LAUSR

www.thelancet.com Vol 394 August 17, 2019 561 this issue is far from being addressed in a thorough and systematic way. It is true that a real emergency now exists, up to the point where several Italian regions are trying to recruit doctors from Eastern Europe and Pakistan, are hiring Italian trainees in their last year of training, and doctors with no specialisation in emergency departments. Nevertheless, a couple of crucial points are missed in the World Report. There is some uncertainty about the exact number of Italian doctors working abroad; EU data suggest that 1000 doctors leave the country every year, but this is probably an underestimate. Retaining these doctors in Italy could at least partially solve the problem. Yes, not enough training positions exist compared with the number of graduates. Simply increasing the number of training positions (with no reassessment of the training path way) would result in an uncertain curriculum. The number training positions have not been substantially increased this year; however, hiring doctors straight out of medical school with no specialisation (which is mainly being done in emergency departments) poses serious questions about quality of care. Hiring doctors in their last year of specialisation is allowed as long as they start working once their training is complete. The real problem does not lie in the mismatch between the number of new specialists entering the workforce and the number of doctors who retire at the end of their career, but in the mismatch between the number of doctors leaving (ie, either retiring or leaving the country to work abroad) and entering the system. The real problem is not the scarcity of specialists but rather how unattractive the Italian system is to foreign specialists. Have those politicians, press journalists, and representative of doctors’ unions who have been making their opinions known ever wondered why no doctor wants to move from France, Germany, the UK, or North America Biomics, Johnson & Johnson, Novartis, Teva, Glucome, and DarioHealth, outside the submitted work. MSS reports grants from AstraZeneca, during the conduct of the study; grants and personal fees from Amgen, AstraZeneca, Intarcia, Janssen, Medicines Company, Medimmune, Merck, and Novartis, grants from Daiichi-Sankyo, Eisai, GlaxoSmithKline, Pfizer, Poxel, Takeda, Abbott Laboratories, Gilead, Roche Diagnostics, Bayer, and Quark Pharmaceuticals, and personal fees from Bristol-Myers Squibb, Consumer Value Stores Caremark, Dyrnamix, Esperion, Alnylam, Ionis, MyoKardia, and IFM Therapeutics, outside the submitted work.