Luana Ricca

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The death of the internationally renowned liver surgeon and researcher Luana Ricca at the age of 38 sparked outrage in Italy and provided the catalyst for a campaign that now has the ear of government.

Ricca took her own life but those closest to her say that she was a victim of a professional culture—rooted in patronage and favour rather than merit and quality—that ground her down. A blog she posted for Italy’s Radio24 two years ago showed her frustration at trying to secure a public sector hospital post that was commensurate with her experience and skills. “In Italy, I currently have no chance whatsoever of doing the work I know how to do, despite having carried out more than 1500 surgical procedures—two thirds of them as lead surgeon—and having published in international surgical journals, and speaking three foreign languages,” she wrote.

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Her younger brother, Francesco, describes Ricca as a spirited, generous, and fiercely energetic woman, who had set her sights on becoming a doctor as a child. To that end, she left her native Catania in Sicily as an 18 year old after winning a scholarship to study in Rome.

Once qualified, she went first to London before heading to Barcelona and then to Paris to gain the experience she needed.

“She never stopped and was continually pushing herself to do more,” he said. “But she was always there for others and eager to help whenever she could. She had a kind word for everyone.”

Italy produces many more doctors than it needs, forcing many to work overseas if they want to pursue a career in medicine. Ricca was no exception. After completing specialist training in general surgery in 2007 in Rome, she faced the prospect of being unable to find work as a surgeon in Italy, so she returned to Paris. Here, she worked at Paul Brousse Hospital—one of Europe’s leading centres for liver transplantation and hepatobiliary surgery—becoming its medical director, as well as completing a doctorate in oncology.

After eight years of “professional exile” in France, she tired of the enforced separation from her husband and young son in Rome. Ricca returned to Italy in 2014, having been offered a senior position at the private European Institute of Oncology in Milan.

Within a month of taking up the post, however, her sponsor died and she no longer had any guarantee of long term employment at the institute. In the hope of better job security and in order to be closer to her family, she competed for a public sector surgical post in L’Aquila. But someone else—who had scored fewer points than her—was given the job and Ricca was consigned to a six month tenure in an endoscopy clinic 64 km away, and not allowed to operate. Worse still, her colleagues didn’t value her experience or achievements and dismissed her professional opinions and expertise, says Francesco.

“She was very direct and she wasn’t afraid to speak up when she felt things weren’t right. They just looked on her as a problem,” he explains. “My sister was the complete opposite of what Italy represents, in many ways,” he adds. “She played by the rules, was incredibly professional, and never did anything by halves.”

After her death, Francesco set up a Facebook group, Con e Per Luana Ricca, to provide a discussion forum for those who, like Ricca, felt that they had no choice but to leave Italy to follow their career path.

The group quickly acquired thousands of members and is still growing. The stories shared on the forum attest to the blight of an opaque and unfair system of career progression in medicine. They have been presented to the Italian minister of health, Beatrice Lorenzin, along with formal proposals, backed by the Italian Medical Association, to overhaul postgraduate accreditation and standardise the competencies required. “I wanted something positive to come out of Luana’s death,” Francesco said.

Lucio Fumi, president of the Italian Medical Society of Great Britain, who asked Ricca to give a presentation last November on the difficulties of repatriation after working abroad, says that as a female surgeon she may have come up against some gender discrimination once back home but that the points system would have stymied her progress far more.

“You gain points with service, but even if you work at the highest level [elsewhere] you don’t collect those seniority points in Italy. Experience counts, but not officially, so you end up doing lowly jobs—but it can all depend on the whim of others,” he explained.

Stefano Palazzi, a consultant in child and adolescent psychiatry at Derbyshire Healthcare Foundation Trust, who spoke at the same meeting, added, “The main measure of progress in your career is loyalty, not ability. Loyalty is paramount. People like Luana who migrate are very talented, but when you want to come back, cronyism matters more than talent.”

Luana Ricca leaves her parents; her brother; her husband, Alfredo; and her son, Riccardo.