Density of medical doctors (per 10,000 population) (2012-2020): 39.5
Density of nursing and midwifery personnel (per 10,000 population) (2012-2020): 62.7
Density of dentists (per 10,000 population) (2012-2020): 8.4
Density of pharmacists (per 10,000 population) (2012-2020): 12.1

Remuneration of Doctors, Ratio to Average Wage (2019)
General Practitioners: NA
Specialists: 2.3

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

Remuneration of Hospital Nurses, Ratio to Average Wage (2019): 1.0
Remuneration of Hospital Nurses, USD PPP (2019): $39,000

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

“The total number of doctors in Italy is slightly higher than the EU average, at 4.1 compared to 3.9 per 1,000 population in 2019. However, the number of doctors working in public hospitals and general practitioners (GPs) is declining. As the average age of Italian doctors has increased, a significant shortage is projected in the years to come – especially in some specialties and general practice – if the current criteria for accessing specialty training remain unchanged.

“Italy employs fewer nurses than nearly all western European countries, and the number (6.2 per 1,000 population) is 25 % lower than the EU average (Figure 9). As the number of nursing graduates has declined since 2014, nurse shortages are likely to exacerbate in the future.”

Source: OECD/European Observatory on Health Systems and Policies (2021), Italy: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

“National data show that in 2018, the SSN employed over 600,000 workers (almost 50,000 less than in 2010) of which 72% were health professionals, 17.4% technicians, 10.4% in administrative roles and 0.2% engineers, lawyers, architects and other graduates (Ministero della Salute, 2020c). Generally speaking, Italy has a relatively high number of doctors but a scarcity of nurses (Fig. 4.2). The ratio of nurses to doctors is 2.5:1 (see also Chapter 7). The geographical distribution of health personnel is uneven, reflecting the locations of health facilities across the country and also the budgetary constraints that have been impacting the health sector (Box 4.3). In 2020 and 2021, the COVID-19 pandemic necessitated measures to rapidly increase the recruitment of medical and other support staff to meet the needs of the emergency (Box 4.4).”

“On average, Italy has a higher number of doctors than the EU average (Fig. 4.2). The number of practising physicians has grown steadily since the 2000s, reaching 412 per 100,000 population in 2021 (Fig. 4.3) which is above the EU average of 397. However, the number of public hospital physicians and GPs is now decreasing, potentially causing future shortages. It is noteworthy that more than half of the doctors working in the public system are aged over 55, which is among the highest figures in the EU. In 2019 there was a total of 42,428 GPs working in Italy, (the equivalent of one for every 1,409 inhabitants, compared with the EU average of 1 430) and representing 17.5% of the total number of physicians (ISTAT, 2019). Alongside the crucial role they play in primary care, a major function of GPs is to be gatekeepers to higher levels of care and SSN services: they are responsible for patient referrals, and also play an essential role in ensuring continuity of care, prevention, early detection of diseases and monitoring (see Chapter 5).”

In contrast, the density of nurses per 100 000 population is among the lowest in EU Member States – 626 per 100 000 in 2021 (Fig. 4.4) compared with the EU average of 835 – despite the nursing profession experiencing an expansion of its tasks, especially with regard to the management of patients with chronic conditions. In 2019, there were 17 253 midwives and 367 684 nurses working in Italy (ISTAT, 2020b), placing Italy 15th in the EU ranking for the proportion of nurses and midwives in the total workforce, with a value of 1.8% (against 2.2% EU average). The number of nurses and midwives has increased by only 15 000 over the last decade, which contrasts with much larger increases in Germany and France (147 000 and 125 000 respectively) (Eurostat, 2020a).

“Most of the SSN’s employees are women (68%). Whereas 78% of nurses are women, female physicians constitute less than half of their category and only a minority are directors of health facilities or hospitals. Notably, however, 60% of physicians under the age of 40 are women. With women earning 24% less than men, Italy ranks eighth among the worst EU countries for overall working conditions of female health professionals and is far from achieving gender equality (Lenstore, 2020).”

“General practitioners (GPs, or medici di medicina generale) and family paediatricians (pediatri di libera scelta) are independent professionals with a special contract with the SSN to provide basic health care for adults and children under 14 years of age, respectively. Their remuneration is mainly based on capitation. The maximum number of patients on each doctor’s list is 1 500 for GPs and 800 for paediatricians, but many doctors exceed these numbers.

“Fee-for-service remuneration also applies for some services (e.g. home visits). Remuneration of GPs is divided into the following (ACN, 2022):

“ƒ A per capita amount, defined and negotiated at national level. It isan annual flat-rate fee (EUR 41.32) paid to GPs for each patient.For each patient under 14 or over 75, an additional flat-rate fee ispaid (of EUR 18.95 and EUR 31.09, respectively).

“ƒ A variable amount (defined at national level and negotiated at regional level) aimed at carrying out specific activity programmes for the promotion of clinical governance, the development of initiative medicine and the care of patients suffering from chronic disease.

“ƒ A fee-for-service (mainly home care, Assistenza Domiciliare Integrata and Assistenza Domiciliare Programmata), defined at national level and negotiated at regional level.

“ƒ A share of the corporate fund for production factors (defined at national level and negotiated at regional level) including fees for associative activities and allowances for IT, the employment of a study collaborator and nursing staff or other health professionals.

“ƒ A fee for further activities and services (defined and negotiated at regional level), such as essential levels of assistance other than primary assistance, as well as for carrying out the activityin areas identified by the regions as extremely disadvantaged or disadvantaged.”

“Currently, the annual mean gross salary of GPs is about EUR 105,000 (approximately EUR 4,600 net per month), 197% higher than the average monthly salary in Italy. Of course, salary is higher for GPs with more patients on their lists.

