Phlebologist compares practicing specialized medicine abroad

By Emma Stout, MD

I grew up in Italy, idolizing my grandfather, who was a surgeon. With his influence, I became passionate about the medical field, specifically practicing specialized medicine and providing the best possible care for all patients.

I am a general practitioner licensed to practice medicine in Colorado with a specialty in venous and lymphatic disorders. While I have not practiced medicine in Italy since 2005, my time providing care in both Italy and the United States has given me an exclusive perspective in the differences in healthcare practice between the United States and Italy. The two primary differences include:

• Insurance guidelines and restrictions.
• Patient attitudes and expectations.

INSURANCE GUIDELINES, RESTRICTIONS

In both the United States and Italy, the general mentality is that the United States has the best healthcare options available. Based on my experience and observations from my time practicing in Italy, their preference is to come to America for the best specialized healthcare; however, they sidestep the United States because of the high costs of healthcare here.

Italy practices socialized medicine. As noted in HealthcareManagement.org, “Italy has a national health plan (Servizio Sanitario Nazionale), which provides universal coverage for hospital and medical benefits.” Their taxes are higher but they receive no-cost healthcare. The downside to “free” healthcare is the wait time.

As noted later in this article, patients needing specialized care must wait, sometimes for several months, to see a physician because a gatekeeper (aka primary care) physician is responsible for providing citizens with access to secondary healthcare. Of course, cash is king and those patients with extra cash available to bypass the public healthcare system and visit private practice physicians typically bypass those wait lists.

In the United States where we have many more restrictions and guidelines to practicing medicine, it’s challenging for physicians to practice in the “right direction.” What I mean by that is we want to practice medicine as compassionate human beings and not as people following government guidelines that sometimes seem designed to benefit large drug companies and healthcare organizations rather than patients. We want to do what’s best for the patients versus what’s best for their insurance coverage.

I recall a patient here in the United States that desperately needed a hip replacement. Because she had no insurance, the cost of her hip replacement was going to be $250,000. She ended up temporarily moving back to her home country of Italy and received the hip replacement for free (excluding the health system taxes she paid based on her income). She was willing to endure wait times in lieu of high costs in the United States.

PATIENT ATTITUDES, EXPECTATIONS

The United States pays physicians better wages than in Italy. According to Expat Focus, which provides country guides, forums and expat experiences for those considering moving abroad, the annual average salary of a physician in Italy is $84,000 as compared to $230,000 here. Additionally, U.S. patients pay much higher costs for medical care than Italian citizens pay with their health system taxes — as previously noted. And, U.S. patients spend many hours working through various insurance requirements and regulations that must be met before insurance companies reimburse patients for medical care costs.

The costs of their time and money often bring an “I want it now and you better solve all my problems” mentality from U.S. patients. I think the primary difference is that U.S. patients have higher expectations than Italian patients and those expectations translate to additional demands, questions, and sometimes, lawsuits.

In Italy, a patient visits his/her primary care doctor for all issues and then as needed, sits on a waitlist to see a specialist. In the United States, a patient may see a primary care physician first and be referred to a specialist, or, they may go directly to the specialist. Either way, U.S. patients are not waiting for several months to see that specialist and Italian patients often wait that long or longer due to the sheer number of people participating in Italy’s public healthcare system.

By the time Italian patients receive treatment from their specialist physician, they are extremely grateful for the attention from the doctor. They overlook the wait time, the doctor’s personality and the perceived quality of care they receive from the specialist. There are no feelings of entitlement.

The general mentality in the United States, because we rarely have any comparison to healthcare in other countries, is that we’re entitled to prompt, high-quality care from a specialist dedicated to our particular issue. After all, we pay dearly for healthcare in the United States and we have high expectations with that cost.

In summary, it boils down to cost versus wait time, and the level of expectation that comes with it. I believe Italy will trend toward the United States over the next decade, with patients having stricter expectations on wait times, referral process organization and level of care. Only time will tell.

ABOUT DR. STOUT

Emma Stout, MD, is a phlebologist who specializes in the treatment of vein disease at American Vein & Vascular Institute. She finished her phlebology fellowship under the direction of Dr. Gordon Gibbs, American Vein & Vascular Institute founder and chief medical executive. Completion of the fellowship ensures that doctors are trained in the American Vein & Vascular Institute treatment philosophy, which focuses on patient-centric, personalized care paired with compassion and expertise.

As a general practitioner licensed to practice medicine in Colorado with a specialty in venous and lymphatic disorders, she has a hospital affiliation with Parkview Medical Center.

Dr. Stout is from Novara, Italy, and graduated from medical school at La Sapienza University of Rome in 2003. The granddaughter of a surgeon, she grew up with a passion for medicine and providing care for those in need. She performed her residency at St. Mary-Corwin Regional Medical Center in Pueblo, Colorado, and has since volunteered in Guatemala as well as in the oncology department at Phoenix Children’s Hospital. Dr. Stout is proficient in the languages of Italian and