Italy’s medical school reform: a fake open door? Anaao su EURACTIV 

Italy’s medical school reform: a fake open door? 

The Italian government is claiming victory over the long-standing restricted access system to medical schools—but is it really the revolution they say it is? Critics argue it’s more smoke and mirrors than actual change, with students and universities left to deal with the fallout.

On 28 March, the Council of Ministers approved a key measure for the 2025-2026 university admissions cycle, which Minister of University and Research Anna Maria Bernini during a press conference on Friday called a breakthrough.

“The taboo of restricted access has been broken.”, she said at the press conference.

The reform promises a gradual increase in available medical school seats—30,000 over the next seven years—based on national workforce needs.

The Italian government claims the reform eliminates the infamous entrance exam, long criticized for being overly selective and reliant on general knowledge rather than relevant subjects. But in reality, the test is not disappearing—it’s simply being postponed.

Under the new system, medical schools will not have unlimited seats. Instead of filtering applicants before they enroll, universities will allow all interested students to sign up for an initial “filter semester.”

During this period, students will take three core courses—shared with other biomedical disciplines—before facing a national selection exam. Those who pass will continue their medical studies; those who don’t will have to transfer to another program, though they will retain their earned credits.

The filter semester can be repeated up to three times, and attendance will not be mandatory—a workaround to address concerns about the lack of university resources and space. However, key details, including whether the exam will take place after three months or a full semester, are still unclear and will be determined by future decrees.

An unpopular reform
Although the move follows years of demands for change from students and professionals alike, university rectors, the National Council of University Students, and medical associations have overwhelmingly rejected it.

"The only ones who support this are the politicians who pushed it through," said Pierino Di Silverio, secretary of the leading medical union Anaao-Assomed, in an
interview with Euractiv.

“It’s a populist, demagogic move that will ultimately backfire—not just on them, but unfortunately on thousands of families," he said.

Di Silverio, like many in the sector, agrees that the entrance exam needed a complete overhaul in terms of content but not in terms of its structure. He criticized the government for failing to engage with key stakeholders before implementing such a significant change.

"We expected, as in any normal decision-making process, that those directly involved —students, university rectors, and deans—would be consulted. That didn’t happen," he said.

The ministry did not respond to Euractiv’s request for comment at the time of publication.

Many professionals also pointed out the flaws in the reform that effectively delays medical training by at least six months. Normally, first-year medical students complete around eight exams in their first year; under the new model, they will complete only three in their first semester, wasting precious time.

Furthermore, universities are also already at full capacity, Giovanna Iannantuoni, president of Crui, the conference of Italian university rectors, declared last month.

Last year, around 70,000 students applied for medical school. Now, with what many critics say is the illusion of open access, even more are expected to enroll.

Yet, Italian universities have repeatedly stated that they cannot handle more than 15,000 new medical students per year due to a lack of faculty, infrastructure, and resources.

There is also concern that the selection criteria could be manipulated as Bernini suggested that students' grades in the filter semester may play a role in their ranking for admission.

According to Di Silverio, it creates an unfair system where grades could be influenced by university discrepancies or favoritism, adding that it could lead to a resurgence of academic nepotism, where the children of professors would always come out on top.

From doctor shortage to doctor surplus?
One of Italy’s greatest challenges is a shortage of doctors, and according to the leading medical union Anaao-Assomed, the reform fails to address the very issue it was meant to solve.

The issue isn’t just how many students are admitted to medical school—it’s whether they can actually become doctors.

While the government plans to increase the number of medical school seats by 30,000, there are currently only 14,700 specialty training positions available each year.

This means that 15,000 to 16,000 newly graduated doctors could be left without a path to specialization, effectively blocking their entry into the healthcare system.

“According to our projections, if no changes are made, we could face a surplus of around 60,000 doctors within five years”— compared to the needs of the National Health System, Anaao-Assomed's Di Silverio said.

According to him, the problem is not just about numbers, but also about where and in which fields doctors are needed.
Professionals in the field agree that the crisis also lies in specific fields that are increasingly being abandoned due to overwhelming workloads, limited career prospects, low pay and, above all, high legal risks.

"Italy still lacks adequate legal protection for medical professionals," says Di Silverio. Emergency medicine, pathology, and microbiology are among the hardest-hit specialties, struggling to attract new doctors. Even surgery - once considered a prestigious career path - is becoming less desirable.