Almost 10% of Italian graduates choose emergency medicine: the numbers from the report published in Internal and Emergency Medicine.
«America, I love you but we need to talk!» writes the American travel blogger Debbie Evans accompanying a video that has gone viral in recent days, in which she describes her experience in an Italian emergency room, where she went for a spider bite. The tourist said on social media that she spent 6 hours in the emergency area of a hospital in Lazio, that she received an IV, tests, a bed, and at the time of her discharge no request for a credit card: “I expected someone to chase me to ask me for payment, and instead it didn’t happen: I just went out”, she said again in her reel. We Italians, on the contrary, give ours Health service so taken for granted that they no longer grasp what appears almost incredible in the eyes of many foreigners: being able to receive care without the bank account determining the quality of the care. We demand immediate, free and no-wait answers, and a few hours spent in an emergency room, often for non-urgent conditions that could be addressed by the GP, becomes a reason for complaints, outbursts on social media and even violence against those who work to treat us.
However, in a narrative that for years now has described the emergency room as a trench of aggression, exhausting shifts and frustration, where no doctor wants to go to work anymore, excellent news has now arrived: a study conducted byMario Negri Institute of Pharmacological Researchfrom the IRCCS Fondazione Maggiore Policlinico Hospital of Milan and fromUniversity of Milan with the collaboration of Fenice network, just published in the journal Internal and Emergency Medicine and of which Panorama writes in preview, reveals that specialization in Emergency and emergency medicine (Meu) is among the most loved by young doctors, immediately after Cardiology and even before Internal Medicine and General Surgery; and that therefore the alleged “vocational crisis” regarding work in the emergency room does not exist.
The mirage of percentages and the crux of programming
But then where do the alarms raised by scientific societies come from – often a little too inclined towards claims, self-pity and the rhetoric of young people who do not want to make sacrifices – about the fact that 75% of the specialization scholarships in MEU remain vacant and that new graduates prefer more profitable branches? First of all from one incorrect programming. «For years we have significantly increased the number of specialization grants in emergency-urgency, but without the number of medical graduates also increasing at the same time» he says Ludovico Furlandoctor of the Internal Medicine department of the Milan Polyclinic and first signatory of the study. «If I triple the places available, it is inevitable that the coverage percentage will decrease, even if the number of candidates increases. This is why looking only at this rate leads to a wrong conclusion: it does not tell how many young people really choose Meu and it does not mean that the specialty is less attractive, but simply that supply and demand have not been allowed to grow together”.
Therefore, while politicians, unions and healthcare companies ask themselves why emergency room work no longer attracts young people (is it defensive medicine? Or low salaries? Attacks, shifts, or what?) looking at the finger rather than the moon, it turns out that the emergency lanes continue to attract those young people: also and above all for noble reasons. «We chose emergency medicine because it is the specialization in which the precision of the clinic is intertwined with the social and emotional dimension of the treatment» they tell us during a shift in the emergency room Chiara Scarpelli And Tabata BarbieriMEU trainees at the Milan Polyclinic. «Here it is not enough to make a diagnosis, we must also be able to read the fragility, the context and the emotions of the person, always remembering that we do not cure diseases, but human beings».
Managerial pressure, improper access and lane checks
All roses and flowers, then? Can we say that the news about the death of the Italian emergency room has been greatly exaggerated? Not entirely, because there are still many problems and many derive from the discrepancy between supply and demand in healthcare, which makes the ED the last resort for problems that should be addressed elsewhere. Precisely in this sense the speech of a few days ago fits in Guido BertolasoCouncilor for Welfare of Lombardy Regionwhich issued a harsh warning to the general managers of healthcare companies, attributing to them the responsibility for the overcrowding recorded in some emergency departments and asking for much more proactive management.
But the message was above all political: the ability to govern emergency/urgency flows will fully enter into the evaluation of managers, with possible repercussions on the confirmation of positions. Bertolaso also announced the sending of inspectors to the EDs to systematically check whether patients arriving at the hospital had first contacted their GP, in an attempt to reduce improper access. At the other end of the peninsula, in Sicily, to try to understand how serious the problems are in the emergency rooms, a parliamentary question signed by the vice president of the Chamber, Giorgio Mulèbecause the data on structural deficiencies, lack of safety procedures and overcrowding that emerged from a series of inspections apparently had even been “secreted” by politics.
Beyond the narrative of escape: the European confrontation and the future
Nothing new under the sun: all problems that the doctors know inside out, which cannot be overlooked but which must no longer be at the center of the scene, if we don’t want to find ourselves truly deprived of young doctors in the ward. «Those who work in the emergency department know well the harshness of the profession: heavy shifts, overcrowded departments and attacks» says the professor George Constantinedirector of the emergency room of the Milan Polyclinic, also among the signatories of the study. «But precisely for this reason it is essential to distinguish between the real critical issues, which require investments in salaries, organization and quality of working life, and the narrative of an alleged “escape” from emergency medicine which the data does not confirm. Continuing to fuel this perception risks discouraging young doctors precisely when they are choosing their professional future.”
Also because, making a comparison with Europe, we discover – again thanks to the study of the three Milanese bodies – that they are much better off than other countries, often described as more virtuous and efficient. In fact, if in Italy the number of those who choose emergency medicine from more than 50 specialties reaches almost 10% of the total graduates (which in recent years has always been around 10 thousand units) in France this percentage drops to 6 and in England even to 3. And while the TV series The Pitt, set in the Pittsburgh emergency room has collected 25 nominations for the prestigious Emmy awards – and as already happened in the nineties with the ER series it will bring with it a wave of new vocations – it turns out that the Italian government has already undertaken the solution to replenish the PS, by widening the number of registrations to Medicine and Surgeryblocked in previous years by the very strict criteria of limited number. «Once we understand that the solution is not to find more young people interested in emergency medicine, because they are already there, but to increase the overall number of doctors who can access specialization schools, we have the elements to understand how to plan the work» he concludes Giovanni Nattinoof the Department of Medical Epidemiology of the IRCCS Mario Negri, who oversaw the analysis of the study data. «For years, as we were saying, we only tried to respond to the shortage of specialists by expanding the number of scholarships without however increasing the pool of graduates. Today we are already seeing the effects of the increase in access to medicine courses, but it will take at least six years for these students to complete their training and be able to enter specialization schools.”
