Imagine walking Rome’s ancient cobblestone streets, skiing on the slopes of the Alps, sipping wine in Chianti’s vineyards, and spending the summer swimming in the crystalline waters of the Amalfi coast. Italian beauty, tasty food, and warm people leave me speechless every time I go back.
As you’ve probably already figured out, I am Italian and completed my medical training at the University of Milan-Bicocca. After graduation, I moved to the United States for residency and fellowship and I currently live in Virginia. I have not gone through the process of having my specialty recognized in Italy, yet, with this post, I offer a perspective on the Italian Health Care System and the initial steps you can take if you are interested in living and practicing medicine in this beautiful country.
For more information on medical licensure in Italy check out How to Obtain an Italian Medical License.
Italy’s Healthcare System
Italy has a National Health Care System, called “Sistema Pubblico” , and also Private Hospitals and clinics. The quality of care varies according to where you are located.
Italian citizens and legal permanent residents qualify for a health card, or tessera sanitaria, to use the Sistema Pubblico; you simply need to register at a local health center. The tessera sanitaria grants you access to free emergency and inpatient services at public hospitals and a reasonably priced “ticket “or copayment for outpatient services. There are certain groups of people that are exempt from a copayment – such as individuals who are older than 65 or living with a chronic medical illness or earn a low income.
Waits are at times very long in the public sector and that’s why some people might opt to go to private hospitals or clinics where you pay out of pocket. Depending on where you are in Italy, there might be different types of private hospitals that could be more or less connected to the public sector. Private Health insurance is not needed and not mandatory, but more people in recent years are opting to get it to help to pay for services obtained in the private sector.
All health care services are provided by physicians only; there are no physician assistants or nurse practitioners. There are EMRs but this depends on where you are; in some regions paper charts are still the mainstay.
Finding a Job
After receiving your Italian Medical License, a physician can choose to work for the public or private sector. There are some physician recruitment agencies but the easiest way to find a job is via word of mouth or getting to personally know doctors working at your hospital of interest.
To work for the public sector, you will need to wait for a competitive examination for qualified candidates, called Concorso, to be published online for the desired hospital and position and apply for it. They will evaluate you based on your credentials and the results of a practical and written exam. If you end up being first in the final list, graduatoria, you will get the job. Working for the public system means that you will have a contract for a permanent job, contratto a tempo indeterminato, something that a lot of physicians in Italy aspire to get because you are salaried, get many benefits as detailed below and the focus is not placed on productivity alone but also on academic work.
In the private sector, finding a job is similar to the United States. You can contact the hospital or the clinic and set up an interview if they have positions open and you will be evaluated based on your credentials. If you are offered the job, it will be a temporary job, contratto a tempo determinato, so the hospital can decide at any time to let you go and productivity is the main focus.
Salary & Work Culture
In Italy, it is uncommon for a physician to change jobs frequently; there is a tendency to grow in the hospital or clinic where you are. It is important to note that cost of living varies significantly throughout Italy; if you live in Milan or Rome, your cost of living will be higher than living in smaller cities or in Central/Southern Italy, so keep it in mind when looking or applying for a job. The average salary in Italy for a doctor is 82.000 euros/year.
If you work for the public sector, you are considered a medical director, dirigente medico. You would work about 36 hours a week and all extra shifts are paid in addition to that. You are allowed to do extra work outside of those 36 hours in the private or public sector, but you will need to negotiate the terms with your hospital, which will take a part of the revenue. You have 32 vacation days per year plus holidays unless you are scheduled for shifts. Some specialties at higher risk of work-related illness, like radiologists, have 46 vacation days; you can carry unused vacation days to the next year. You will pay taxes that go towards the public retirement program, and you will pay into the trattamento di fine rapporto (TFR), severance pay, which is a sum that will be given back to you when you leave the job.
If you work for a private hospital or clinic, you will negotiate your salary directly, and you can receive bonuses based on productivity. Benefits vary since it is a private contract between the physician and the hospital or the clinic.
EU/EEA/Swiss Citizens do not need a work visa to live and work in Italy – one less hurdle to overcome when going through the process of obtaining an Italian Medical License. Non-EU/EEA/Swiss citizens may qualify for a Highly Skilled Work Visa contingent on having a 1 year employment offer from an Italian employer as well as a resident permit. This visa may be tricky to obtain as the medical licensure process can take a long time, a rate limiting step in terms of finding employment to qualify for this type of visa.
Individuals married to an Italian Citizen can apply for Italian citizenship directly though you do need to attain Italian language fluency to the B1 level. Those individuals of Italian descent may be eligible for Italian citizenship based on certain criteria. Becoming an Italian citizen makes it easier to live in Italy while obtaining language fluency, medical licensure and registration, and then to later work in Italy.
Living in Italy is a dream for many but working there can have its pros and cons. Given the many barriers to tackle to be able to practice there, it can be the right career move for those physicians that are committed to leaving the US in the long-term, to enjoy the Italian lifestyle. I hope you find this information useful and wish you the best in your next career and life move!
Valentina Cimolai, MD is an Italian-born physician who moved to the United Stated in 2012, after graduating from medical school at the University of Milan-Bicocca. She is now triple board-certified in Child/Adolescent Psychiatry, Adult Psychiatry, and Integrative Medicine. In 2021, along with Dr Roberta Zanzonico, Dr Cimolai co-founded Bloom Psychiatry And Wellness: a boutique telepsychiatry practice that focuses on the specific needs of women and girls. Valentina and Roberta are currently seeing patients in Florida and about to expand the practice in New York and California.
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