1 Paterlini M Italy calls on retired doctors to fill health worker gap. I read with interest the World Report by Marta Paterliniabout the shortfall of doctors in Italy. I commend Paterlini for highlighting this unsolved problem, but unfortunately, the piece fails to identify its real cause. Born, raised, and trained as an anaesthesiologist in Italy, then re-trained in the USA, I have had the privilege of living and working in different countries, and in my opinion, this issue is far from being addressed in a thorough and systematic way.

It is true that a real emergency now exists, up to the point where several Italian regions are trying to recruit doctors from Eastern Europe and Pakistan, are hiring Italian trainees in their last year of training, and doctors with no specialisation in emergency departments. Nevertheless, a couple of crucial points are missed in the World Report.

2 European Commission

Geography of mobility: establishment. There is some uncertainty about the exact number of Italian doctors working abroad; EU datasuggest that 1000 doctors leave the country every year, but this is probably an underestimate. Retaining these doctors in Italy could at least partially solve the problem.

Yes, not enough training positions exist compared with the number of graduates. Simply increasing the number of training positions (with no reassessment of the training pathway) would result in an uncertain curriculum. The number training positions have not been substantially increased this year; however, hiring doctors straight out of medical school with no specialisation (which is mainly being done in emergency departments) poses serious questions about quality of care. Hiring doctors in their last year of specialisation is allowed as long as they start working once their training is complete.

The real problem does not lie in the mismatch between the number of new specialists entering the workforce and the number of doctors who retire at the end of their career, but in the mismatch between the number of doctors leaving (ie, either retiring or leaving the country to work abroad) and entering the system. The real problem is not the scarcity of specialists but rather how unattractive the Italian system is to foreign specialists.

Have those politicians, press journalists, and representative of doctors' unions who have been making their opinions known ever wondered why no doctor wants to move from France, Germany, the UK, or North America to Italy to work? Why does Italy have to recruit from countries with a lower income and worse working conditions rather than just improving its own working environment and ultimately becoming a more attractive place to work? The benefits of making these improvements would be enormous for patients and the whole medical community.

Italy is not an attractive place to work. Inadequate working conditions, little stability, growth, or potential for career progression, low salaries, the commixture of politics and the health-care system, and fake recruitment committees (the notorious Concorsi Truccati) hit the headlines regularly. Many other countries have plenty of well educated Italian and non-Italian doctors with great skills and ideas who would be willing to work in Italy if circumstances changed.

I do not think (and certainly do not hope) that politicians, doctors' unions, and journalists are purposefully hiding the problem and diverting the public attention from what the issues are, but I do think that there is inadequate understanding of the real problems. The rest of the world is moving fast, and Italy is reaching a point of no return.

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I declare no competing interests.