Pack 'Em In

Lecture Hall at an Italian Medical School, 2014

When I first moved to Italy, any high school graduate who thought they might like to be a doctor had the right to give medical school a whirl. Because of this open admissions policy, ten times more physicians were churned out each year than the country needed. And because there was no way those hordes of students could get individual attention from their teachers, and far too few bodies for them to learn on, you could graduate from med school without having ever touched a patient. Literally. Italian medical training was so notorious that when the European Union started recognizing degrees and specializations across borders, Italy risked being the only country excluded.

The threat of that humiliation goaded Italy to begin a minor revolution. By the turn of the century a system of selection for medical school had been introduced (based on a multiple-choice test), freshman classes had been slashed by 90%, and students were starting to be taught at patient bedsides instead of only from books. Italian medical training was making giant strides toward joining the rest of Europe.

Now, twenty years after Italian doctors began their Long March from laughingstocks to world-class clinicians, the Italian Health Minister, Giulia Grillo—a physician previously known mainly for waffling on the need for vaccination—has been crusading to turn back the clock by bringing back open admissions for medical school. No more tests. No more selection process. Anybody who made it through high school would again be welcome. Come one, come all!

Dr. Grillo, from the Five-Star Movement, has even added a sour cherry on top: the downgrading of postgraduate training. She points out, correctly, that due to sloppy planning Italy has gone from too many prospective General Practitioners to too few, and trains far too few specialists in emergency medicine to keep hospital Emergency Rooms properly staffed. Her proposed solution? Stop requiring docs hired for those jobs to have any residency training. Instead, she says, hospitals should be able to employ anybody with experience, such as night coverage (Guardia Medica) on the National Health Service, assuming they’ll have picked up their trade by osmosis. Even worse, she’s suggested maybe those ER docs and GPs could be hired fresh out of medical school. Anywhere in the world that would be a mistake, given the complexity of modern medicine, but in Italy—where medical school is still relatively weak on the practical—it would be madness.

Already many young Italian medical graduates flee the country, headed for nations where they expect superior specialty training, higher stipends, and eventually a better chance at real jobs. And already Italian specialty training is uneven, turning out specialists whose levels of competence range from superb to iffy. If even that spotty training is turned into an optional, with self-taught doctors handling heart attacks and accident victims . . . poor Italy!

Pardon my rant. I’ve never been good at buddhistic acceptance, and the coronation of Donald Trump reset my indignation threshhold even lower. By now even a considerably less dangerous Italian Minister of Health can trigger it.

P. S. The picture of a medical school lecture hall at the top of this post was from 2014, when the admission process was highly selective. Imagine how packed those halls used to be when ten times as many students were enrolled, and how they will be again if Dr. Grillo gets her way.

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