“The great waste of public health: token operators in the ward, specialists waiting”

The photograph taken by Il Sole 24Ore between ‘rented’ healthcare workers and measures to hire doctors in training on time that don’t take off

The “great waste” of public health, with doctors paying more than a thousand euros a day to plug the gap in ward shifts and young specialists – with scholarships of the same amount, but on a monthly basis – who could fill those gaps. This the photograph of waste in the NHS taken today by Il Sole 24Ore, between healthcare ‘for rent’ and measures to hire doctors in training on time that don’t take off.

According to the economic newspaper, this is the “poisoned fruit of that hiring freeze that has persisted for over 15 years and which over time has forced hospitals to ‘rent’ white coats paid in gold from cooperatives (sometimes they are the same doctors who resigned from the hospital to earn more as token operators.) The loophole to keep the NHS afloat so far has in fact been to draw on the resources to pay the token operators and the cooperatives they work for under the heading ‘assets and services’ where there is no spending ceiling such as on staff hiring. But with expenditure now out of control, given that entire departments are supported by them, starting with the emergency rooms where they account for 50-60%: they do not yet exist official estimates at national level but the prudential costs of token operators are around at least 200 million a year given that Lombardy alone spends 27”.

Yet, the newspaper underlines, “there are fresh forces from which the National Health Service could draw heavily while also saving: they are the over 35 thousand specialists (those enrolled from the second year onwards) who, as foreseen by the bills decree of last May, they can be hired with fixed-term contracts in the ward where they can complete their training or, alternatively, taking on freelance assignments for a maximum of 8 hours per week to work in the emergency rooms, the ones closest to collapse due to lack of staff”.

That of the specialists, continues Il Sole 24Ore, “would not be a ‘stop-gap’ solution as is the use of token operators, who among other things, as also provided for by the bill decree, should no longer be employed in hospital wards by the end of the year. the problem is that only a few, less than one in ten (around 2,500), are actually recruited: the ones holding back are the universities with their schools that train specialists and set limits because according to the most critical the universities do not want to see their manpower taken away from low cost'”.

Hence the comment from health workers on the front line on the topic. “Although the rules provide for the hiring of medical specialists, almost all universities apply moral suasion to convince them not to be hired. We have collected dozens and dozens of cases: from non-compliance with the rules on authorization to more or less veiled threats of retaliation at the end of the year exam, even reaching the final failure”, warns Giammaria Liuzzi of Anaao Giovani, the main acronym of the hospital workers, from the pages of the economic newspaper. Which together with the specialists’ associations are asking for a new contract to be reached directly – training with rights and duties like senior doctors and with increasing salaries and responsibilities. It must be said that the one between NHS hospitals and universities is a historic tug of war that is softening in the face of the great flight of professionals.

“If we still see opposition from the University to the work activity of postgraduates, at the same time today in that world there are also those who are ready to change, aware that certain prerogatives are no longer current. That it is unthinkable that the postgraduate is only responsible to the Ministry of the University and that perhaps from the third year he should enter the NHS”, explains Fabio De Iaco, president of the Society of Emergency Medicine (Simeu), to the Sole 24Ore.

«Faced with an increase in admissions to Italian emergency rooms estimated at between 5 and 10% this year too – he continues – and with just 30% coverage of places in our specialization school, if we continue like this, in 5 years we will close the doors and the university students know it.” However, the president of the Permanent Conference of the Faculties of Medicine and the Schools of Medicine and Surgery, Carlo Della Rocca, holds back on the use of trainees as token operators: «Imagining colleagues in training as employees – he says – is equivalent to belittling their training: they are in the wards to be tutored, protected and trained, not to work replacing the structured doctor, which is prohibited by law. Especially in the Covid years, emergency solutions have been introduced due to an exceptional contingency but this cannot become the rule. Contractualization could only make sense from the last year of specialization, when you have a certain autonomy and to accelerate entry into the job market. Having brought it forward to the second year is indecent and makes no sense: we are not moving towards greater safety of the NHS but towards further exploitation of colleagues. Who – underlines Della Rocca – would rather need a contract, to replace the “scholarship”, decent from both an economic and protection point of view such as maternity and sickness, as well as incentives for activities that are less attractive today such as emergency medicine” .