Specialist training contract
Upon enrolling in the Postgraduate school, the medical student enters into a specific specialist training contract with the University for a period of time equal to the official duration of the programme (pursuant to Legislative Decree 368/1999), replacing the medical specialisation scholarship governed by the previous Legislative Decree 257/91.
The contract entered into with the University of Milan and the Lombardy Region, does not ensure any rights of access to permanent employment as a member of staff, nor does it constitute an employment relationship with the National Health Service or with the University.
For the purposes of welfare and social security, doctors undergoing specialist training are registered with the INPS separate pension and welfare scheme for the self-employed. The contract provides for maternity protection in accordance with the pregnancy regulations referred to in Law 151/2001, as far as compatible.
During the specialised training period, resident doctors are forbidden to work as freelance professionals outside of the healthcare facilities in which they are training. Neither can they enter into permanent or temporary employment with the National Health Service, or with public or private enterprises and organisations, for the entire duration of their specialist training.
Notwithstanding the full-time employment rule, medical students are permitted to stand in for general practitioners operating within the National Health Service on a temporary basis and be registered in the lists of emergency medical staff to work overnight, on weekends and national holidays, and to provide healthcare for tourists, but only when there are not enough doctors registered in these lists available to work at these times (pursuant to art 19, paragraph 11, Law No. 448 of 28 December 2001).
The specialist training contract established with Legislative Decree 368/99 replaces the medical specialisation scholarship governed by the previous Legislative Decree 257/91.
Student doctors undergoing specialist training are required to complete a full weekly programme of theoretical and practical activities, in line with the School’s programme regulations.
The commitment required for a specialised training course is the same as that required by full-time National Health Service medical personnel.
Attendance control is the responsibility of the Head of the Operational Unit where the specialist training doctor operates.
The School Administration acquires the regular attendance of the specialist medical students from the Head of the Operational Unit where the activity took place.
The School Administration is required to send a communication to the Training and Research Contracts Office at the email address [email protected] in case the absences of the trainee doctor exceed 30 working days.
For the entire official duration of the programme, specialist medical students receive an all-inclusive annual fellowship of 25,000 euros for the first two years of specialisation and 26,000 euros for subsequent years, exempt from personal income tax and paid in monthly instalments in arrears.
The fellowship comprises a fixed portion and a variable portion:
- The fixed portion amounts to 22,700 euros gross per year
- The variable portion amounts to 2,300 euros gross per year for the first two years of the course, and 3,300 euros gross per year for subsequent course years.
The fellowship includes all national insurance contributions payable by the contracting parties: both the two thirds payable by the University and the one-third payable by the specialist medical student.
To consult the monthly payslips, access U-Web - I miei documenti,
To the doctor undergoing specialized training, a specific Fiscal Certification is issued annually. Such certification can be downloaded, after authentication, from the CU online page, in the "Informazioni Fiscali" Section of LaStatale@work.
Requests for leave for personal reasons must be addressed to the School’s Management using the appropriate form and:
- must not exceed 30 working days in total per academic year
- must not jeopardise the achievement of educational targets
- cannot be made up
- do not result in a fellowship suspension.
Leave for personal reasons does not include leave due to participation in meetings, congresses, courses and seminars authorised under ‘educational activities’ by the School’s Management.
Temporary impediments lasting more than 40 consecutive working days will result in the suspension of the specialist student’s training period and oblige him/her to make up the absence.
In such cases, the School’s Management must notify the Salary, Benefits and Independent Contractor Division, Office for Training and Research Contracts of the specialist student’s absence. During the period of suspension, the student will only receive the fixed portion of their fellowship and only for a maximum total period of 1 year more than the official duration of the course.
- For suspension due to pregnancy, female specialisation students must follow the procedure set out by the Occupational Health and Safety Department.
- Absences due to illness must be electronically certified by the student’s GP or by a doctor operating within the National Health Service.
The specialist student is obliged to immediately notify their absence to the School’s Management and to provide the reference number of the electronic certificate (PUC, printed top left) and the duration of the illness by email, by no later than the day following the start of the illness, to:- [email protected]
- the official email address of the Postgraduate school’s Management.
The specialisation student must specify the ‘University of Milan’ as the addressee in order for the medical certificate to be accurately completed.
At the end of the period of suspension, the School’s Management is obliged to email [email protected] notifying the date on which the specialisation student resumes his/her training.
Temporary impediments lasting less than 40 consecutive working days are not considered as absences for personal reasons (MIUR No. 3750 of 06/02/2019).
In this case also, absence due to illness needs to be electronically certified, as described above.
Prolonged unjustified absences will result in the termination of the contract. A prolonged unjustified absence is considered as an unauthorised absence that does not allow the achievement of the training objectives; the School’s Management must immediately notify such absences to the Office for Training and Research Contracts so that the necessary processes can be put in place.
Female students enrolled in postgraduate schools are entitled to the protection of their maternity rights.
Training must be strictly suspended during the period of compulsory maternity leave and resumed afterwards. Only the fixed portion of the fellowship will be paid during absence for maternity leave.
Maternity Suspension
Specialist trainees must notify the University of Milan of their pregnancy by filling out the form available on the "Gravidanze" page.
Subsequently, they are required to send the birth self-certification and, if necessary, the form to communicate the intention to extend the maternity suspension to [email protected] and [email protected].
If the trainee has an employment contract with an entity or hospital companies, as required by current legislation, they must still notify the University of their pregnancy by filling out the form on the Unimi website. In this case, maternity is managed by the employer. It is the trainee’s responsibility to send communications regarding the start date of the mandatory leave and the date of resumption of work activities to [email protected] and [email protected] in order to postpone the natural end of the Specialization School.
