundation, which analysed the dynamics and criticalities governing the inclusion of freely chosen paediatricians (PLS) in the SSN, estimating the extent of the shortages in the Regions. According to the Ministry of Health website, the free-choice paediatrician is the doctor in charge of protecting the health of children and young people between the ages of 0 and 13. Every child, from birth, must be assigned a PLS to access services and benefits included in the Essential Levels of Care guaranteed by the National Health Service (SSN). "Reports on the difficulty of access to a PLS," says Nino Cartabellotta, president of the Gimbe Foundation, "are arriving today from all the Regions, highlighting recurring criticalities: bureaucratic complexities, lack of responses from Local Health Authorities (ASLs), paediatricians with a high number of patients, and the impossibility, for many families, of registering their children with a PLS. A situation that generates significant inconveniences and requires urgent organisational interventions, in order to guarantee the continuity of paediatric assistance, especially to the youngest and most fragile".

Age groups. Up to the age of 6, children must by law be assisted by a PLS, while from 6 to 13 years of age inclusive, parents may choose between a PLS and a general practitioner (GP). When the child reaches the age of 14, the assistance is automatically withdrawn, except in cases of chronic pathologies or documented disabilities, for which an extension can be requested until the child reaches the age of 16. According to ISTAT data, as of 1 January 2024, the 0-5 age group (compulsory registration with the PLS) included almost 2.5 million children, while the 6-13 age group included more than 4.1 million minors, who could be registered with the PLS or family doctor according to their parents' preferences or, above all, according to local availability.

Demographic picture. The progressive decline in births is significantly changing the number of paediatricians' patients. ISTAT data document a constant reduction in the number of children in the 0-5 age bracket, for whom registration with the PLS is compulsory: between 1 January 2019 and 1 January 2025 there will be approximately 430,000 fewer potential patients for PLSs. "Consequently, in the same period," Cartabellotta observes, "the collapse of births has reduced, on a national scale, the need for PLSs by more than 500 in just six years. In 2023 there were 379,890 new births in Italy, while 570,894 adolescents turned 14. Considering that 57.5 per cent of the 6-13 year age group is still enrolled in PLSs, it is estimated that 328,264 patients have moved from PLSs to family doctors, compared to almost 380,000 newborns enrolled in PLSs. The balance implies a net increase of more than 50,000 patients for PLSs, with a consequent increase in the care load.

Maximum number of assistants. The latest National Collective Agreement (NCA), in force since 25 July 2024, has set the maximum number of assistants for each PLS at 1,000, eliminating the previous distinction between ordinary and exceptional choices. Once this ceiling has been reached, the PLS can only acquire new patients by recusing an equivalent number of children in the 6-13 age group at the same time. Above the 1,000 threshold, the only exception is the enrolment of siblings of patients already in care. Temporary exceptions to the 1,000 threshold can be granted by the ASL exclusively for a limited period, in the presence of specific needs related to the local context or organisational criticalities (e.g. unavailability of other PLSs in the area). "The real crux," emphasises President Gimbe, "is that the shortage of more than 5,500 GPs, already highlighted by one of our previous analyses, runs the risk of leaving uncovered those 'rejected' by the PLS, who may not find an available GP. In many cases, therefore, the only solution remains the extension of exceptions to the ceiling, fuelling a vicious circle of overload and reduction in the quality of paediatric assistance'.

Deficient territorial ambits. The inclusion of new PLSs in the National Health Service takes place after the Region - or a body appointed by it - has identified the deficient territorial ambits, i.e. the areas where it is necessary to fill a need for care and ensure a capillary distribution of PLSs' practices throughout the territory. According to the latest ACN, the shortage is calculated on the basis of an optimal ratio of 1 PLS for every 850 children, or fraction above 450. In particular, to define the shortage, all residents under 14 years of age are added together, deducting those in the 6-13 age bracket in the care of GPs. In the absence of regional supplementary agreements, 70% of the population between 6 and 13 years of age is considered to be cared for by PLSs. "Substantially, with the new ACN," Cartabellotta explains, "all patients in the care of PLSs are included in the calculation of the requirement, including those in the 6-13 year age bracket, who were previously excluded. This makes it possible to correctly parameterise the number of PLSs with respect to the population actually assisted'.