Territory Medicine Doctor
Territory Medicine Doctor in Italy
What is a Territory Physician and what do they do?
Italy has a national health service that was started in 1978. Before that time it had a privately funded health system similar to what is currently in Germany. It was based on an Insurance system. Everyone had to be insured and if you weren't able to insure yourself the Italian State would insure you. There were also a lot of private insurance companies that integrated into this public-private network of health insurance. The Hospitals were owned by private companies and when you worked as a general practitioner you were paid by these companies. All of this changed in 1978, when the Italian State made a major investment in it's healtcare system. in 1978 Italy's economy was booming and there was money to spend on social services. After instating the Social Health Care system that was run, owned and operated by the state there were many groups that weren't happy with the change in policies. One of these groups were the general practitioners, who were getting less money than they did before for the same job. To appease this group a service was started so that instead of having to be on-call for your patients 24 hours a day 7 days a week, you could be on-call 12 hours a day 5 days a week. The rest of the time for every 5 general practitioners (or about 5000 people) there was one out-of-hours General Practitioner or as they call it in Italy a Territory Medicine Physician (Territory Medicine because in contrast to the Hospital Physicians that don't leave the hospital the territory Medicine Physicians also do house calls). Doing this made the General Practitioners happy and gave jobs to a lot of Doctors that were specialists but didn't have a fixed position. Over the years the position has changed and instead of 1 doctor every 5000 people at night in some places that we work it is 1 doctor every 50000 people at night. This has been especially evident during the last few years where there have been significant budget cuts and there have been less and less doctors per area. During this time there is also an Emergency room active that serves approx. 250.000 people where another Doctor and a team of nurses and assistants work. Needless to say, things get crowded both at the emergency room and at our clinics. A lot of people prefer to come to us rather than go to the emergency room since the average wait is 5-8 hours. This should be said for the emergency services in Italy, if there is a serious case you will be seen right away and treated appropriately, but if it isn't a possibly life threatening illness it will take a long time.
Initially the role of Territory physician was thought of as an after hours General Practitioner that was supposed to work as such but over time different things have been added to the job. The most difficult of these extra requirements are dealing with psychiatric patients and possibly issuing Restrictive Public Health orders that in effect locks them up in a secure hospital room for 3 days. Just dealing with all the psychiatric meltdowns that happen during the nights can be a real challenge. Now, immagine a meltdown in strong, physically healthy person that is intent on destroying his house and/or hurting his family. Not fun. These psychiatric cases often involve the police and often we are called out by the police to pharmicalogically subdue patients (aka DRUG THEM UP and PUT THEM OUT). Valium, Halloperidol ecc, whatever it takes. The police hold them down, you shoot them up and the ambulance carts them away to their hospial cells. There aren't Nut houses in Italy anymore since 1983
What is a Territory Physician and what do they do?
Italy has a national health service that was started in 1978. Before that time it had a privately funded health system similar to what is currently in Germany. It was based on an Insurance system. Everyone had to be insured and if you weren't able to insure yourself the Italian State would insure you. There were also a lot of private insurance companies that integrated into this public-private network of health insurance. The Hospitals were owned by private companies and when you worked as a general practitioner you were paid by these companies. All of this changed in 1978, when the Italian State made a major investment in it's healtcare system. in 1978 Italy's economy was booming and there was money to spend on social services. After instating the Social Health Care system that was run, owned and operated by the state there were many groups that weren't happy with the change in policies. One of these groups were the general practitioners, who were getting less money than they did before for the same job. To appease this group a service was started so that instead of having to be on-call for your patients 24 hours a day 7 days a week, you could be on-call 12 hours a day 5 days a week. The rest of the time for every 5 general practitioners (or about 5000 people) there was one out-of-hours General Practitioner or as they call it in Italy a Territory Medicine Physician (Territory Medicine because in contrast to the Hospital Physicians that don't leave the hospital the territory Medicine Physicians also do house calls). Doing this made the General Practitioners happy and gave jobs to a lot of Doctors that were specialists but didn't have a fixed position. Over the years the position has changed and instead of 1 doctor every 5000 people at night in some places that we work it is 1 doctor every 50000 people at night. This has been especially evident during the last few years where there have been significant budget cuts and there have been less and less doctors per area. During this time there is also an Emergency room active that serves approx. 250.000 people where another Doctor and a team of nurses and assistants work. Needless to say, things get crowded both at the emergency room and at our clinics. A lot of people prefer to come to us rather than go to the emergency room since the average wait is 5-8 hours. This should be said for the emergency services in Italy, if there is a serious case you will be seen right away and treated appropriately, but if it isn't a possibly life threatening illness it will take a long time.
Initially the role of Territory physician was thought of as an after hours General Practitioner that was supposed to work as such but over time different things have been added to the job. The most difficult of these extra requirements are dealing with psychiatric patients and possibly issuing Restrictive Public Health orders that in effect locks them up in a secure hospital room for 3 days. Just dealing with all the psychiatric meltdowns that happen during the nights can be a real challenge. Now, immagine a meltdown in strong, physically healthy person that is intent on destroying his house and/or hurting his family. Not fun. These psychiatric cases often involve the police and often we are called out by the police to pharmicalogically subdue patients (aka DRUG THEM UP and PUT THEM OUT). Valium, Halloperidol ecc, whatever it takes. The police hold them down, you shoot them up and the ambulance carts them away to their hospial cells. There aren't Nut houses in Italy anymore since 1983