2023-10-07 13:07:38
The war on coin-operated doctors, declared by the Minister of Health Orazio Schillaci since his inauguration with the Nas of the Carabinieri who at the end of 2022 went to verify in the field the phenomenon managed by cooperatives that ‘rent’ coin-operated doctors to work in emergency rooms public, enters a new chapter given that Schillaci has given an ultimatum to the Regions to put an end to this practice at the end of the year. But who are the token doctors and how much do I earn compared to fellow employees who work with them in the emergency room? The time.news Salute investigation tried to understand the phenomenon and give a face and a voice to these professionals portrayed as one of the evils of the NHS.
The passion for Medicine, long experience in emergency rooms in the province and in a large and complex city like Rome. Then, after almost 30 years in the profession, the choice to resign because “doing my job, the best of all, was now impossible” and the “personal” decision to become a ‘tokenist’ doctor, that is, one who offers his services as a freelancer through a cooperative to public and non-public structures, which have a shortage of doctors. This is the story told to time.news Salute by Dr. Antonella Maria Ciammella.
“I have been working in the emergency room since 1999 and I have always liked it, but now everything has changed and certainly not for the better, on the contrary. I asked to change department, but I was denied – he continues – After Covid the situation has become intolerable and I have I chose to leave public healthcare, which I have defended and will always defend. For a couple of years I have been working as a ‘token operator’, I want to clarify that the salary is not the figures that appear in the newspapers, I do not earn three times as much as my colleagues. I get less. Of course, a young colleague who earns 1,200 euros for a 12-hour shift and is always available can reach significant sums at the end of the month, even 10 thousand euros. But the price he pays is high: you no longer have a life, above all if the cooperative you work for ‘rents’ your skills to a large hospital”.
“Instead of giving an ultimatum to the Regions” on the issue of token operators as the Minister of Health did, “it would be more correct to understand the problem well. The era of those who entered the hospital and remained there 24 hours a day all their lives is over, today whoever arrives wants to know what they are up against and gives a different weight to the work”, remarks Biagio Epifani, president of Simeu, the Italian Society of Emergency Medicine (Simeu) of the Veneto – But who are the token doctors? “They are doctors who have been working as freelancers for years, there are colleagues who come from military backgrounds, those who work for VAT, it is clear that the orientation is to earn more – he replies – but it is all under the sun. Of course, these are not the figures that appeared in the newspapers, they are not a thousand euros a day, but much less given that it is the cooperative that has the contract and the hospital pays the company which then pays the doctor. Whoever manages the emergency room can do even a selection, you may not accept, for example, doctors over 70 who are proposed”.
The economic point of view in the issue of ‘coin-paying’ doctors in emergency rooms has become the crusade of the Minister of Health Orazio Schillaci. But hospitals and local health authorities have made extensive use of cooperatives. “I earn less than 50 euros an hour – she specifies – because I have to pay for everything myself, social security, insurance. I earn if I work, if I get hurt I stay at home and I don’t get a single euro. Of course – warns the doctor – today that I am in a private clinic affiliated with the NHS with a small emergency room, the rhythms are not those of an Umberto I or a San Camillo. But they are hiring several doctors with token contracts because they should open a new structure”.
The doctor specialized in Gastroenterology has always worked in emergency departments. “I had a very good time in Formia with a good head doctor who managed to bring the emergency room to excellent levels, then returned to Rome. But in the capital – she underlines – healthcare experiences other dynamics, often linked to baronies and politics, and here things got worse. Then I had some health problems, the workload in the emergency room became insurmountable and finally the Covid pandemic arrived which dragged everyone into the abyss.”
As heroes of the pandemic, emergency room doctors have returned to being in the trenches, between grueling shifts and attacks on staff. “In the emergency room the most obvious problem is that of ‘boarding’, that is, the people who arrive are assessed and while waiting to go to the department they remain on stretchers because there are no beds in the departments. They stay there for hours, days, even up to 10 days – adds the doctor – So the workload of us emergency doctors increases dramatically because you have to manage new accesses and also those who remain with us because there are no beds in the hospital”.
Instead of giving an ultimatum to the Regions” on the issue of token operators as the Minister of Health did, “it would be more correct to understand the problem well. The era of those who entered the hospital and remained there 24 hours a day all their lives is over, today those who arrive want to know what they are facing and give a different weight to the work”, Epifani remarks. But who are the token doctors? “They are doctors who have been working as freelancers for years, there are colleagues who come from military backgrounds, those who work for VAT, it is clear that the orientation is to earn more – he replies – but it is all under the sun. Of course, they are not the figures that appeared in the newspapers, they are not a thousand euros a day, but much less given that it is the cooperative that has the contract and the hospital pays the company which then pays the doctor. Whoever manages the emergency room can also make a selection, for example, doctors over 70 who are proposed may not be accepted.”
“Many doctors have left, the amount of work has become truly impossible to bear, I have seen younger colleagues – he recalls – crying in a corner of the emergency room due to tiredness, the inhuman work, the attacks by patients exasperated by the long expectations”. After Covid, the Government decided to give an incentive to those who, employed in the hospital but in other departments, decided to take shifts in the emergency room. “But don’t improvise as an emergency doctor – concludes – the doctor – They came to lend a hand but many don’t know what to do, you need professionalism that can’t be invented overnight”. (by Francesco Maggi)
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