Legislative Decree 368/99 and subsequent modifications;

Inter-ministerial Decree N. 68 - 04/02/2015 "Riordino scuole di specializzazione di area sanitaria"

Ministerial Decree N. 130 – 10/08/2017 "Regolamento concernente le modalita” for the admission of doctors to medical specialisation schools, as established by Art. 36, Section 1, Legislative Decree 17/08/1999, N. 368"

Inter-ministerial Decree N. 402 – 13/06/ 2017 on the definition of standards, prerequisites and indicators for educational and assistance activities in medical specialisation schools, as established by Art. 3, Section 3, D.I. N. 68/2015

The commitment is 38 hours/week. As established by Art. 40, Section 1, D. Lgs. 368/99 - The commitment required for specialisation education is the same is that required of full-time NHS medical personnel, which also allows doctors to practice their profession in public facilities and private offices (attività libero professionaleintramoenia).

The Financial Budget 2006 (Art. 1, Section 300) established registration in the “Gestione Separata,” starting from academic year 2006-07, for doctors on specialisation residency programmes.

As all other professionals registered in the “Gestione Separata,” medical specialisation students are subject to:

• reduced rates (if they are already registered with the “cassa professionale”);
• full rates (if they are NOT registered with the “cassa professionale”).

Moreover, medical specialisation students are subject to the same rules applied to “collaborazioni coordinate e continuative” in terms of:

• enrolment;
• contribution breakdown;
• payments and returns;
• funding rates, maximum limits and contribution payments.
• Further information is available on the INPS website.

Art. 41, Section 3, D.Lgs. 368/99 established that the medical facility where the doctor conducts his medical specialisation must cover all insurance costs related to professional risk, civil liability to third parties and accidents related to the services conducted by the student in its facilities, with the same conditions as its personnel.

Contracts may be terminated early for all cases established by Art. 37, Section 5, D.Lgs. 368/99:

a) Medical specialisation students abandon studies;

b) Violation of incompatibility regulations;

c) Prolonged unauthorised absence from educational programme or exceeding the allowed sick leave (12 months);

d) Failure of exams established for each medical specialisation school programme.

Periods of suspension are only allowed for:

• sickness
• maternity or parental leave
• recruitment of the civil servant for the time necessary for them to be hired and normally for a further 90 days from the date of hiring. At the end of this period, the suspension is deemed to be terminated. Sapienza is responsible for carrying out the necessary checks on the legal position of the resident.

As established by D.Lgs. 368/99, Art. 40, Section 3 – periods of absence exceeding forty working days for military services, pregnancy and sickness will lead to suspension from the educational programme. This does not affect the duration of the programme. Pregnancy is safeguarded by Bill N. 1204 30/12/1971 and subsequent modifications, as is military service by Bill N. 958 24/12/1986 and subsequent modifications.

Sick leave exceeding forty working days must be compensated entirely. As established by Art. 40, Section 5, during leaves of absence, students only receive their fixed stipend, while they receive the variable quota during periods of compensation. The maximum period of leave allowed for the entire programme is 12 months.

You will have to communicate such absences to the administration office of your specialisation school within 3 days of the beginning of the period of absence along with a medical certification provided by an NHS or doctor operating in another public facility specifically indicating the allowed sick leave. The same communication must also be made to the school didactic office.

Medical specialisation students who are pregnant are safeguarded by D.Lgs. 151/2001 and subsequent modifications. This includes:

• Five months mandatory maternity leave;
• Optional parental leave for six months;
• Reduction of daily working hours by 2 hours/day for breastfeeding throughout the child’s first year.

Naturally, the educational programme must conform to the period established by law. Therefore, periods of absence must be entirely compensated. Breastfeeding leave must be compensated for 1/3 of the total number of days enjoyed.

As established by Art. 40, Section 5, during leaves of absence, students only receive their fixed stipend, while they receive the variable quota during periods of compensation.

In case of pregnancy, exceeding the 12-month maximum period of absencewill not lead to the early termination of your contract, as established by D.Lgs. 151/01 and consequent rights and duties.

You will only receive your fixed stipend for the 12-month maximum period of absence for the duration of your specialisation programme. Further absence for maternity leave is allowed as described above, but the student will receive no payment.

If, for example, your first pregnancy leave totalled 11 months (5 months mandatory maternal leave + 6 months optional parental leave), during your second maternity leave, you will only be entitled to one month of pay on the five months mandatory maternity leave. Optional parental leave, if taken, is not paid.

In any case, all periods of absence must be fully compensated. Thus, if a student enjoys 6 months of optional parental leave for the second pregnancy, too, she will have to compensate 22 months to obtain her specialisation.  Your full stipend will be paid during periods of compensation.

No, you cannot work more than 38 hours/week. Your contract end date will be extended based on the number of days of absence that must be compensated.

