Low salaries and uncertain careers, few want to be surgeons or anaesthetists

Between now and 2029, Italy will at best have more than 81,000 brand new graduates in Medicine when the record peak of 16542 young graduates will be reached. This is good news for a country that has been grappling with a shortage of white coats for years. In reality, the matter is much more complicated: not only is there the risk of creating a bubble - we already have more of them than other European countries, while there is a serious shortage of nurses - but the crux of the matter is that more and more medical graduates are deserting many specialisations (the postgraduate courses that actually train a complete doctor) because they are unattractive in terms of salary and career.

If there is an overbooking of applications to specialise in plastic surgery or to become an ophthalmologist, a dermatologist, or to specialise in cardiovascular disease, almost no one wants to be a general surgeon or a thoracic surgeon - struggling with stress and the risk of lawsuits - or to work in the emergency room (specialising in emergencies) or to be an anaesthetist or a microbiologist. What often weighs heavily are the earning prospects, which are much lower for those medical specialisations that do not allow major outlets in private practice. And so, in 2023 alone, in the face of no less than 15,701 grants for specialisation courses (which last from three to five years) paid for by the State and the Regions, the actual number of places filled was 10,153, in practice more than 5,000 places left empty: one in three. An unprecedented negative record.

On medical education, Anvur puts the Church back at the centre of the village. Or at least it tries to. Thanks to an extensive 100-page report that was presented yesterday at the Chamber of Deputies and that tries to frame the issue from all points of view: from the international comparison to the entrance test, from the growing stock of graduates to the crucial link with the specialisations on which the now famous "training funnel" depends, which for years has seen us produce far fewer white coats than we needed and which, with the increase in available slots that has been underway for five years and the hump of retirements coming up, now risks making us fall into the opposite error. The topic is doubly topical. Both because we are less than 40 days away from the second session of the entrance test scheduled for 30 July, and because next week the Senate's Education Committee will begin its examination of the Ddl with the reform of the closed number announced for next academic year.

The report of the Evaluation Agency starts from the macro numbers recounted by President Antonio Uricchio: 'It is estimated that in 2050 the resident population in Italy will shrink to around 54.4 million (in 2021 the population will be around 59 million), 7.7 million of whom will be at least 80 years old (in 2021 it will be 4.5 million), with inevitable repercussions on healthcare and on the models that universities will be called upon to design to train the doctors of the future'. According to the latest OECD data, Italy already has the highest number of medical graduates (10.7 thousand), and their ratio per 100 thousand inhabitants is also high: 18.2 compared to 14.2 in Spain, 13.1 in the United Kingdom, 12.4 in Germany, and 11.9 in France. If we take into account that the educational capacity of our universities has also increased in the meantime, since the number of courses has risen from 55 in 2011/12 to 89 in 2023/24, while the number of students enrolled has risen from around 66 thousand to 99 thousand, we can already anticipate a probable surge in the number of graduates, thanks to the growth in available slots (which, in 2024/25, will be close to 21 thousand).

From today's 10-11 thousand graduates per year we will increase to 15-16 thousand: if we count from the academic year 2023/24 to 28/29 we will have, net of drop-outs, between 81318 and 76581 medical graduates. Succeeding in absorbing all of them, avoiding if possible the departure of about a thousand a year as has happened so far, is one of the goals to be achieved. In this context, the connection with specialisations is fundamental, as pointed out by the Agency's director, Daniele Livon, who invites us to "take into consideration several variables in order to analyse complex phenomena such as those that characterise such a long training pathway". And among the most urgent interventions is that of incentivising certain medical specialities that have few outlets in the private sector and need more recognition, starting with salary. As envisaged by the recent bill on waiting lists, which, however, risks a biblical timeframe for its approval.