The “state of health” of the National Health Service is a topic on which everyone has something to say. It’s a shame that, even in important debate spaces, we continue to hear – often from communications champions – the expression “family doctors’ lobby”. A definition that is jarring and turns up one’s nose. Logically, a truly privileged and powerful category, such as to be defined as a “lobby”, should be inundated with requests to enter: young doctors ready to queue to enter that world. But that’s not the case. And the numbers prove it.

What the data really says

There were 37,260 general practitioners (GPs) on 1 January 2024, with almost 51.2 million patients in total. On average, each family doctor treats 1,374 people, but the differences between the Regions are significant: they range from 1,100 patients in Molise to 1,548 in the Autonomous Province of Bolzano.

Behind these numbers, the scenario is much more critical than it might seem. The current level of saturation puts the principle of free choice at risk: finding a general practitioner near your home is increasingly difficult, both in “desertified” areas and in large cities.

There are 5,500 doctors missing, and 7,300 will soon retire

According to the eighth report of the Gimbe Foundation, there is an overall shortage of 5,575 general practitioners, distributed across 17 Regions and autonomous Provinces. The most critical situations are recorded in the large regions: Lombardy (-1,525), Veneto (-785), Campania (-652), Emilia-Romagna (-536), Piedmont (-431) and Tuscany (-345). Basilicata, Molise, Umbria and Sicily, however, do not present significant deficiencies.

The lack of attractiveness of the profession is evident: in 2024, 15% of training grants have not been awarded and at least 20% of those enrolled abandon the training course before completion. Far from being a “privileged lobby”: it seems more like a critical area of ​​the system.

A training course considered “series B”

To better understand where these problems arise, I asked two professionals who represent the medical world well: Alberto Molteni, specialist in general surgery and medical-scientific communicator, and Massimiliano Bellisario, family doctor, also involved in dissemination.

“After graduating in Medicine, the path is not over: young doctors must pass a national competition to access specialization schools or the specific training course in general medicine. The specializations, lasting 4-5 years, train hospital or specialist doctors; the course to become a GP lasts three years, is regional and practical, but external to the university” explains Molteni to uisjournal.com.

And this is where a first, big problem emerges: the course to become a general practitioner, unlike other specializations, is not university-based.

Molteni is clear: “The training of the general practitioner takes place through a three-year regional course, managed with the support of Fimmg and other training bodies. It is a very practical path, with periods of internship and outpatient activities, however, being external to the university, it suffers from less integration with the academic world and with research. Making this path university-based, in my opinion, would be an important step forward: it would make it possible to standardize training standards, it would give greater dignity and visibility to the role of the family doctor and, probably, it would attract more young graduates. Many students today perceive general medicine as a second-class path, but this is not the case at all”.

In a context of an aging population and growing demand for local assistance, the figure of the family doctor is central. Precisely for this reason we need more structured, modern training linked to the rest of the medical world. Being defined as “part of a lobby” is not only inappropriate: it is light years away from reality.

“If we were a powerful lobby, there would be a queue”

Doctor Massimiliano Bellisario experiences this world from the inside. Pugliese, born in Taranto, he graduated in Medicine in Chieti in 2006 and in 2010 he graduated as a general practitioner. After seven years as an on-call doctor, he moved to Bergamo, where he immediately became a family doctor thanks to the lack of these figures.

His reflection is disarming in its simplicity: “If we were really part of a very powerful lobby, with a simple job, lasting a few hours and highly remunerative, don’t you think there would be a queue to do this job?”.

The reality is very different. The shortage of general practitioners translates into daily inconvenience for those who work and for patients:

“Unfortunately, we are now living in an unsustainable situation – says Bellisario – crushed by the weight of a bureaucracy that has increased dramatically after the pandemic, and burdened with an increasingly higher number of patients precisely because of the shortage. Clinical activity is reduced to the bare minimum and I almost have to feel uncomfortable when I ask a patient to undress and lie down on the table, because people are no longer used to it: they expect to be referred immediately to a specialist or to an instrumental examination. In short, rather than Doctors we are seen as simple dispensers of prescriptions, like ATMs, by the majority of users”.

Trust and “health consumerism”

Has citizens’ trust in family doctors really collapsed? Bellisario doesn’t see it that way: “Those who don’t have trust in the doctor didn’t have it before either; therefore, I haven’t noticed a change. The truth is that during the pandemic, my information campaign on vaccines led me to lose some patients.”

For him, one of the growing critical issues is another: “health consumerism”. Patients who self-diagnose on Google, who arrive with a list of tests to do, who demand tests without any criteria of appropriateness.

“I have spoken clearly with my patients: specialist visits and tests are carried out if they come to me first and I consider them useful. If they want to do it on their own initiative, they will not have positive feedback from me. Over the years I have managed to get this message across, but I must admit that it is difficult. Many colleagues, to avoid arguments, give in and prescribe what is requested, with an inevitable increase in healthcare costs”.

Reducing General Medicine to simply “making prescriptions” is misleading and harmful, not only for doctors but for the entire system. “It is necessary to change the narrative to restore value and attractiveness to a profession that is crucial for public health” Molteni also underlines.

The real lobbies

The real “lobbies”, if anything, are those that for years have been holding back the reforms necessary to give more dignity to this career:

• those who want to maintain regional courses instead of transforming them into structured university courses;
• those who continue to keep family doctors as private affiliated professionals, without guaranteeing them the same protections as employees: paid holidays and leaves, work in multidisciplinary teams, permits, recognition in the event of dramatic events such as death at work.

In short: stop calling general practitioners “lobbies”. If there is a cultural battle to be waged, it is precisely the one to restore value, tools and rights to those who, every day, are the first point of health for millions of citizens.