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Medical specialisations: the most lucrative and the flight of young doctors

One third of the places are in danger of remaining empty. Boom in applications for plastic surgery, dermatology or gynaecology where it is easier to do private practice. Medical careers are increasingly geared towards lucrative specialisations, while some specialities suffer from a lack of young doctors. The situation calls for urgent measures to boost the choice of these specialisations and improve working conditions

by Marzio Bartoloni

Illustrazione di Giorgio De Marinis / Il Sole 24 Ore

3' min read

3' min read

Becoming a surgeon or saving lives in the emergency room is no longer the dream in the drawer of those who aspire to wear a white coat. So is being an anaesthetist, radiotherapist, anomapathologist, microbiologist or virologist or even a pharmacologist or working in primary care.

Much more attractive seems to be the career of plastic surgeon, gynaecologist, dermatologist or cardiologist, where the overbooking of young scrubs also seems to be linked to the possibility of being able to do private practice more easily and thus earn more.

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IL TREND

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At least that is what the numbers tell us about the path of those who, after graduating in Medicine , decide to take the obligatory path of specialisation.

Today in fact, thousands of young doctors fresh out of university are taking part throughout Italy in the national selection test - a quiz of 140 questions to be completed in three and a half hours - to enter one of the 51 specialisation schools (for 1,429 locations) that will make them become white coats to all intents and purposes. About 15,000 specialisation scholarships are up for grabs (the exact number will only be known in September), but as happened last year, at least a third of the places - about 5,000 - are likely to remain unoccupied, with a waste of resources (financing the scholarships costs hundreds of millions) and above all with the spectre of not being able to find certain types of doctor in the hospital.

The much-talked-about shortage of white coats is in fact not generalised, but concerns certain specialities from which, for some years now, young doctors seem to be fleeing, who, in order to specialise, decide not to enrol in certain courses any more, as shown by the figure of uncovered places: "The total coverage level has gone from 89.2% in the 2016/17 academic year to 64.7% in 2022/23, indicating a worrying downward trend.

LA FUGA

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Among the schools with the most critical issues, those in the surgical area and clinical services in particular stand out,' warns Anvur, the national agency for the evaluation of the university system and research, in its recent report on medical education.

Thus, for example, of the 718 places available last year for general surgery, only 278 (38.7%) were filled, or of the 898 scholarships for the school of emergency medicine (the one that trains doctors for emergency rooms), only 225 (25.1%) were used by trainees. An important branch such as anaesthesia and resuscitation also performed badly, with only 753 places filled compared to 1567 specialisation scholarships (48.1%).

The worst performers - although there are fewer places here - concern specialities such as primary care medicine (only 10.1% places filled), radiotherapy (10.7%) or pharmacology and toxicology (8.2%).

By contrast, specialities such as plastic surgery (135 out of 136 places), ophthalmology (253 out of 258), dermatology (156 out of 157) and obstetric gynaecology (510 out of 567) fill up.

This is a trend that is likely to be repeated again this year when the rankings for entry into the various schools will begin to flow from September after the competition today, which will have to take into account the preferences of young doctors: 'It is practically certain that this phenomenon will be repeated with a similar number of contracts being lost. For two reasons: first of all, the specialities are not attractive because specialists are not framed as professionals but as students," warns Giammaria Liuzzi, head of Anaao young people, who also points out that a trainee receives around EUR 1,700 a month from the grant and that is why "a turning point is needed, such as the introduction of a real training contract".

"And then, as is evident, many young people prefer to choose those specialities that open the door to outpatient freelancing or private practice with higher earnings than working in the NHS, which suffers from chronic underfunding".

Calling for a change of pace is also the Anvur itself: "These figures indicate an emergency situation in the specialisation school recruitment system. The steady decline in coverage rates could, in fact, jeopardise the health system's ability to respond adequately to the needs of the NHS. There is a clear need for urgent measures to improve working conditions, increase funding and encourage young doctors to choose these specialisations'.

Will this new desperate cry of alarm be heard by the government and the Ministry of Health, which has been busy for months studying a reform of medical specialisation?

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