Higher salaries in Germany, but healthcare under stress: 'My experience as an Italian doctor abroad

I read with interest Governor Fabio Panetta's words on human capital and the wage gap between young Italian and German graduates. It is true: you earn more in Germany. But, as far as we doctors are concerned, this truth must be complemented with another, less told and much more uncomfortable one.

In recent years, German healthcare has entered a phase of reform and structural contraction: departments have been merged, beds have been reduced, hospitals are in financial difficulties and, in several cases, closures and redundancies. The result is not only a more 'efficient' system, but often a more fragile system, where the remaining staff is squeezed to the bone.

In daily practice, this means increasingly long and heavy shifts, sometimes with interdisciplinary 24-hour shifts in which the ward doctor becomes, at the same time, orthopaedist and traumatologist, but also neurosurgeon 'of necessity', general, thoracic and visceral surgeon. Not by choice, nor by structured training, but because the staff is not enough and the machine has to keep running anyway. It is here that the salary comparison loses part of its meaning: yes, the salary is higher, but the workload may be double or triple, with clinical and medico-legal responsibilities growing proportionally - and often without adequate support.

Complicating the picture is a figure that should give us pause for thought: in Bavaria, according to regional order statistics, there are approximately 3,000 doctors classified as unemployed. It is a number that clashes with the prevailing narrative of the 'doctor shortage' and suggests that something in the recruitment and staff allocation mechanism is not working. A shortage that coexists with unemployment is not a paradox: it is a sign of systemic friction, contractual insecurity, forced transitions and administrative inefficiencies that take away clinical capacity just when it is most needed.

For Italy, this has a precise meaning. If we really want to 'bet on human capital', it is not enough to chase wage comparisons. We need to make a career path of stability, growth, merit and sustainable working conditions credible. Otherwise we will continue to train doctors, engineers and computer scientists only to lose them: not only to countries that pay better, but to systems that, while paying them more, consume them faster.