Physicians working at the primary level of healthcare in Italy went on strike on March 1 and 2, on the call of the Italian Union of Territorial Doctors (SIMET) and the Italian Doctors’ Union (SMI). The trade unions reported that over 10,000 doctors joined the strike, and another 300 of them gathered in Rome for a protest in front of the ministry of health.
Actions took place in all parts of Italy, from Veneto to the regions of southern Italy where, according to the organizers, the situation is particularly dire.
The health workers who joined the action included family doctors and pediatricians contracted by the government to work in the Italian National Health System (SSN), as well as medical guards and doctors in emergency services. Their grievances concern an overwhelming amount of bureaucracy which limits the time they spend face-to-face with patients, badly regulated working hours, and lack of access to basic rights like maternity and sick leave – all issues that have been accumulating for years and have been exacerbated by the COVID-19 pandemic.
Shortage of workers leads to shortage of care
“A majority of the physicians working in primary, territorial healthcare in Italy today are women. Yet they cannot use their maternity leave because of the shortage of doctors making it difficult to find replacements.They are basically forced to give birth in the ambulatories where they work. If we’re serious about ensuring equality among women and men in this sector, and want to keep the system running, then these rights have to be upheld as well,” said one of the doctors in Rome.
As older physicians prepare for retirement, there is no one to take their place. Younger doctors are aware of the working conditions that await them at this level of the health system and opt for working in hospitals instead. At the end of the day, the absence of planning and organizing does not impact only the employees in the primary healthcare, but also the patients as well.
Speaking to the press during the protest on March 2, Pina Onotri, general secretary of SMI, said, “Our protest today should raise general alarm. As we meet, more than 3 million people in Italy do not have a family doctor, ambulatories do not have a physician in charge, and medical guard stations are closed. With every doctor missing from the system, someone is denied the care they deserve.”
Another pressing issue shared by the health workers is a lack of recognition of the contribution of primary healthcare professionals during the pandemic. Although almost 400 family doctors died in the last two years due to COVID-19 – many of them during the early stages of the pandemic when Italy was particularly hit – the Senate recently failed to secure indemnities for their families.
“We were the first line of information and protection for our patients during the pandemic. We worked every day. Even when we had little clarity about the disease, we talked to our patients, we comforted them, and they respect us for what we did. But no such recognition is given by the Ministry,” said Vincenzo Immordino, one of SIMET’s regional secretaries, during the protest.
A fragmented system paves the way for privatization
The protesters also addressed a delayed 2016-2018 collective agreement that was signed in January by two other trade unions – the Italian Federation of General Medicine Doctors (FIMMG) and CISL Medici x which, according to them, does not provide an adequate protection of workers’ rights. Additionally, SIMET and SMI warned that the collective bargaining process did not address possibilities of strengthening the primary healthcare system as it could have, which means that existing problems will continue to persist in the future.
In a joint statement issued ahead of the strike, the trade unions stated: “During the pandemic, our system of territorial, primary healthcare showed all the weaknesses of a fragmented and ungovernable system, and that is because it is based on the activity of the single-practice doctor, isolated and poorly integrated in the rest of the network.”
This feeling is echoed by other ongoing health campaigns in Italy too. According to the initiative “Campagna Primary Health Care” — a group of medical students, young doctors, general practitioners, nurses, and medical anthropologists dedicated to implementing the promises of the Convention of Alma Ata in the Italian health system — one of the most serious problems of the SSN is that it is very fragmented and bureaucratized when it comes to primary care.
The campaign’s introductory statement states that this is related to the system’s almost complete orientation towards the hospital system, which leaves primary and preventive healthcare underdeveloped. To change this, it will be necessary to change the whole paradigm on which the SSN is currently based — not only when it comes to financing the system, but also when it comes to the education of workers to be employed in primary health care and staffing, which should take into account the needs of different communities.
While calling for necessary changes in the realm of primary healthcare, the physicians on strike warned that the current situation is actually paving the way for privatization. The longer patients are exposed to a weakened and fragmented system, the easier they will be convinced of the advantages of private medicine. “We say, enough of the creeping privatization of medicine. The aim of our strike is to protect physicians and, by doing that, to protect the public health system,” SIMET wrote on their website ahead of the industrial action.
The doctors’ actions are largely supported by their patients, said Vincenzo Immordino (SIMET) in front of the ministry of health. “While I was preparing for the strike, they told me, ‘You’re right to do this, we’re rooting for you.’ And that’s because they know that we’re striking for them as well. By striking today, we are trying to make the system better for everyone,” he stated.
Read more articles from the latest edition of the People’s Health Dispatch and subscribe to the newsletter here.