“The remuneration of paediatricians is structured in the same way. The per patient amount is EUR 86.31. An additional fee (EUR 17.93) is paid for each child under the age of 6 because of the additional workload related to early childhood programmes (neonatal and paediatric patient pathways).”

“All health care professionals working in public facilities are remunerated according to the National Collective Labour Agreement (CCNL) – Health, negotiated between trade unions and the government, and reviewed every 3 years (the latest refers to the 3-year period 2016–2018). The CCNL defines monthly salaries, performance-related payments, extra fees (e.g. for night duty or risk indemnity), annual leave, other permitted leave (e.g. for family reasons), illness, resignation and dismissal. The average gross salary of a physician is about EUR 75,000 per year (approximately EUR 3,400 net per month), 119% higher than the average monthly salary in Italy. Annual salary significantly increases according to seniority (from EUR 24,000 during the training period to over EUR 100,000 for chief physicians) (Jobbydoo, 2021).

“Physicians working in the public sector are also allowed to practice privately, earning extra-income on a fee-for-service basis. The freelance work performed within the hospital of employment (also called intramural or intramoenia activity), is regulated by law and refers to services provided outside normal working hours by using the hospital’s facilities, and receiving payment from patients, with a fee withheld by the hospital. Law 189/2012 promoted intramoenia activity through the creation of ad hoc facilities within public hospitals, the activation of telematic network infrastructure, the setting of adequate tariffs to remunerate professionals and support staff (defined at local level), setting pro-rata costs for depreciation and maintenance of equipment and to ensure the coverage of all direct and indirect costs incurred (Ministero della Salute, 2021d).”

“Most personnel working in the SSN (administrative staff, nurses, pharmacists, psychologists) are employees paid on a salary basis with contracts similar to those for physicians. Their remuneration tends to be lower than those of medical doctors. For example, nurses’ average gross salary is about EUR 26,400 per year (approximately EUR 1,450 net per month). Higher compensation (up to EUR 2,300 net per month) applies if they are at the end of their career and/or hold a position of higher responsibility (e.g. nursing coordinator).

“Most dentists work in the private sector (i.e. clinics or practices), with variable but generally high profits depending on seniority and job title. For example, a freelance dentist working in a dental practice earns up to EUR 4,000 net per month. Conversely, dentists working in the public sector have salaries that are comparable to those of physicians (about EUR 3,000 net per month).Some medical specialists (so-called Sumaisti) have a particular contract with the SSN. They are independent professionals who operate in SSN outpatient facilities and are paid according to the actual number of hours they work.”

“To boost the supply of emergency health workers during the first wave of COVID-19, in March 2020 the Italian government allowed the NHS temporarily to hire retired doctors, nurses and final-year medical students for a period of six months. Furthermore, to alleviate pressure on both GP offices and hospital emergency departments, the government began rolling out new special units for continuity of care – Unità Speciali di Continuità Assistenziale (USCAs). These special units were set up to undertake proactive management of suspected COVID-19 cases with home health advice and diagnostic tests, follow-up at home of less severe COVID-19 cases and supervision of COVID-19 cases in long-term care residential facilities. Staffed by volunteer medical doctors, specialists, nurses and administrative staff paid on an hourly basis, they were active 12 hours a day, seven days a week. To strengthen and broaden their effectiveness in managing COVID-19 cases, the government subsequently permitted USCAs to be staffed also by psychologists and social care assistants.

“In May 2020, Italy introduced the profile of the “family and community nurse”, a new type of advanced practice nurse designed to strengthen home-based care and support the activity of the USCAs. The government allocated EUR 480 million to hire an estimated 9,600 of these nurses over the course of 2021.”

Source: OECD/European Observatory on Health Systems and Policies (2021), Italy: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

“Concerns about the future availability of medical personnel are heightened by bottlenecks in the training and recruitment of new doctors needed to replace the large number of doctors who are soon to retire. These bottlenecks also result in large migration outflows of new medical graduates and young doctors starting their careers.

“Between 2010 and 2016, the number of medical graduates from Italian medical schools increased from about 6,700 to over 8,000. However, many of these new graduates were not able to find an internship and specialty training place to complete their training because the number of places is capped at a level significantly below the number of graduates, so many decided to go abroad to complete their specialty training. In addition, a number of newly trained doctors in Italy also moved abroad to take advantage of better job opportunities, as entry-level salaries of doctors in Italy are very low (between EUR 2,000 and EUR 2,500 per month, even for general surgeons). As a result, between 2010 and 2018, over 8,800 new medical graduates or fully trained doctors emigrated to find internships or regular positions elsewhere in Europe. This was only marginally offset by an inflow of 1,100 foreign-trained doctors during that period.

“The limited supply of new doctors is straining the capacities of some local health units and hospital trusts to fill job vacancies, resulting in growing shortages. To improve the attractiveness of employment contracts, a decree was adopted in 2019, providing more flexibility to regions to offer permanent contracts to replace doctors who are retiring.”

Source: OECD/European Observatory on Health Systems and Policies (2019), Italy: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

“The regulatory framework for nursing has not yet been revised in Italy to allow new roles and task shifting, as is the case in several other EU countries. However, in a survey conducted in 2015-16 among health professionals, health care managers and patients, around 30 % of respondents reported that changes to nurses’ roles had occurred over the past five years in the field of breast cancer management. Furthermore, over 50 % reported that there had been an expansion of the role of nurses in AMI management (Maier et al., 2018). These findings suggest that, in practice, task shifting seems to be emerging in Italy, but regulatory changes may be required to remove barriers to further implementation.”

Source: OECD/European Observatory on Health Systems and Policies (2019), Italy: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

Page last updated Feb. 4, 2023 by Doug McVay, Editor.