JUDGMENT NO. 76

YEAR 2026

ITALIAN REPUBLIC

IN THE NAME OF THE ITALIAN PEOPLE

THE CONSTITUTIONAL COURT

composed of:

President: Giovanni AMOROSO;

Judges: Francesco VIGANÒ, Luca ANTONINI, Stefano PETITTI, Angelo BUSCEMA, Emanuela NAVARRETTA, Maria Rosaria SAN GIORGIO, Filippo PATRONI GRIFFI, Marco D’ALBERTI, Giovanni PITRUZZELLA, Antonella SCIARRONE ALIBRANDI, Massimo LUCIANI, Maria Alessandra SANDULLI, Roberto Nicola CASSINELLI, Francesco Saverio MARINI,
has handed down the following

JUDGMENT

in proceedings regarding the constitutional legitimacy of Article 24, paragraph 5, of Legislative Decree no. 368 of 17 August 1999 (Implementation of Directive 93/16/EEC on the free movement of doctors and the mutual recognition of their diplomas, certificates and other evidence of formal qualifications, and of Directives 97/50/EC, 98/21/EC, 98/63/EC and 99/46/EC amending Directive 93/16/EEC), initiated by the Regional Administrative Court for Lazio, Third-Quater Section, in the proceedings pending between A. K. and the Ministry of Health et al., by referral order of 11 September 2025, registered as no. 208 of the 2025 registry of orders and published in the Official Gazette of the Republic, no. 44, First Special Series, of the year 2025.

Having heard in chambers on 12 March 2026 the Reporting Judge Emanuela Navarretta;

deliberated in chambers on 12 March 2026.

Legal Reasoning (Ritenuto in fatto)

1.– By order of 11 September 2025, registered as no. 208 of the 2025 registry of orders, the Regional Administrative Court for Lazio, Third-Quater Section, raised questions concerning the constitutional legitimacy of Article 24, paragraph 5, of Legislative Decree no. 368 of 17 August 1999 (Implementation of Directive 93/16/EEC on the free movement of doctors and the mutual recognition of their diplomas, certificates and other evidence of formal qualifications, and of Directives 97/50/EC, 98/21/EC, 98/63/EC and 99/46/EC amending Directive 93/16/EEC), insofar as it fails to provide that the legal effects of the diploma of specific training in general medicine, obtained following the recovery of the period of suspension due to pregnancy and maternity, shall be retroactive "to the date of the natural original expiry of the three-year training period (i.e., the date of the ordinary examination session).”

According to the referring court, the challenged provision conflicts with Articles 3, 31, 32, and 37 of the Constitution, as it creates a detrimental and discriminatory treatment toward women who, due to pregnancy and maternity, are forced to suspend their training course, thereby postponing the attainment of the qualification and its associated effects, including access to employment and career progression.

2.– The court a quo states, as a matter of fact, that it is presiding over an appeal filed by a doctor enrolled in the three-year specific training course in general medicine for 2020-2023, organized by the Lazio Region.

The appellant had commenced the course on 4 October 2021 but suspended it from 7 January to 6 June 2022 for compulsory maternity leave and, subsequently, from 7 June to 7 August 2022, for optional parental leave. Pursuant to Article 24, paragraph 5, of Legislative Decree no. 368 of 1999, these periods of suspension resulted in the deferral of the completion of the three-year training period, with the final date of attendance being postponed to May 2025.

Consequently, the Lazio Region did not include the appellant in the list of trainees admitted to the ordinary session of the final examination, scheduled for 12-13 December 2024, deeming the full recovery of the suspended training period to be mandatory.

3.– Accordingly, on 20 November 2024, the appellant submitted an application for conditional admission to the final examination in the December 2024 ordinary session, proposing to recover the remaining training activity subsequently, in order to obtain the diploma within the course’s original term. This would have allowed her, inter alia, to avoid the application of the new regulations introduced by the National Collective Agreement (ACN) of 4 April 2024 for general practitioners, which provided for the establishment of a single primary care role for physicians specializing after 1 January 2025.

The Lazio Region rejected said application, with a decision that was challenged by the appellant; on 28 November 2024, the latter submitted a new application, reiterating the request for conditional admission to the final examination, "without prejudice to her willingness to perform supplementary activity to complete the course’s natural duration,” and, alternatively, requesting the "backdating of the fixed-term convention, should the party concerned be forced to wait for the subsequent examination session.”

