The problem of general practitioners remains unresolved


by Enzo Bozza

31 OCTDear Director,
why after so many years we are still stuck in the debate on public health care with a thousand considerations on the subject and as many proposals for reform of the service, arriving at nothing but the progressive advancement of a private type of care system?

Already the extent of the debate, the more than ten-year duration and the multiplicity of the solutions proposed, speak volumes about the complexity of the problem but whenever the dispute becomes so heated, there is almost always an ideological prejudice.

The first obstacle is the lack of conception on the importance of local medicine in the public service: no government has ever realized that all health management has its pivot in primary care in the area: the general practitioner governs pharmaceutical expenditure, specialist medicine , hospital admissions, screening prevention, much of the public and private certification.

However, we are children of that medical conduct that has had so much history and role in the past but has never evolved into a dimension of public role recognized by the State, we have remained freelancers, paid per service, after the conduct, we have moved on to mutual and in 1978 we became “general practitioners” with a parastatal role, never subordinate and never dependent on a structure. For this reason, the patients have never become such, but they have remained customers as in medical conduct, customers with a knife on the side of the handle, because as long as the doctor’s salary depends on a capital share per patient, he will always be blackmailed. for any undue and improper request: “otherwise I change doctor”.

Another prejudice that weighs heavily, contractually, is the perception that one has of the general practitioner: a second-class doctor who has no credit towards real hospital doctors: hence the devalued role by customers who prefer the noble specialist often private and the subtle contempt of the health company that has never re-evaluated this plebeian healthcare in white coats, managing it more as a necessary evil than a very important resource. Closer to annoyance than a fundamental tool.

The third hitch in the evolution of local medicine towards a modern organization and in step with a more institutional role, is the absolute convenience for the State to maintain the agreement, because as freelancers with a VAT number, it collects 43% of Irpef, a revenue tax that would be drastically reduced with the dependency relationship. Among other things, the State should bear all the ancillary running costs for the management of the clinics. Let’s talk about money, the most authoritative interlocutor for any question. And it is always money, when the Enpam does not give up.

As freelancers we keep up the bandwagon with our contributions. As civil servants, everything would pass into the hands of the INPS and goodbye bandwagon. The major centers of power: the state, the Enpam and the largest union of the mmg, the Fimmg, have no interest in changing our role. For all these reasons we have been losers for almost half a century and we will continue to be losers if starting from ourselves, the medical basis, we do not change the paradigm, abandoning the useless intramoenic discussions on the sex of angels and, for good time, we try to establish first of all our role, starting from the principle that the NHS must have as its pivot not a mercenary but a general practitioner, a public doctor recognized at all levels. Only in this way will we have optimal, fair, proportionate and efficient performance. Stop chasing Matrix digital algorithms or the logic of hospital-style outpatient clinics.

The medicine of the territory is still medical conduct, with modern tools but with a logic of proximity to the people and capillarity on the territory which is its specificity and can never be anything else and certainly not the bad copy of hospital medicine, it is from our specificity of role that we must share. That they understand it, at the Ministry, once and for all, but we doctors must understand it, above all.

Enzo Bozza
General practitioner in Vodo and Borca di Cadore

October 31, 2022
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