Trainees sign a specialist training contract, and this different qualification of the contractual relationship, compared to the employment relationship, leads to the conclusion that the references of Law 151/2001 to maternity protection must be applied as far as and if compatible.
As a result, all absences caused by maternity, including pregnancy, must be attributed to the contractual suspension period, without references to “parental leave” or “maternity leave.”
Temporary impediments exceeding forty consecutive working days due to maternity, for which the provisions of Legislative Decree 26 March 2001, no. 151, and illness remain unchanged, suspend the training period with the obligation for the specialist trainee to make up for the absences. During the suspension for the aforementioned impediments, the specialist trainee is entitled only to the fixed part of the economic treatment for a maximum total period of one year.
The trainee father is not entitled to the 10 days of paternity leave, see INPS circular no. 122 of 27/10/2022, point 2:
“Mandatory paternity leave is not due to working fathers registered with the Separate Management referred to in article 2, paragraph 26, of law 8 August 1995, no. 335, nor to self-employed working fathers referred to in Chapter XI of the T.U., including workers who have a self-employed relationship in the entertainment sector.”
However, the 30 working days of justified absence for personal reasons per academic year can still be used.
The healthcare facility at which the medical specialisation student carries out his/her medical training provides and pays for professional risk insurance, third party civil liability and insurance for accidents connected with the healthcare activities carried out in their facilities, at the same conditions as the insurance provided for their own medical personnel. Insurance for gross negligence is not provided, however.
Specialist training can also be undertaken in health facilities in foreign countries, within the framework of integrated scientific educational collaboration agreements between universities, in compliance with the medical student’s personal training programme and as recommended by the School’s Council.
The period of stay must not exceed 18 months in total, notwithstanding the fact that the specialisation student must take the official annual exam by the specified deadlines.
The decision of the School authorising the period of training abroad must be conveyed to the Student Registrar and “Right To an Education” Division and to the Salary, Benefits and Independent Contractor Division. The School is responsible for noting the training period abroad on the daily attendance sheet.
In order for the medical student to be able to carry out his/her activities in hospitals abroad, the Postgraduate School Director must contact the relevant offices of the host university, who must provide all the operational instructions to guarantee the appropriate insurance cover for the entire period of the student’s stay abroad.
During the period of stay abroad, no increases or supplements to the provided economic treatment are foresee.
Reasons for early termination of contract
The following reasons will give rise to early termination of the contract:
- the specialisation student’s withdrawal from his/her study programme
- violation of the rules relating to incompatibility
- prolonged unjustified absences from the training programme, or exceeding the so-called period of protection (12 months), in the case of illness
- failing the programme exams established by each individual school of specialisation.
Serious violation of the Code of Conduct for Employees of the University of Milan is another reason for early termination of the contract.
As indicated by Article 40, paragraph 1 of Law 368/99 and Article 1, paragraph 1 of the specialist training contract signed by the trainees:
“1. The specialist trainee doctor undertakes not to carry out any freelance professional activity outside the healthcare facilities where the training takes place, nor to enter into conventional or precarious relationships with the National Health Service or with public and private entities and institutions.”
To date, the specialist trainee doctor, while respecting the principle of full-time commitment, can also carry out the following activities, pursuant to Article 19, paragraph 11, of Law 448 of December 28, 2001:
- temporary replacements of general practitioners contracted with the National Health Service
- registration in the lists of holiday, night, and tourist medical guards, but only employed in case of insufficient availability of doctors already registered in the aforementioned lists
- collaboration with entities that carry out blood collection activities.
According to Article 19-sexies of Decree-Law 137 of October 28, 2020, converted with amendments by Law 176 of December 18, 2020, and subsequent amendments, the trainee can also:
- provide services at the Special Continuity Assistance Units.
The specialist trainee doctor is also granted additional activities, only if provided for by other specific regulatory provisions (e.g., Legislative Decree 34/2023 or Law 145/2018 or Decree-Law 18/2020).
Violation of the provisions listed here regarding incompatibility is grounds for early termination of the specialist training contract.
The specialist medical students from the second year onwards can participate in public competitions or public notices, if such possibility is provided by the current legislation.
In the event that, following a selection procedure, an institution intends to offer a position to a specialist medical students, it must send the job proposal to:
- specialist medical students
- Director of the School of Specializations and the school’s administration office
- Training and Research Contracts Office at: [email protected]
- University of Milan: [email protected]
- Presidency of Medicine: [email protected] .
The School, after verifying that the proposing institution is accredited according to D.I. 402/2017 annex 1, and considering the work activity as formative, can grant the authorization to the specialist medical students to accept the position and sign the contract. The authorization must also be approved by the School of Specialization Council (CdS). The CdS minutes must include:
- a specific certification regarding the level of autonomy achieved by the specialist medical students:
- the training project.
The specialist medical students, once the employment contract is signed, must send an email to [email protected] within 5 days of signing, with the following information:
- type of contract (indicate the regulatory reference)
- contract start and end dates.
Additionally, the specialist medical students must send a copy of the signed employment contract to: [email protected].
The specialist medical students is required to inform the Training and Research Contracts Office of any resignation or withdrawal from the position, always via the email address [email protected].
Important: any activity, even if performed outside the hours dedicated to specialist training, must always be approved by the School Council, provided it is allowed by specific regulatory provisions.
The attached circulars, addressed to the Postgraduate Schools Directors, specify:
- the main administrative obligations with which the Schools must comply
- recommendations on the management of absences.