Goodbye to the scalpel: surgeons are a dying breed, and 10 per cent of operations could be at risk within five years

Surgeons, too, are at risk of becoming a ‘species facing extinction’. Within five years, many parts of Italy could in fact be left without any, given that one in two practising surgeons is over sixty and young people are shunning this specialism, to the extent that by 2026 a third of specialist training places will remain unfilled, with the situation being particularly acute in various areas such as L’Aquila and Udine. The reason? The appeal of surgery is waning, not only for financial reasons – namely, salaries that are not particularly high given the level of responsibility – but also due to the fear of criminal charges and claims for compensation, which force surgeons to protect themselves with very expensive insurance policies. This exodus will mean that, within five years, at national level, the number of those approaching retirement will outnumber young specialists, with the risk that access to operating theatres will, on average, become more critical for one in ten general surgery procedures out of the 650,000 performed each year, against an expected 12 per cent increase in demand for surgical care in the coming years.

The warning comes from the 128th National Congress of the Italian Society of Surgery (SIC), currently taking place in Rome. The Society therefore considers it urgent to take remedial action: “We need greater legal safeguards, wider access to new technologies and more financial incentives immediately,” is the SIC’s warning. For Health Minister Orazio Schillaci, who described surgery as a “pillar of the public health service”, the reasons for the sector’s lack of appeal are not only economic but also organisational and linked to litigation. In this context, he reiterated the commitment to establishing a stable criminal immunity provision, as provided for in the reform of the healthcare professions currently under consideration by the Chamber of Deputies, and the allocation of 120 million per year for the least attractive specialisms.

In the United States, according to the latest estimates, 15 million people already live in counties without a general surgeon. This is also a very real risk in our country: “The signs are pointing in the same direction,” warns Ludovico Docimo, president of SIC. “The 2026 figures on the take-up of general surgery specialist training places, in fact, whilst showing a slight improvement compared with last year – with 30 per cent of places unfilled, down from 37.8 per cent in 2025 – confirm that the crisis in recruitment is far from over. To date, at national level, 193 out of 646 advertised places remain unfilled – equivalent to almost a third of those available – with the situation being far more severe in certain parts of the country. In L’Aquila, for example, no contracts were awarded; in Udine and Genoa, almost 9 out of 10 posts remained unfilled; whilst in Cosenza, Sassari, Campobasso and Perugia, fewer than 20 per cent of posts were filled. Added to this is the fact that 10 per cent of the places awarded are set to be abandoned before the five-year course is completed, and 10 per cent of those who specialise go on to work abroad or in the private sector.”

It is also worth noting that over half of Italian general surgeons working in hospitals are over sixty years old, compared with 32 per cent in Spain and 44 per cent in France and Germany. “By 2030, around 2,800 of the 6,500 surgeons employed in hospitals could leave the profession, driven by stress and a lack of resources, whilst the number of young specialists – based on places filled in postgraduate training programmes from 2022 to the present – will not reach 1,300, resulting in a shortfall of around 1,500 surgeons,” continues Docimo. Among the main reasons behind this ‘dramatic’ exodus of young people from surgery – a field that until recently was highly sought-after – are gruelling working hours coupled with inadequate financial remuneration; the lack of a criminal liability shield – still under consideration by Parliament, and for which surgeons are calling for the implementing decrees to be approved by the deadline of 31 December; assaults; and the slow modernisation of medical technology. Added to this is a growing volume of medical-legal litigation – a 150 per cent increase in court cases over the past 10 years – which in most cases proves to be groundless, but which causes the costs of insurance cover to soar; as the SIC concludes, exceed the earnings of young specialists themselves.