“They earn 3,600 euros in 48 hours” – Corriere.it

from Simona Ravizza and Giovanni Viafora
The great escape from hospitals and the business of cooperatives. Here are the deals and prices in the Telegram jungle. “There are colleagues who travel by bus. With 3 or 4 shifts they take more than one hired in the hospital “
Lo last March, in a hospital in Brescia, a young woman dies a few hours after giving birth to her third child.
One of the doctors who is treating her, according to an authoritative testimony collected by
Courier
, has been at work for 36 hours. At the moment it cannot be said whether the circumstance played a direct role in the death; to establish it will have to be the Prosecutor’s Office, which has opened an investigation on the case (7 health workers investigated). One thing is certain: that doctor could stay where he was even after all that time, because unlike his fellow hospital employees – and therefore bound to respect schedules – he was there as a token operator. That is, as one of the thousands of professionals who enter Italian hospitals every day, hired by external cooperatives entrusted to health companiesto cover the increasingly numerous organic holes. Called tokenwhich means paid for a single shift (usually 12 hours), in a field essentially without rules. Result: today it is possible, perhaps driven by economic needs, to accumulate even more tokens one after the other. Without anyone checking. As it happened in this case. But who among us would see a doctor standing up for 36 hours? This is just one of the critical issues that emerged from our investigation into the phenomenon of tokenists. A phenomenon which is now becoming more and more widespread and which is radically changing the physiognomy of Italian hospitals struggling with staff reduced to the bone. And which represents, in addition to all that we will see, first of all an expense for the state coffers: for a token you can offer up to 1,200 euros per shift for each doctor, essentially more than half of the salary that a trainee takes in a whole month. But why did this situation come about? Who is behind the cooperatives that act as intermediaries? And who are the doctors who end up in hospital and how are they chosen? These are the questions we have tried to answer to ultimately understand, today, who cares for us.
The holes in the organic We must start from the (impressive) numbers concerning the shortage of doctors. A phenomenon that is essentially due to three reasons.
One: the turnover in Healthcare blocked for 14 years (from 2005 with the Berlusconi 2 government to 2019, with Conte 1, which brought hirings to + 10%).
Two: a short-sighted planning, if not completely wrong, with downward specialty contracts for years and never calibrated to replace those who retire, so much so that from 2015 to 2020 the retirees were 37,800, compared to 24,752 specialized ready to enter the health service.
Three: a sensational acceleration of voluntary resignations by hospital doctors, especially after Covid, due to a general worsening of working conditions, with increasingly grueling shifts and increased conflict with patients.
In 2021, 2,886 voluntary layoffs were recorded: + 39% compared to 2020. It is a trend that, if confirmed, will lead to an overall loss between retirements and layoffs of 40,000 specialists by 2024 (estimate by the Anaao medical union).
The mechanism Someone, however, must also be in the hospital. Healthcare companies, with their backs to the wall, rely on cooperatives: they are the ones who guarantee the doctors paid by the token. The problem is above all the First Aid, which are the wards most in crisis. According to a survey carried out for the Courier from the Italian Society of Emergency and Emergency Medicine, led by Fabio De Iaco, out of a sample of 31 hospitals, today one patient in 4 has a chance of being assisted in the emergency room by a doctor from a cooperative. But on nights or weekends the proportion can be as high as one in two. It sounds like a paradox, but finding a doctor for the cooperatives is not difficult. Hospitals to the holds concede remunerative announcementswith often low entry requirements (and in any case far from those required for an internal doctor, who must be at least specialized). Example: the Papa Giovanni XXIII hospital, with one of the most important emergency rooms in Lombardy, and whose name has been around the world as one of the first outposts of the fight against Covid, manages to solve the situation by relying on a cooperative. The determination is the number 233 of May 4, 2022 entitled: «Assignment of the medical guard service at the Emergency Room of the Asst Papa Giovanni XXIII headquarters. Duration 7 months from 01.05.2022 to 30.11.2022. Total presumed expenditure € 183,382.50 including VAT 5% ». The need is to cover 175 shifts, each lasting 12 hours, remuneration 998 euros per shift. The criterion of choice, as can be read verbatim, is “the lowest price”. Point. In this context, it is easy for those who want to escape any type of quality constraint to expand to the detriment of cooperatives which instead invest in safety, experience of doctors and legality. It is also simple, for those who do not bear these costs, to be able to apply lower prices and thus win many calls for tenders: they can perhaps be entrusted to recent graduates, which is easy, among other things, given that in the last ten years 11,652 have been excluded from specialty schools. recent graduates, or to foreign doctors. Of course, at the expense of patient safety.
