Garattini Livio, Mazzone Antonino, Badinella Martini Marco, Nobili Alessandro
Department of Health Policy, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, 20156, Milan, Italy.
Department of Internal Medicine, Legnano and Magenta Hospitals, ASST Ovest Milanese, Legnano, MI, Italy.
Intern Emerg Med. 2025 Sep 8. doi: 10.1007/s11739-025-04100-4.
Health systems in Europe are under growing budgetary pressures to provide appropriate and affordable healthcare for their populations. At the same time, there is a worsening workforce crisis from the supply side among clinical roles, and there has been an expansion of new health professions in many countries. The current shortage of physicians in many European countries has become a matter of widespread concern at political and societal level. Meanwhile, the shortage of nurses has become an even higher concern. Allied health professionals are the third largest healthcare workforce, and the WHO has promoted their training as a priority to compensate the increasing shortage of physicians and nurses. The workforce crisis in the European health systems could somehow reflect the growing issue of dual practicing followed by many professionals working inside them. Although legally allowed, any form of dual practice inevitably raises financial conflicts of interest. Moreover, the workforce organization in health care is quite peculiar because of the greater influence that health professionals placed at the delivery of care have over daily decision-making. Since a hierarchical approach is not recommended in health care, the increasing number of health professions could undermine multi-professional team building and deter inter-professional knowledge. Finally, clinical activity is expected to be a professional mission aimed at caring patients. Since the most productive and fulfilling strategy for health professionals is to work together in integrated workplaces, the growing number of graduations and specializations in health professions is likely to favor fragmentation.
欧洲的卫生系统在为民众提供适当且负担得起的医疗保健方面面临着越来越大的预算压力。与此同时，临床岗位在供应端出现了日益严重的劳动力危机，并且许多国家新兴卫生专业有所扩张。目前许多欧洲国家医生短缺已成为政治和社会层面广泛关注的问题。与此同时，护士短缺问题更令人担忧。专职医疗人员是第三大医疗劳动力群体，世界卫生组织已将对他们的培训作为优先事项来推进，以弥补日益短缺的医生和护士。欧洲卫生系统中的劳动力危机在某种程度上可能反映出许多在其中工作的专业人员存在的双重执业这一日益严重的问题。尽管双重执业在法律上是允许的，但任何形式的双重执业都不可避免地会引发财务利益冲突。此外，医疗保健领域的劳动力组织相当特殊，因为在提供护理过程中发挥更大作用的卫生专业人员对日常决策有更大影响。由于医疗保健领域不建议采用层级式方法，卫生专业数量的增加可能会破坏多专业团队建设，并阻碍跨专业知识交流。最后，临床活动应是一项旨在关爱患者的专业使命。鉴于卫生专业人员最富有成效且令人满足的策略是在综合工作场所协同工作，卫生专业毕业和专业化人数的增加可能会导致工作碎片化。
