Hospital doctors: how they risk being overlooked in regional and university nominations
The assignment of hospital directorships to university professors is a common practice that has a long history in Italy. In many cases, university professors, especially those with tenure, associates and associates, are responsible for an entire division or a special diagnostic and treatment service in the hospital.
In the past, this practice was regulated by specific agreements between the hospital and the university, which provided for a division of tasks and responsibilities between teachers and chief physicians. For example, Legislative Decree 129 provided for the attribution of the qualification of chief physician to university professors, as they were responsible for the divisions.
Currently, this situation is evolving, with greater attention to the role of university professors in the healthcare sector. Agreements between universities and hospitals are increasingly oriented to promote collaboration and synergy between the two institutions, in order to improve the quality of care and the training of doctors.
Recently the Lombardy Region has promoted the initiative of being able to choose the university directors directly by the region and no longer only by the universities.
This is the proposal of the Welfare Councilor Bertolaso to change the appointment criteria in the contracted hospitals. The draft protocol presented provides that the appointments of the new directors of the departments take place only after an agreement between the Region and the University, and not - as has happened until now, automatically, in agreement with the hospital directors. The top brass at Palazzo Lombardia also aim to decide where to send the new heads of departments, whether to the largest and most renowned hospitals or to the smaller and less attractive ones, and therefore less well-equipped in terms of staff. Already in April, Mario Melazzini, Welfare General Director of the Region, had warned the companies that new agreements for the assignment of healthcare functions to university staff would not be authorized pending the redefinition of the memorandum of understanding between the Lombardy Region and the Lombardy Universities that host the faculties of Medicine and Surgery. Protocol with which the Lombardy health system wants to have supervision of these decisions, also to be able to direct the primary doctors to the structures considered most suitable.
The doctors' trade unions (Anaao, Cimo, Acoi) have intervened in this operation, which is also spreading to other regions, to safeguard the role of hospital doctors threatened by the so-called "clinicalization" of hospital structures, asking the Ministry of Health and the Conference of the Regions to intervene urgently.
The management of the “primariati” is increasingly entrusted to university professors appointed by the Rector, and now also by the Region. Health workers who do not have to pass a competitive exam as is instead required of hospital workers despite the fact that the medical staff is predominantly, if not exclusively, hospital staff.
In a time of particular crisis for hospital doctors, forced to work in unacceptable conditions to cope with serious staff shortages, it is intolerable, say the Unions, to add further causes of demotivation, which will increasingly push health workers away from the NHS. Demotivations linked to their marginalization in the "reserve" of a poor NHS and for the poor, leaving to others the "luxury" of training, teaching and assistance in highly specialized sectors.
It is necessary, it is reiterated, to define in a clear and transparent way the structural equipment and organization necessary for teaching and research, in order to avoid dispersing fundamental resources in a thousand streams and to create a real collaboration between Universities and Hospitals in compliance with the functions and roles of each, giving life to teaching hospitals to guarantee quality training to specialist doctors. Suddenly, hospital workers find themselves, instead, not only without any career opportunities, but must also take on the responsibility of dealing with the practical training of specialist doctors entrusted to that particular department. Without, moreover, receiving any additional compensation and professional recognition.
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