Improving Italian general practice training: the role of academia

Background

The modern Italian national health service is a Beveridgean system centred around GPs and funded by central taxation.^1,2 In order to become eligible to work as a GP, Italian doctors need to undertake a 3-year postgraduate training in general practice.^3–6 The latter training — governed nationally by the Italian Ministry of Health and locally by the various Italian regions — is organised by the primary care establishment.^3–6 By contrast, all other postgraduate medical specialties in Italy are organised by universities and are governed by the Ministry of Education, University and Research (MIUR).

On successful conclusion of the above GP training, Italian doctors are awarded a certificate of completion of training which is then mutually recognised in all member states of the European Union (EU).^3–5 Italian doctors in postgraduate university specialty training (that is, non-GP trainees) had not benefited from any financial support from the government during their training until 1991. From 1992 until 2000 a tax-free monthly studentship of about 960 000 Italian Lira was introduced to support non-GP trainees; the latter bursary then became approximately €960 from 2000 to 2006 (after the introduction the Euro currency to Italy). Proper working contracts with an annual gross salary of €22 700 (a variable monthly amount of €1600–1700 after taxes) for this category of specialist trainees started in 2007. As a result, the Italian Supreme Court recently ordered the Italian government to pay compensation to Italian doctors training for medical specialities governed by the university authority from 1 January 1983 onward, in compliance with the Directives of the Council of the EU regarding stipends of doctors during postgraduate specialist training. The latter directives were accompanied by related decisions of regional tribunals. Unfortunately, these decisions concerned only doctors in training in secondary care specialties (that is, non-GP trainees), while Italian GP trainees currently still lack working contracts for their postgraduate clinical training in …