Payroll doctors running out and holidays coming: there's already an alarm going off in the emergency room for the summer

There are fewer and fewer doctors in Italian hospitals. This is not a new criticality, and is linked to the long-standing shortage of staff, but with the arrival of summer and heat the situation promises to be critical: the demand for care, in fact, will increase, while the number of white coats in the wards and in the emergency rooms is destined to further reduce due to the "vacation effect" and also due to the expiration of many contracts of the so-called "tokenist" doctors, the rented white coats often paid a lot of money (even a thousand euros per shift), essential to cover shifts and absences. In fact, the decree bills (34/2023) provided for the possibility of extending for another year the expiring "rental" contracts of the "tokenists" for another 12 months from the date of entry into force of the conversion law and the subsequent guidelines of 17 June 2024. In particular, in the coming weeks and months, the possibility of still using the "tokenists" to fill the gaps in the wards will end for many hospitals. Token workers (doctors and nurses) who according to Anac cost 457 million in 2024 alone and a whopping 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 will have to be closed. The deadline concerns the so-called paid doctors and with their disappearance, considering the already serious shortage of personnel in the wards, the situation in the hospitals will worsen and this especially during the summer season when the demand is greater also due to the heat”. In view of the summer therefore, he warns, “the biggest problem is represented precisely by the shortage of doctors and nurses. In addition to the already insufficient staff, the 'holiday factor' will lead to an even smaller number of doctors at work. But another critical factor will be precisely the deadline decided by the ministry for the closure of the existing contracts with the cooperatives for the temporary employment of white coats. This will lead to a further drastic reduction in the number of doctors present”. The rule, Riccardi specifies, "actually provides for exceptions, but only in particular and exceptional cases and net of the procedures that companies are required to implement to remedy the staffing situation".

A critical summer is therefore expected: "Currently - says the Simeu president - 20-30% of emergency rooms have doctors from cooperatives in their staff, and in some facilities, paid doctors cover up to 80% of shifts. It is obvious that with the end of their contracts the staff shortage will worsen, with a strong impact on the hospital service". Furthermore, he underlines, "many cooperatives foresee that their doctors cannot be hired by health companies before 2 years from the end of their contracts with the cooperative itself, excluding the possibility of drawing from this pool of white coats". At the moment, he specifies, "we are not yet registering emergencies or massive access to emergency rooms linked to the increase in heat. However, the forecasts indicate a further increase in temperatures in the short term and therefore we expect a strong growth in the demand for assistance soon". In short, a difficult situation to which is also added the problem of the lack of beds in the departments. This will also be one of the issues to address: "Every hospital is trying to implement measures to avoid the problem of patients forced to stay on stretchers in the emergency room for days during the summer months, with the increase in influxes. But it's not easy". To date, however, the situation appears to be under control and no particular situations of suffering have been reported in first aid points. But the expected increase in temperatures does not bode well: already on Sunday, the Ministry of Health indicates that there will be 11 scorching cities marked with a red dot for heat and heat waves. "We will meet the demand for assistance, but the problem of staffing - concludes Riccardi - can no longer be ignored".