Family Pediatricians: Over 500 are missing, three out of four in Lombardy, Piedmont and Veneto

There is a shortage of at least 502 family pediatricians and most of the shortages are concentrated in three large regions in the North: Lombardy, Piedmont and Veneto. In some areas, the maximum of 1,000 patients per pediatrician is exceeded, while 2,598 will retire by 2028. This was revealed by the Gimbe Foundation, which analyzed the dynamics and critical issues that regulate the inclusion of private pediatricians (PLS) in the NHS, estimating the extent of the shortages in the Regions. According to the Ministry of Health website, the private pediatrician is the doctor responsible for protecting the health of children and young people aged between 0 and 13. Every child, from birth, must be assigned a PLS to access services and benefits included in the Essential Levels of Assistance guaranteed by the National Health Service (SSN). "Reports on the difficulty of accessing the PLS - says Nino Cartabellotta, president of the Gimbe Foundation - are arriving today from all the Regions, highlighting recurring critical issues: bureaucratic complexity, lack of response from the Local Health Authorities (ASL), pediatricians with a high number of patients and the impossibility, for many families, to enroll their children in a PLS. A situation that generates significant inconvenience and requires urgent organizational interventions, to guarantee the continuity of pediatric care, especially for the youngest and most fragile".

Age groups. Up to the age of 6, children must by law be assisted by a PLS, while from 6 to 13 years old, parents can choose between the PLS and the general practitioner (MMG). Upon reaching the age of 14, the assisted person is automatically revoked, except in cases of chronic pathologies or documented disabilities, for which it is possible to request an extension until the child reaches the age of 16. According to Istat data, as of January 1, 2024, the 0-5 age group (mandatory registration with the PLS) included almost 2.5 million children, while the 6-13 age group included over 4.1 million minors, who could be registered with the PLS or with the family doctor according to the parents' preferences or, above all, based on local availability.

Demographic picture. The progressive decline in births is significantly changing the audience of pediatricians' patients. Istat data document a constant reduction in children in the 0-5 age group, for whom registration with the PLS is mandatory: between January 1, 2019 and January 1, 2025, there were approximately 430 thousand fewer potential patients for the PLS. "As a result, in the same period - observes Cartabellotta - the collapse in births has reduced, on a national scale, the need for PLS by over 500 units in just 6 years". In 2023, 379,890 new births were recorded in Italy, while 570,894 adolescents turned 14. Considering that 57.5% of the 6-13 age group is still registered with PLS, it is estimated that 328,264 patients have moved from PLS to family doctors, compared to almost 380 thousand newborns registered with PLS. The balance involves a net increase of over 50,000 patients for PLS, with a consequent increase in the care burden.

Maximum number of assisted persons. The latest National Collective Agreement (ACN), in force since 25 July 2024, has set the maximum number of assisted persons for each PLS at 1,000, eliminating the previous distinction between ordinary and derogation choices. Once this maximum has been reached, the PLS can acquire new assisted persons only by simultaneously rejecting an equivalent number of children in the 6-13 age group. Above the threshold of 1,000, the only exception provided for is the registration of siblings of assisted persons already in charge. Temporary exceptions to the maximum of 1,000 may be granted by the ASL exclusively for a limited period, in the presence of specific needs related to the local context or organizational criticalities (e.g. unavailability of other PLS in the area). "The real issue - underlines the president Gimbe - is that the shortage of over 5,500 GPs, already highlighted by our previous analysis, risks leaving uncovered the children "rejected" by the PLS, who may not find an available GP. In many cases, therefore, the only solution remains the extension of the exemptions to the maximum, fueling a vicious circle of overload and reduction in the quality of pediatric care".

Lacking territorial areas. The inclusion of new PLS in the NHS occurs after the Region - or a body identified by it - has identified the lacking territorial areas, i.e. the areas where it is necessary to fill a care need and ensure a widespread distribution of PLS ​​studies throughout the territory. According to the latest ACN, the shortage is calculated on the basis of an optimal ratio of 1 PLS for every 850 children, or a fraction greater than 450. In particular, to define the need, all residents under 14 are added, deducting those in the 6-13 age group in the care of GPs. In the absence of regional supplementary agreements, it is considered that 70% of the population between 6 and 13 years of age can be assisted by PLS. «Substantially, with the new ACN - explains Cartabellotta - all patients in the care of PLS ​​are included in the calculation of the need, even those in the 6-13 age group who were previously excluded. This allows us to correctly parameterize the number of PLS ​​in relation to the population actually assisted".