Offers on social networks Matching supply with demand is easy. Cooperatives place ads on their sites, but especially on social media, such as Telegram. There are channels ad hocwhere if you are a doctor you can register with a click and wait for the right token. The Courier
he managed to have access to one of these channels, where he could observe incoming messages for a few weeks. Like these: «Would anyone be interested in covering night shifts with minor codes in the province of Vicenza? I pay 65 euros per hour ». And it is specified, for those who had not understood: «By making a simple calculation that’s 4,680 euros for six tokens“. There are dozens of messages a day. Shift schedules don’t seem like a problem. A company places the announcement for a day and night guard post in a rehabilitation clinic in Arezzo: “Compensation 420 euros per shift, possibility of 24 or 48 consecutive hours (allowed by the clinic) and merged shifts “. Another: «We are looking for a doctor to be included in the staff for the coverage of day and night shifts and for the management of the minor codes of the Nuoro emergency room. Fee 600 euros per 12-hour shift plus accommodation. Possibility of combining shifts for those coming from outside the Region ». The amalgamation of shifts is considered a benefit: «There are doctors business travelers who organize themselves by bus, take 3 or 4 consecutive tokens working until they are exhausted and then return home with a booty of 4-5,000 euros which is enough for the whole month», A Lombard head physician tells us who asks to speak covered by anonymity. The picture is so distorted that there are now paradoxical cases: the former director of the Monza Polyclinic and then deputy primary in Paderno, Riccardo Stracka44 years old, he resigned, leaving his permanent position, and started to work as a coin operator for a cooperative that moves between Lombardy, Piedmont and Veneto. He says he earns 60-70% more than before; while the quality of life has radically changed: the possibility of organizing. And consecutive tokens are just one of the problems. Another concerns the continuity of care: “I find a different doctor on the ward every evening,” confides another director of a complex unit in Lombardy. Not to mention the titles: a few nights ago, one of the main emergency rooms in Milan was managed by a transport doctor (which certifies the renewal of driving licenses). After his work at the company, he went to get the 1,200 euro token.
Who arrives in the ward? The cooperatives themselves oversee the quality of the doctors sent to the ward, whose seriousness is entrusted with the evaluation of the curricula. And it’s a jungle. No provision of the Ministry of Health imposes on the general directors of hospitals the rules to be followed for drawing up tenders for outsourcing to cooperatives, so that everyone can do practically what they want. It is enough to go through the tenders of the last few months to realize that the cooperatives operate in a market that is absolutely out of control. Promised professionals of excellence, no certainty about who really gets to the ward. Another important aspect is that of sureties (banking or insurance) that almost no ASL takes the trouble to check. “I know companies that have presented sureties from unknown foreign entities and ASL which, after having revoked the contracts, have big problems in collecting the guarantees,” says the manager of one of the most important cooperatives operating in Northern Italy. “And many ASLs don’t even bother to consult the Anac Anti-Corruption records to verify that the companies have not had any problems” .
Health and business There is no shortage of surprises among the various cooperatives. One of the most active, with contracts in dozens of hospitals between Lombardy and South Tyrol (and a tour of a hundred doctors) is for example the Medical Service Sudtirol. Behind the group established in 2018 “with the aim – as stated on the modest web page – to provide health professionals suitable to meet the need for staff”, there is only one person, Dr. Jamil Abbas, Lebanese origins, for years transplanted to Bolzano where he works as a freelancer in the emergency room. The two companies that operate behind the Medical Service are registered in the name of one of his wife, the other of his 23-year-old son (active since 2021). Employees: one. Oddities, such as the one regarding Venice Medical Assistance, run by husband and wife, Carla Pirone and the doctor Pietro Piovesan. The messages with their announcements appear in the doctors’ chats: last May a token operator was offered 90 euros per hour for a place in the emergency room of the Santorso hospital in Vicenza. Too bad, however, that the hospital had the contract with the giant Anthesys of Treviso (cooperative with 390 employees). Who controls, then, who is entrusted with what? «It was naïve, we had simply relayed a message on behalf of a person – Pirone told us on the phone -. We take care of something else ». In fact, on the chats of doctors, in the period we observed, there are other announcements of Venice Medical Assistance. See that of 6 August for “shifts at the Conegliano emergency room”. Token: 59 euros per hour. Like this business for cooperativeswhich usually retain a percentage ranging from 7 to 15% on each shift, are booming. Anthesys itself indicated revenues almost doubled in 2021: 14 million euros against 8.8 in 2020. Profit 234 thousand euros against 92 thousand of the previous year. “The continuous expansion of services – reads the budget – has led to an increase in activity of over 64% with peaks of 90 compared to the previous year”. And the same goes for Medical Service Sudtirol: in 2021 revenues reached 1.4 million euros (+ 30%) with a profit of 178 thousand euros. “The year was characterized by an increase in revenues from services, even significantly surpassing the results of previous years”.