by Orhan Yilmaz
No matter if you are getting your student visa, Italian medical care card or a residency permit, chances are you will need to deal with the infamous Italian bureaucracy. Knowing how to do this might make a difference between success and failure as a med student. On an influential measure of bureaucracy – the World Bank Doing Business rankings – Italy is in position 51 out of 190 countries in the world, comparable to Mexico, Serbia, and China. This does not mean Italy is a bad place to live or study. It does mean, however, that when you come to Italy to study medicine, you need to prepare yourself for bureaucracy. To save time and provide resources to my future colleagues, I will now share with you some tips and several personal stories of how I made it through the hardships of Italian bureaucracy as a medical student.
You may find it challenging, and even heartbreaking, to jump through hoops to get your paperwork done, particularly if you do not speak the language fluently. My two years in Rome as a medical student taught me some tricks to dealing with bureaucracy a little more easily. However, no matter how prepared you are, you could still be overwhelmed.
The general tip for success with Italian bureaucracy is persistence. You just have to keep remembering that the system may function slightly – or completely – differently than regions, states, or countries that you are already used to. The silver lining is that if you learn to navigate Italian bureaucracy, you can probably handle bureaucratic procedures anywhere in Europe. This increases self-esteem, confidence, and independence.
Anyway, that is enough abstract encouragement for the day. Let’s get right down to my experience with Italian bureaucracy. It begins with my permesso di soggiorno (residence permit).
When my permesso was due for an extension, the last item on the list of documents necessary for renewal was a copy of my Italian health card (tessera sanitaria). But I did not have one. So, I paid the fees at a post office for a type of Italian health coverage that temporary foreign residents can buy through the SSN, the national health care system. I then went to a policlinico hospital, where you normally apply for your tessera. To my surprise, I was informed that, due to the limited time left on my current permesso, I was not eligible to get a tessera. I pleaded that without tessera, I would not be able to apply for the extension. A catch-22!
Rome’s Policlinico metro stop
Tip #1: If office A does not give you what you need, try again at office B. Or C. Or D.
Then came my key insight: despite the fact that all Italian hospitals belonged to the same regional regulatory body, their modi operandi just might vary slightly. I made it my mission for that day to visit as many policlinici as possible (!), to see if one would give me my desired precious tessera!
I visited exactly six hospitals throughout Rome. A few of them said that my residence was out of their jurisdiction. Others simply had never dealt with a foreign student, and thought that only Italians were eligible for SSN. Regardless, my consistent efforts paid off. A couple of minutes before the end of the business day, I was able to get a paper copy of my tessera, which was sufficient to complete my permesso renewal.
The cherry on the cake was the actual physical tessera, which arrived few months (yup, months) later!
Therefore, Tip #2: Extend your permesso and tessera far in advance, to avoid such last-minute bureaucratic challenges!
Tip #3: Get any official documents you can, even if you do not theoretically need them.
Once I had fulfilled these legal duties to the Republic, I was determined to integrate fully into society! I wanted to establish my residence (residenza) in Rome, in order to get an Italian ID card (carta d’identità), which is the same size as a credit card.
You don’t actually need a carta d’identità to live in Italy. Indeed, I found it surprising that foreign residents of Italy can register with their municipality (the registry office is called an anagrafe) to establish their residenza. Obviously, just by registering, you do not become an Italian national, and you cannot use the card like a passport to enter or exit Italy. Your actual nationality is, indeed, written on the card. It is not theoretically necessary to get one of these cards.
However, a carta d’identità can be useful for obtaining certain home and wireless internet packages that are not available to foreign tourists and nationals without Italian residence, as well as membership with railway companies for discounts on train tickets. Plus, a little card is easier to carry around than a passport!
That being said, when I wanted to get my carta d’identità, there were no appointments available at my local anagrafe… for a few months. I was ready to give up.
Tip #4: Try to tackle bureaucracy by going online.
After some digging online, I found out that my anagrafe also takes applications by email! I just had to scan my documents, and clearly mention in Italian that I was applying to register myself as a foreign resident of Rome at my anagrafe. It sounds too good to be true, but to my surprise, the response came only one week later. A few weeks – and a few easy steps – later, I was ready to visit the real anagrafe to present original copies of my documents, and get my carta d’identità!
I should mention, however, that as a med student, it may very well be impossible to declare your collegio (dormitory) address as your residence when applying for registration with anagrafe. Student dorms are usually for temporary short stays and belong to a government, institution, or corporation, and not to a private entity. Thus, you may need a residential house, apartment, or condo as your physical address. However, I have not explored the depths of this collegio address realm, and would love about to hear your experience when you try!
If you are planning to practice medicine in Italy after graduation, then by establishing your residenza, and constantly updating it to make sure that the period of your residence in Italy is continuous, and not having any breaks that resets the countdown (when you change your residential address), you can apply for Italian nationality! (After only ten… short… years!)
A Roman questura (police headquarters)
Tip #5: Use good record keeping habits to save time.
I would highly recommend keeping blank and filled copies of all your applications for future reference. Especially for permesso renewals, the changes you make on the application in the following years could be very minimal, and you can simply use previous applications as a template to fill out the forms. Also, in case of dispute when you renew your documents at an anagrafe or police headquarters (questura), you can produce your former documents to the Italian officials to verify your claims or resolve matters. I personally keep a scanned copy of all my previous applications in a hard drive. This has saved me many hours of paperwork and countless headaches, when I had to extend my permesso over the years.
Archiving your documents is also valuable in Italy, since schools, hospitals and other public and private institutions sometimes require original copies of certain documents and applications when making renewals or adjustments. Do yourself a favor: buy a folder, keep your documents organized, and thank me later!
Long story short: persistence pays off, one way or another. I was able to learn about the inner workings of the Italian bureaucracy. This persistence was also helpful in improving my legal Italian vocabulary as well! Tedious record keeping also saved me endless hours of dealing with paperwork – time that I put towards studying for my medical exams! I encourage you to navigate the Italian bureaucracy on your own. You might even enjoy the experience, which I eventually did!
To learn more about Italian bureaucracy, check out this post with more details about how to enter Italy’s superb health care system.
Erik Campano is a graduate student in Umeå, Sweden, studying the ethics of artificial intelligence in medicine. He formerly was an academic consultant to the English-language medical school of the University of Turin. Erik completed his Bachelor’s of science in Symbolic Systems (cognitive science) at Stanford University, and then he worked for about eight years as a radio news anchor, before moving to biomedical scientific study and research at the University of Paris and Columbia University. Erik grew up in Connecticut, is a citizen of the United States and Germany, and his family is a mix of Filipino, Italian, and German.
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