One doctor for 100 patients: Italian medical workers went on strike last week

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“The reality is that we are hostages to the hospital, in a climate of ever-increasing pressure which demands more and more from us, like an assembly line,” says Dr. Mirko Schipilliti, an emergency room physician in Padua and union representative for ANAOO, one of the unions on strike on Wednesday. In emergency rooms, which are already unpredictable and complex in themselves, the lack of resources has long exacerbated structural problems that are negatively affecting the quality of service that medical staff are able to offer (and that patients are able to get), as well as the very lives of doctors and nurses.

“Our troubles at work are the result of two main types of problems: the lowest salaries in Europe in our category, and the fact that we are overworked,” he says. Regarding undersized departments, the numbers were recently announced by Health Minister Orazio Schillaci: at least 4,000 more doctors are needed. A study by the Italian Society of Emergency Medicine (SIMEU) estimates that at least 4.5 million more ER visits take place each year than the national standard for the number of physicians available, amounting to 22 percent of the total: one in five patients are being treated while surpassing the capabilities of the doctors available. 

“Each doctor deals with at least 3,000 cases a year, working as many as 50 or 60 hours a week. Under these conditions, it’s impossible not to reach burnout: at least 40 percent of emergency room physicians are at risk of it, twice as many as other hospital physicians. The result is that they leave,” Schipilliti stresses. In Genoa, on Nov. 18, at 10 a.m. the emergency department at Villa Scassi had only one physician available to handle more than 100 patients.

The resulting drop in service quality is affecting health care staff in the form of assaults by patients. This issue even reached the attention of the government, which tried to address it by passing a bill in the Chamber of Deputies this week. The majority's obsession for repression also spilled over into the healthcare field: a new criminal offense was introduced, “damage to property intended for the health service,” with deferred flagrancy. In September, Senator Ignazio Zullo of Fratelli d'Italia also presented a bill to introduce a healthcare “ban order,” according to which free treatment would be suspended for three years for those who commit violence against health care providers. A measure that provides no funding and which “envisages turning repression into prevention,” Schipilliti explains. The resources that would be needed to improve life on the ward for doctors and patients continue to be lacking.

Preventing such incidents would mean first and foremost investing resources to have more security, he says, but more importantly to add new staff. An emergency room position is very unappealing to new medical school graduates, and the residency school in emergency medicine opened only a few years ago. “As little as half as many people respond to calls for applications than the number of places advertised, to give you an idea,” one resident says. ”Until recently, those working in emergency rooms were internists or clinicians, who then moved elsewhere. Even now, I’m seeing surgeons or geriatricians.”

It's not just doctors that are lacking; about 10,000 nurses would be needed as well. Carlo Torricella is a union activist with NURSID and works at Pertini Hospital in Rome: “It often happens that a nurse has to manage even fifteen patients alone. That's how aggression happens: it's impossible to give explanations to everyone when you have the relatives of so many people to deal with.” The grueling shifts, he says, restrict nurses' personal lives, which is why more and more are choosing to become freelance home care providers. The strike is a blunt instrument, made less effective by minimum service requirements: “We have de facto no right to strike. We want to protest because there are too few of us, but we can’t do it because there are too few of us. It’s paradoxical, but that's how it is.”

Then, the local medicine reform has gotten bogged down as well: the reorganization of the health care system, a project started with the pandemic, which should have had the function of decongesting hospitals through the opening of community health centers. There were to be more than 1,300 across Italy, ensuring the constant presence of a multidisciplinary medical team, including general practitioners. First, their numbers were cut down to less than 1,000, with Health Undersecretary Alberto Gemmato preferring to shift funds to another infrastructure network: pharmacies. He is more familiar with that sector, as it is the one in which his family operates. Furthermore, the NRRP investment in community health centers was made without all the necessary coverage, since it provides enough money only for physical facilities (many of which still remain a mystery) and not for staffing.

Overall, the result has been cuts in funding and closed facilities. As a result, voluntary projects started by mutualist organizations have sprung up in recent years to make up for the shortcomings of the public healthcare system and turn the spotlight back to its situation. In Rome, in Quarticciolo, a working-class neighborhood in the eastern suburbs, the popular outpatient clinic set up by the neighborhood committee has offered its services for years, with general practitioners, psychologists, and nutritionists, among others. In Rebibbia, also in the capital, the health desk run by volunteers helps people to get through the maze of the waiting lists, taking advantage of a 2005 law that allows access to extra-hours appointments when waiting times are longer than those stipulated in the regulations.

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Originally published at https://ilmanifesto.it/la-protesta-un-solo-dottore-in-corsia-per-cento-pazienti on 2024-11-20