Paediatricians: Lombardy, Veneto and Piedmont in crisis, care up to the age of 18 difficult

The number of scholarships for paediatrics residency school, stable for a decade, has increased significantly in the last six years: from 496 scholarships in the 2017-2018 academic year to 854 in 2024-2025, peaking at 973 in the 2020-2021 academic year. "However," Cartabellotta notes, "it is not possible to predict how many paediatric specialists will choose family paediatrics instead of hospital paediatrics. For this reason, we cannot know whether the new recruits will be sufficient to guarantee an adequate and homogeneous generational turnover between the regions, nor to fill the gaps already present today'.

According to the findings of the Struttura interregionale sanitari convenzionati (Sisac), as of 1 January 2025 there were 6,284 freely chosen paediatricians, with almost 5.8 million patients: 41.9% in the 0-5 years bracket (2.42 million) and 58.1% in the 6-13 years bracket (3.35 million). Overall, 82.9% of the ISTAT population between 6 and 13 years of age is attended, but with marked regional differences: from 94% in Tuscany to 56.3% in Sardinia. In absolute terms, the national average is 917 paediatricians per paediatrician: Piedmont (1,126), the Autonomous Province of Bolzano (1,114) and Veneto (1,018) exceed the ceiling of 1,000 paediatricians. "With these saturation levels," Cartabellotta explains, "the principle of free choice remains only on paper: in many areas of the country, finding an available paediatrician is becoming increasingly difficult, if not impossible. And the problem no longer concerns only mountainous or peripheral areas, but also many large cities. In other words, the care reality may be much more critical than regional averages suggest'.

"Our estimate," Cartabellotta explains, "takes a snapshot of the need for paediatricians at a regional level, but it does not allow us to identify individual shortage areas, which depend on local variables such as population density, distribution of the paediatric population, geographical characteristics and accessibility of surgeries. In order to guarantee quality of care, proximity of practices and real freedom of choice, the GIMBE Foundation used the optimal ratio of 1 free-choice paediatrician for every 850 patients using the SISAC surveys as of 1 January 2025. The result is an overall shortage of 497 paediatricians, with strong regional imbalances. In fact, 78.7% of the shortage is concentrated in just three large northern Regions, which are worse than on 1 January 2024: Lombardy (186), Piedmont (109) and Veneto (96). On the contrary, in five Regions (Abruzzo, Emilia-Romagna, Latium, Apulia and Umbria) there are no shortages, since the average number of patients per PLS is less than 850. This figure is also worsening because on 1 January 2024 there were nine regions without shortages. "Inevitably," Cartabellotta points out, "the shortage estimated in terms of regional average tends to underestimate possible local shortages, even very critical ones, especially in inland, mountain and low population density areas, but now increasingly frequent in large metropolitan cities as well.

The draft reorganisation of primary care strengthens the role of PLSs in the network of territorial care provided for by Ministerial Decree 77: in particular, paediatricians should guarantee at least six hours a week, for 48 weeks a year, in Community Homes, with the possibility for the Regions to increase this quota in relation to local needs. The proposal also intervenes on the age of paediatric care: the relationship with the PLS would be extended until the age of 18. "Overall," comments President Gimbe, "the reform aims to strengthen the integration of PLSs in the territorial network and to ensure greater continuity of care during the age of development. However, the risk is that it will remain a mainly organisational reorganisation if it is not accompanied by adequate resources, homogeneous implementation criteria among the regions, and monitoring indicators capable of measuring the real benefits for children, adolescents, and families". Moreover, maintaining the optimal ratio of 850 patients, today more than 3,500 additional PLSs would be required to guarantee coverage of the entire population between 0 and 18 years of age: 811 to take care of the 690,000 minors aged 6-13 years currently assisted by general practitioners and 2,721 for the 14-17 year age bracket. "The hypothesis of extending paediatric assistance up to the age of majority," Cartabellotta concludes, "without changing the optimal ratio and the maximum number of patients is unrealistic. In order to avoid a further work overload and preserve the quality of care, especially for the youngest children, today about 4,000 more paediatricians would be needed: almost 500 to fill the existing gaps and more than 3,500 to guarantee the taking care of the entire 0-18 age bracket. And this is without considering the economic impact of the measure, given that the capitated quota recognised to PLSs is about double that of the GPs".

In short, much more accurate planning is needed. "The Regions must be able to have reliable estimates on the number of specialists who actually embark on the career of PLS, integrated with demographic projections on the birth rate," Cartabellotta concludes. "At the same time, it is essential to complete the reform of territorial care envisaged by the PNRR, developing organisational models oriented towards work in multidisciplinary teams capable of fully exploiting the potential of digital transformation, as well as reforms and union agreements consistent with the objectives of generational turnover and with the need to ensure a widespread presence of PLSs in the territory.