Doctors In Limbo: How Italy’s Grey Coats Are Fighting Back

In the height of a pandemic, bureaucracy is blocking thousands of doctors from joining the fight.

A grey coats protest in Naples
A recent grey coats protest in Naples. Photo: Francesca de Vita.

24,000 doctors took their entrance exam in July 2020 to specialize in their fields. Instead, these ‘grey coats’ are blocked by the Italian bureaucracy and political wrangling.

The Covid-19 emergency has slowed the legendarily sclerotic Italian bureaucracy into near paralysis, with almost every aspect of our daily lives in some way affected. However, one case in particular has sparked outrage in the media and highlighted the glaring holes in the system. The exam for medical specialization, which qualified doctors must pass in order to move into their field, was postponed to September of this year by order of the government. However, due to an error in a question and other mistakes found in the exam, the results have not yet been released and consequently those doctors cannot move into their specialties. This is only one of a series of barriers put up by the government to prevent highly trained and dedicated doctors from entering the field where they could be a critical asset to the health system.

Those who took the exam in September now await their fate in purgatory, as the Ministry of Education continues to postpone the deadline. They are effectively in limbo, and as such have been unable to support their colleague in the Italian health system during this pandemic. This highly qualified group of essential workers must wait on the sidelines because of a clerical mistake that no one seems willing or able to fix. But rather than sit idly by while their colleagues face exhaustion and danger, these ‘grey coats’ are taking to the streets, calling for the government to release them from limbo.

Giulia C. (front left) with other grey coats protest in Rome in front of the Ministry of Education. Photo: Matteo Mancini.

“I’m nothing but a dot in the system”

Giulia C. is a certified doctor with a medical degree from La Sapienza University in Rome and dreams of becoming a heart surgeon. Instead, she is protesting outside of the steps of government buildings in Rome along with other ‘grey coats’, the nickname given to those men and women who wait as certified doctors to specialize in a specific field of medicine. The protests, which began on December 4, have taken place every day and are full of doctors in the same situation in which Giulia finds herself. 

For those unfamiliar with the process, becoming a medical doctor in Italy is one of the most arduous professional pursuits one can undertake, and can involve more than a decade of study, internships, and residencies before being able to actually practice medicine. Even getting to such a point involves passing a number of notoriously difficult exams for which places are tightly controlled, making medical school an intensely stressful experience from the very beginning.

While recently there have been calls to abolish the closed number system of medical schools, it does not really help those who are already in the system and looking to advance. Though Education Minister Gaetano Manfredi has allowed more people access to a medical degree, it inevitably led to a bottleneck of ‘grey coats’ still stuck in the system. Because so many roles in the health system require a specialized doctor, a lack of them in particular fields results in an imbalanced health system. As Giulia notes, “when you finally pass, there is no information about the field you are allocated to work in. Professors do not want the information to be leaked and those who are in already are too scared to share anything.”

Changes to the exam guidelines have also been proposed, with various representative organizations of young doctors collaborating on drafting an outline. However, the changes that the government would approve would only partially help doctors waiting for specialization by also includes a clause that would allow the privileged few to advance far more quickly than others.

As Giulia explains, “one particular article determines that more points are granted to applicants who were able to publish articles before graduating, studied abroad, or even based on the thesis topic picked. But many students can take up to two years to get their thesis proposal accepted because professors are not encouraged to take students in.” So what about those who cannot publish or cannot afford to study abroad for a semester? Put simply, they remain in limbo. 

For Giulia and thousands of others, the years that they have devoted to their chosen profession seem to vanish in the face of bureacratic inertia and political squabbles. But they refuse to back down. “I am nothing but a dot in this system,” she says, “however, I need to speak up alongside my colleagues because I believe that we have been treated unfairly.” 

#SBLOCCATESSM2020

In a global pandemic, the consequences of withholding the results of these exams goes far beyond the hypothetical. In a time where local, regional, and national politicians are calling for more medical professionals to assist in healthcare around the country, the fact that over 24,000 qualified doctors are unable to work in hospitals feels both surreal and senseless. Giulia shares this sentiment. “If the list of accepted doctors was published, those who had not been accepted could support the pandemic health emergency.”

In an open letter from July 2020 several medical organizations noted that, “medical staff has sharply decreased due to a financial cut of 37 billion euros, leading Italy to call retired doctors and those practicing abroad back to work during the pandemic. How did we get here? […] The government has not prioritized the needs of specialist doctors, nor has it financed an adequate number of contracts for specializing programs.” 

While the ‘grey coats’ can only sit at home and wait, they refuse to do so quietly. Instead, these doctors have been are sharing their concerns online with the hashtag #SBLOCCATESSM2020 — unlock the exam for specialization formation, the scuole di specializzazione sanitaria — and organizing in cities to peacefully protest a system that belittles them and that, at the same time, implores them to make enormous sacrifices.

Giulia is adamant. “We are not students. We are qualified doctors who passed the State exam and want to support our country. But until we complete our specialization, we are given huge responsibilities without the rights granted by a proper contract.” She notes that politicians have sharply criticized their work to improve the examination guidelines and that Minister Manfredi himself called the grey coats “aggressive.” At a time when a virus is running rampant and crippling even the best health systems in the world, perhaps a legion of doctors ready to go to battle, and unafraid to be ‘aggressive’, is exactly what Italy needs.

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