Context
The shortage of healthcare professionals in Italy remains a major concern for the National Health Service (NHS). This shortage is a result of cost containment decisions and poor planning over the past decade.
Although the Budget Law 2024 has allocated an additional EUR 3.3 billion for contract renewals, it is important to consider long-term strategies for managing and satisfying the expectations of healthcare workers. This is crucial for ensuring the provision of quality care and the overall sustainability of the NHS.
The latest data indicates a decrease in personnel units until 2019 due to personnel expenditure ceilings set by previous budget laws and sometimes difficulties in recruiting. However, there was an increase in staff of approximately 13 000 units following the COVID-19 pandemic.
According to the OECD’s 2023 indicators, Italy has 4.1 practising doctors per 1000 population (compared to the OECD average of 3.7) and 6.2 practising nurses (compared to the OECD average of 9.2) in both the public and private sectors. It is challenging to comprehend the shortage of nurses in a country with high unemployment rates. This could be due to lower salaries and job satisfaction of Italian nurses compared to their European colleagues.
Impetus for the policy developments
Physicians and nurses have expressed their dissatisfaction with being “few, poorly paid and mistreated” and are striving to achieve decent working conditions, such as manageable workloads, adequate payment, and career advancement opportunities.
In addition, the Italian NHS faces several workforce management challenges, including the emigration of doctors and surgeons, an aging physician population, and inadequate residency training programs in certain critical medical specialties and subspecialties.
Main purpose and content
To address these issues, the central government has increased the number of specialist training contracts and available positions for medical students.
The allocation of medical residency positions is determined by Italy’s regional governments, based on employment needs. The number of medical residency vacancies is decided every three years by the regions, based on the employment scenario and the health needs of the regional population, and in accordance with funds from the National Recovery and Resilience Plan (NRRP).
The total number of specialist training contracts has increased over the last three academic years. However, there continues to be a discrepancy between job openings and qualified candidates. Recent enrolment data indicates that only about one-third of the 16 165 contracts were filled in 2023–2024. Shortages in the workforce are particularly severe in certain specialties, including Community Medicine, Pharmacology and Toxicology, Emergency Medicine, and Microbiology.
Implementation challenges
The recruitment criteria for the total number of students in Medicine and Surgery have been the subject of intense political debate and technical considerations. The national calculation of the number of students in Medicine, Surgery, and health professions’ graduate programmes is based on the teaching capacity communicated by each university at the biannual intergovernmental meetings, the State-Region Conferences.
Ministerial Decree n. 1107/2022 provides instructions on participation requirements, admission processes, rules, and the structure of the national online application exam for entry to a medical degree programme. High school graduates can take the test twice a year and are ranked based on an equalized score whereby a coefficient reflecting the deemed level of difficulty is allocated to the specific set of questions given to a candidate for their test. The allocated coefficient determines the maximum score a candidate can achieve in the test and thus impacts on their overall ranking in the admissions exam.
On 17 January 2024, the Regional Administrative Court of Lazio (TAR of Lazio) stated that the equalization methodology was flawed. This ruling does not annul the previous ranking established for the 2023/2024 test, as it only suggests directions for the selection process in the future, when it will be necessary to abolish equalized scores to ensure equal conditions among candidates.
Meanwhile, the legal battle, supported by certain politicians and lawyers, over the process of enrolling larger numbers of medical students is still under scrutiny, with the main challenges being how to overcome the hurdle of restricted access to medical degree programmes and how to protect the right of medical students to choose a desired educational programme. Medical associations are urging appropriate and timely planning, starting with forecasting epidemiological health needs and trends in healthcare demand. Apart from addressing needs, this would assist medical students in choosing an appropriate speciality and could help to guide them away from pursuing a specialization where there is an oversupply of doctors.
While the problem of expected shortages of doctors is being debated and partly addressed, nursing shortages and related policies are currently not on the political agenda; and they need to be, as Italy risks a dramatic lack of nurses in the near future.