A few weeks after the signing of yet another national collective agreement in general medicine, Pinetta Vessichelli, national director of the Italian Federation of United Doctors' Unions-Fismu and regional vice-secretary of Fismu-Campania (and provincial secretary of Avellino) draws a bitter and highly critical assessment of an agreement that once again does not respond to the requests and concerns of doctors, especially those in continuity of care (formerly on-call doctors).
"I'd like to make a brief introduction and clearly define who the general practitioner is," Vessichelli emphasizes, "because whether through ignorance or malice, there is often too much confusion. The general practitioner is represented by two categories: the primary care physician (formerly the family doctor) and the continuity care physician (formerly the medical on-call doctor). To simplify: the primary care physician is the one who works during the day, on weekdays, in his own office, providing healthcare to his patients (i.e., those who have chosen him). The continuity care physician, on the other hand, works in public facilities, often dilapidated, at night, on pre-holidays and holidays, and offers healthcare to all patients who request it, often making home visits. This activity, that of the latter, is essential to guaranteeing 24-hour assistance (along with 118) and which, for obvious reasons, is not only exposed to many risks, as demonstrated by the many assaults suffered in recent years, but also creates many sacrifices and not a few problems within the family, because it takes away time from loved ones." on most holidays. Is all this given prominence? Not at all.”
"The employment relationship," explains the national FISMU director, "is regulated for both categories by the national collective bargaining agreement (also known as a convention), which also includes other areas of medical care (service medicine, local emergency medical services, etc.). However, when it comes to renewing the agreement, as in the last one, the current signatory unions regularly try to wrest a better deal from the public sector, forgetting, as always, the 'Cinderella' of the NHS: the continuity of care physician. Perhaps because those who sign the agreement and claim to represent all doctors no longer understand our reality, or have never understood it."
"But it's unclear why continuity doctors are treated like second-class professionals," adds Vessichelli caustically. "In fact, like their other colleagues, who fall under the so-called 'contracted' system, they hold a degree in medicine and surgery, complete a three-year training course in general medicine (considered a full-fledged specialization in other European Union countries), and often hold additional specializations. It's unclear why, despite the various local health authorities demanding the same obligations and duties as a full-fledged employee (time stamps, regulated shifts, work performed in public facilities, etc.), continuity doctors aren't even granted rights such as vacation and sick leave (if you get sick, you have to be sick for at least a month to get your salary back). And not only that, but last but not least, after about forty years of night work (which is considered exhausting for all workers, but not for continuity doctors), the final blow: a starvation pension."
"At this point," he concludes, "I wonder how it is possible that employment contracts of this type still exist in 2019, and why no Minister of the Republic, particularly the Minister of Health, has ever addressed this issue. I suppose it's not difficult to answer: the primary care physician doesn't cause problems for anyone, he does his duty, and has no professional protections. We are forgotten and invisible. So, dear Minister Speranza, I appeal to you: if you care about our public health, put at the center of your political initiative, not only patients, but all healthcare workers without distinction, valorizing them and fighting these injustices."
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