Depleted token doctors and holidays coming up: summer is already alarming in emergency rooms

There are fewer and fewer doctors in Italian hospitals. This is not a new problem, and it is linked to the age-old shortage of staff, but with the arrival of summer and hot weather the situation promises to be critical: in fact, the demand for assistance will increase, while the number of white coats in the wards and emergency rooms is destined to become even smaller due to the 'holiday effect' and also due to the expiry of many contracts of the so-called token doctors, the white coats for rent, often paid by the pound (even one thousand euros per shift), who are essential to cover shifts and absences. In fact, the bill decree (34/2023) provided for the possibility of extending the expiring 'rental' contracts of tokenists for another year by another 12 months from the date of entry into force of the conversion law and the subsequent guidelines of 17 June 2024. Particularly in the coming weeks and months, the possibility of still using tokenists to cover gaps in the wards will end for many hospitals. Tokonists (doctors and nurses) who, according to Anac, cost 457 million in 2024 alone and as much as 2.141 billion from 2019 to 2024.

"From the end of July," explains the president of the Italian Society of Emergency Medicine (Simeu) Alessandro Riccardi, "the contracts of doctors coming from cooperatives and employed in hospitals and emergency rooms will expire and have to be terminated. The expiry date concerns the so-called token doctors and with their disappearance, considering the already serious shortage of staff on the wards, the situation in the hospitals will worsen, and this precisely during the summer season when demand is greater also because of the heat'. In view of the summer, therefore, he warns, 'the biggest problem is precisely the shortage of doctors and nurses. To the already insufficient staff will be added the 'holiday factor', which will lead to even fewer doctors at work. But another critical factor will be the deadline set by the ministry for the closure of existing contracts with cooperatives for the temporary employment of white coats. This will lead to a further drastic decrease in the number of doctors present'. The rule, Riccardi points out, 'actually provides for exceptions, but only in special and exceptional cases and net of the procedures that companies are required to put in place to remedy the staffing situation'.

A critical summer is therefore in the offing: 'At present,' says the Simeu president, '20-30% of emergency rooms have doctors from cooperatives on their staff, and in some facilities token doctors can cover up to 80% of shifts. It is obvious that with the end of their contracts the shortage of staff will worsen, with a strong impact on the hospital service'. Moreover, he emphasises, 'many cooperatives stipulate that their doctors cannot be hired by healthcare companies until two years after the end of their contracts with the cooperative itself, excluding the possibility of drawing from this pool of white coats'. At the moment, he points out, 'we still do not record emergencies or massive accesses to emergency rooms related to the increase in heat. However, forecasts indicate a further increase in temperatures in the near future, and we therefore expect a sharp rise in demand for assistance soon'. In short, a difficult situation to which is also added the problem of the shortage of beds in the wards. This, too, will be one of the knots to be tackled: "Every hospital is trying to put measures in place to avoid the problem of patients being forced to stay on stretchers in the emergency room for perhaps days at a time during the summer months, with the increase in influxes. But it is not easy'. To date, however, the situation appears to be under control and no particular situations of distress have been reported in the first aid stations. But the expected rise in temperatures does not bode well: already on Sunday, the Ministry of Health indicates that there will be 11 hot cities marked with a red sticker for sultriness and heatwaves. 'We will cope with the demand for assistance, but the problem of staffing levels,' Riccardi concludes, 'can no longer be ignored.