Italy: Healthcare Workforce Education and Training

Share of foreign-trained doctors, 2021: 0.9%
Medical graduates per 100,000 population, 2021: 18.2
Share of foreign-trained nurses, 2021: 5.2%
Nursing graduates per 100,000 population, 2021: 17.2

Source: OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/7a7afb35-en.

“The number of students allowed to enter the courses in Medicine and Surgery, and other health professions’ graduate programmes, is calculated nationally at the State-Regions Conference, based on an assessment of social and productivity needs and the capacity communicated by each university. The number of residency vacancies, in contrast, is determined every 3 years first by the regions, taking into account the employment scenario and their populations’ health needs and communicated to the Ministry of Universities and Research and to the Ministry of Health. The final number is then determined by these ministries in agreement with the Ministry of the Economy and Finance, according to the SSN’s capacity and that of the health facilities included in the training network by the National Observatory of Specialist Medical Training.”

Source: de Belvis AG, Meregaglia M, Morsella A, Adduci A, Perilli A, Cascini F, Solipaca A, Fattore G, Ricciardi W, Maresso A, Scarpetti G. Italy: Health system review. Health Systems in Transition, 2022; 24(4): pp.i–203.

“Overall, Italy has not been able to undertake comprehensive planning for the training of health professionals, especially doctors and nurses. For doctors, the main problem is the presence of inadequate planning across specialties, in some cases due to an insufficient level of training capacity (e.g. in anaesthesiology). For GPs, where the future shortage appears to be dramatic in most regions, the main problem is that they are not trained through a university specialty programme, but rather by programmes administered by each region. These programmes are not attractive due to the quality of the curricula and the lack of interest in family medicine. The latter is probably due to the status of GPs in the SSN and, more generally, to professional arrangements that are deemed inadequate to face technological and social changes (e.g. most GPs work in solo practice with scarce IT infrastructure and medical equipment, and limited professional interactions) (Fattore et al., 2009). The shortage of nurses is difficult to justify in a country with a high unemployment rate. Here, professional status and level of compensation contribute to insufficient applications to nursing programmes. To overcome these problems, substantial changes in the distribution of tasks between doctors and nurses and better salaries are the solution. Furthermore, the resources provided through the NRRP [National Recovery and Resilience Plan] to community care will open up more opportunities for GPs and community paediatricians to benefit from greater integration, multidisciplinarity and digitalization.”

“For physicians, the 6-year Medicine and Surgery degree, provided primarily by public universities, consists of preclinical/basic science studies followed by clinical rotation. Graduates are effectively considered medical doctors but must enrol in the National Register to be licensed to practice. Postgraduate study and training cover 51 specialties, but until very recently have not included general practice or family medicine as a specialization.11 Postgraduate specialization schools are supervised by the Ministry of Universities and Research and by the National Observatory of Specialist Medical Training and Regional Observatories which, in 2017, introduced accreditation standards, requirements and indicators to monitor and evaluate the quality of medical schools. Training for GPs is offered by the regional health authorities. Training lasts 3 years and includes internship periods in health care facilities.”

“To be qualified as a nurse, a 3-year nursing university degree alternates compulsory in-class activities with practicums and internships. Graduates are required to pass a state examination to be enrolled in the National Registry of Nurses. As for doctors and other personnel, nurses must pass a public competition to be employed by the SSN, whereas private organizations autonomously organize recruitment. Some nurses may specialize in public health, paediatrics, mental health and psychiatry and geriatrics through 2-year Master of Science programmes. The education of nurses is delivered by medical schools. Ancillary staff are generally trained through specialized courses delivered by professional schools.”

“Concerns surrounding the availability of GPs and medical professionals are exacerbated by their ageing profile, which stands out as one of the most senior in Europe. With more than 55 % of doctors over the age of 55, over a quarter will reach retirement age by 2027. At the same time, the annual influx of newly trained specialists will struggle to compensate for retirement attrition and accommodate increased demand for medical personnel in the upcoming years. A significant portion of this issue stems from the fact that since 2013, Italy’s medical workforce training pipeline has been constrained by a number of postgraduate residency training slots that were lower than the annual output of medical graduates from university. This scenario has arisen from the protracted implementation of reduced turnover of medical personnel in public hospitals as a means to moderate cost increases as well as from limited resources to finance a suitable number of specialist medical training contracts.

“To address this problem, since 2018 Italy has significantly expanded the number of students admitted to medical faculties as well as postgraduate residency training positions for specialists. Notably, the number of medical residency slots for general practice more than doubled between 2018 and 2021 compared to previous four years – an achievement partly supported by Italy’s Recovery and Resilience Plan (see Section 5.3). The outcomes of these substantial increases are projected to fully materialise towards the end of the decade, when the inflow of newly qualified medical specialists is projected to more than offset retirement attrition. However, shortages in specific specialties – such as emergency medicine, are likely to persist due to their limited attractiveness among medical students.”

Source: OECD/European Observatory on Health Systems and Policies (2023), Italy: Country Health Profile 2023, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

“Although the number of doctors per capita in Italy is still higher than the EU average (see Section 4), the age composition of currently practising doctors raises concerns about the ability of the health system to respond to the health needs of the population in the future. In 2017, more than half of Italy’s practising doctors were aged 55 years and over, the highest share in the EU (Figure 17).

“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.

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Page last updated April 22, 2025 by Doug McVay, Editor.