Dermatology is oversubscribed, A&E is understaffed: the specialisms doctors love and hate the most
Fewer and fewer people are choosing careers in hospitals, favouring instead those with opportunities in the private sector: half of the training places for the emergency medicine speciality remain unallocated
The exodus of doctors from the public health service begins immediately after they graduate in medicine. When young doctors have to decide which specialism to pursue – a 3–5-year training programme that is essential for gaining clinical experience – many turn their noses up at any career path leading to a role in a public hospital. For many newly qualified doctors, it is in fact better to choose specialisms that offer the chance to work in the private sector, where earnings are often much higher than the National Health Service salary alone. This trend has been ongoing for years and appears to be intensifying even further this year, as demonstrated by the data on the choices – released yesterday – from the latest national call for applications for medical specialisations, which this year offered 15,503 places to medical graduates, with as many as one in four remaining unallocated (24.9 per cent compared with 17 per cent last year).
One in four shopping bags remains empty
A brain drain, incidentally, that continues even after doctors start working in hospitals, given that, according to the latest figures, for the first time the number of voluntary resignations from the public health service has exceeded the number of retirements. This exodus is only serving to worsen the workload in various departments, starting with A&E, which, coincidentally, continues to be among the medical specialisms (emergency and urgent care) least chosen by young doctors: this year, only half of the available grants were awarded – 515 out of a total of 1,020. The figures – compiled by Als Anaao Giovani for *Il Sole 24 Ore* – which may see some minor improvements in the coming days, including rollovers and second choices, reveal this clear divide linked to the unattractive earning potential within the National Health Service: among the least popular specialisations – with unallocated places ranging from 50 per cent to 87 per cent – are those leading to careers as microbiologists and virologists (which have fallen completely out of favour since the Covid pandemic), as well as pharmacologists, clinical pathologists, radiotherapists, primary care or palliative care doctors – who work largely in the public sector – and, as mentioned, A&E doctors. Even the role of surgeon is losing its appeal, perhaps due to the risks of criminal proceedings and claims for compensation.
Private life is more appealing
By contrast, other specialisms are extremely popular, with places already almost fully booked (between 99 per cent and 90 per cent), such as those leading to careers as dermatologists, ophthalmologists, plastic surgeons, cardiologists, paediatricians or gynaecologists, where private practice can be highly lucrative. ‘A clear dichotomy is evident,’ emphasises Giammaria Liuzzi, deputy secretary of Anaao, ‘young doctors are prioritising specialisms that offer full or preferential access to private practice over hospital-based specialisms, first and foremost emergency medicine. A paradigm shift is needed that puts the specialist of tomorrow at the centre, with a reform of medical training that puts an end to the exodus from hospitals whilst doctors are still undergoing their specialisation.”
Incentives are not enough
In fact, Health Minister Orazio Schillaci had already increased the value of grants – particularly the less popular ones – by an average of around 100 euros in the 2025 budget, bringing them to around 1,700–1,800 euros a month, but the incentive does not seem to have had any effect so far. And in the Budget Bill currently being drafted, Schillaci also hopes to secure at least one billion to incentivise staff: 500 million for recruitment and waiting lists, 150 million for allowances for nurses and staff, and 350 million to increase the ‘exclusivity allowance’ for doctors – that is, the salary component that rewards those who ‘swear allegiance’ to the National Health Service and do not also work in the private sector. Yesterday also saw the timely signing of the new doctors’ contract (see accompanying article), but for ANAO secretary Pierino di Silverio, ‘this is not the end of the road’: attention is in fact focused on the budget to ‘provide concrete financial solutions for doctors and healthcare managers. Without adequate investment in staff, no reform will be able to halt the exodus from the public health service’. Meanwhile, Gimbe reported yesterday that the NHS is set to lose 18.8 billion in funding as a proportion of GDP between 2023 and 2026.