As established by D.Lgs. 368/99, Art. 40, Section 4: periods of leave for personal reasons that do not exceed thirty days during the academic year and do not jeopardize educational objectives are not considered to be suspensions of the educational programme and must not be compensated. In this case, there is no suspension of your stipend.

Therefore, medical specialisation students are entitled to 30 days of authorised absence (holidays) during the academic year. All absences not exceeding 40 days (weddings, childbirth, deaths, absence due to serious reasons, etc.) are considered in the same manner.

As established by D. Lgs. 368/99, Art. 40, Section 1, for the entire period of specialisation, the doctor is NOT allowed to conduct professional services outside of the medical facilities in which the specialisation programme is held, including work in the NHS and public or private agencies and institutions.

Thus, medical specialisation students cannot conduct any activities other than that established by D. Lgs. 368/99 of Bill N. 448 - 28/12/2001 [Budget 2002] Art. 19, Section 11 and DL 81/04 converted into Bill N. 138 - 26/05/2004, Art. 2-octies.

As long as they respect their full-time employment, medical specialisation students may:

• Conduct private professional work in public facilities (attività intramuraria) based on their degrees;
• Temporarily substitute NHS general practitioners;
• Be registered with the guardia medicaemergency service, but only work if all registered doctors are not available.

You are entitled to apply for a VAT code to bill for all allowed medical work (attività intramuraria, substitutions for general practitioners and guardia medica emergency service).

No, not if they are related to your profession. Casual work contracts are regulated by the so-called “Biaggi” Bill, D. Lgs. 276/2003, which determines the categories that can perform tasks that last no longer than thirty days during the course of the year or by the same employer, unless the overall retribution does not exceed five thousand Euro (Art. 61, Section 2).

Medical specialisation students are excluded from these categories. In fact, Section 3 of Art. 61 of the aforementioned bill expressly excludes intellectual professions that require registration in a professional register. Therefore, it is not possible to conduct any medical activity and receive payment through a casual work contract.

Failure to comply with this measure can cause the early termination of your contract, as established by Art. 37, Section 5, D.Lgs. 368/99:

a) Medical specialisation students abandon studies;

b) Violation of incompatibility regulations;

c) Prolonged unauthorised absence from educational programme or exceeding the allowed sick leave (12 months);

d) Failure of exams established for each medical specialisation school programme.

Yes. There is no limitation to the number of specialisations a doctor can obtain. In any case, please make sure there are no special clauses in the call.

From the 2022-2023 academic year, in accordance with the "Manifesto Generale degli Studi - Regolamento studenti dei corsi di specializzazione", simultaneous enrolment of students in two degree programmes is permitted (Law No. 33 of 12 April 2022 and its implementing decrees). It is not possible to hold a research fellowship at the same time.

Art. 40, Section 6, D. Lgs. 368/99 establishes that medical specialisation students can attend courses provided by foreign medical facilities in conformity with the degree programme and in agreement with the school council, whilst respecting the points established by Art. 12 of Presidential Decree N. 162 – 10/03/1982. According to D.P.R. 162/82, Art. 12, Section 3, official documentation is necessary to recognise attendance and activities completed by the medical specialisation student in social/health facilities, even abroad or as determined by Bill N.38 (8) 9/02/1979 on cooperation between Italy and developing countries. 

Therefore, it is possible to attend extra-curricular courses or courses abroad, as long as you are authorised by the school council. If you attend a school abroad, insurance will be your responsibility, but it may also be jointly funded by hosting facility.

The maximum allowed period of study abroad is 18 months, as established by the State-Regions Conference of April 18, 2007.

Sapienza has no available scholarships or grants for attending specialisation schools abroad.

First, communicate your pregnancy to the specialisation school so that the Director may assign you to activities that do not represent a danger to you or your child’s health, but will allow you to continue attending your specialisation. If this is not possible, please inform the Provincial Labour Office which, on the basis of a medical certification of your pregnancy, will authorise you to suspend your specialisation programme before the mandatory maternal leave period.

Maternity leave is mandatory by law. During your sixth month of pregnancy, you will have to present an application (with a €16 tax stamp) to the administration of your specialisation school, indicating your period of absence (two months before childbirth and three after), along with a medical certification from a public facility confirming your pregnancy. The same communication must also be made to the school didactic office.

If, instead, you wish to take one month before childbirth and four after, you will have to present the following documentation:

• Certification by a public facility gynaecologist specifying, besides your state of pregnancy, that there are no health risks posed either to the child or mother by the extra month of work;
• Medical certificate on health prevention and safeguard on the work place. This can be issued by the Director of the specialisation school if the activity is not subject to medical surveillance. 

The same communication must also be made to the school didactic office.

After enrolment, the university will print out your medical specialisation contract and have it signed by the Rector and a representative of the Lazio Region Council. Then, you will be called to sign your contract based on the following schedule.