By note of 6 December 2024, the Lazio Region rejected this subsequent application as well, excluding the possibility of acknowledging a backdating of the diploma's effects, on the grounds that such an action "would have constituted a false entry in a public document.”

On 9 December 2024, the appellant filed additional grounds requesting the annulment of the aforementioned decision of 6 December 2024 and filed an application for an interlocutory injunction.

4.– In the appeal and the additional grounds filed before the Regional Administrative Court for Lazio, the appellant alleged, inter alia, the violation of national and European legislation regarding the protection of maternity and equal treatment between men and women.

Following the granting of the interlocutory injunction, the appellant was admitted conditionally to sit for the examination in the ordinary session of December 2024, which she passed. Subsequently, however, following the hearing in chambers, the application was rejected, and this decision was confirmed on appeal by the Council of State.

In the meantime, the appellant completed the total thirty-six-month training period on 4 May 2025 and sat for the final examination again in the extraordinary session of 13 May 2025, passing it.

5.– The referring court reports that, in light of these developments, the appellant’s interest has focused exclusively on the timing of the legal effects of the diploma of specific training in general medicine and, specifically, on the request that such effects be retroactive to the date of the natural expiry of the three-year course (December 2024).

The court a quo – after excluding the possibility of a constitutionally oriented interpretation of the challenged provision, given its literal meaning and the exceptional nature of the requested mechanism – raised questions concerning the constitutional legitimacy of Article 24, paragraph 5, of Legislative Decree no. 368 of 1999.

6.– As to the relevance of the complaints, the Regional Administrative Court for Lazio notes that the absence of a provision that – for the benefit of trainees who had to recover training following the suspension of the course for pregnancy and maternity – makes the legal effects of obtaining the diploma retroactive to the ordinary examination session provided for other participants "leads to the application to the appellant of a regulation governing the contractual relationship with the National Health Service […] which – regardless of assessments of the degree of burden – is in any case characterized by being different from that applied to the appellant’s course colleagues who, not having had to interrupt attendance due to pregnancy, were able to obtain the relative diploma by December 2024.”

Still for the purposes of relevance, the court notes that the appellant held a fixed-term contract, pursuant to Article 33, paragraph 4, of the ACN of 28 April 2022, which refers to Article 9, paragraph 1, of Law Decree no. 135 of 14 December 2018 (Urgent provisions on support and simplification for companies and public administration), converted, with amendments, into Law no. 12 of 11 February 2019, and that the postponement of the attainment of the training qualification would result in a delay in the conversion of this contract into an open-ended relationship.

7.– On the merits, the court a quo argues that the questions of constitutional legitimacy of Article 24, paragraph 5, of Legislative Decree no. 368 of 1999 are not manifestly unfounded, with reference to the principles of equality and equal treatment (Art. 3 of the Constitution), the protection of maternity and the family (Art. 31 of the Constitution), the protection of health (Art. 32 of the Constitution), and the protection of female labour (Art. 37 of the Constitution).

7.1.– The referring court provides extensive preliminary reasoning, starting from the systematic interpretation of Article 24, paragraph 5, of Legislative Decree no. 368 of 1999 and, in particular, the meaning of the cross-reference therein to the legislation on maternity protection.

The Regional Administrative Court for Lazio holds that this reference must be understood as including the institutions regulated by Legislative Decree no. 151 of 26 March 2001 (Consolidated Law on legislative provisions for the protection and support of maternity and paternity, pursuant to Article 15 of Law no. 53 of 8 March 2000), which are therefore also applicable to specific training courses in general medicine, which involve full-time commitment and the performance of practical activities in health settings. Consequently, absence due to pregnancy, referred to by the challenged provision, would encompass the period of compulsory maternity leave, as well as further cases of early interdiction and optional leave provided by the legal system.

The court a quo notes that, even with the presence of compulsory maternity leave alone, the suspension of course attendance would result in the postponement of the completion of the three-year training period and, therefore, the impossibility of sitting for the final examination in the ordinary session. Current regulations, in fact, allow for the recovery of the suspended training period and access to extraordinary examination sessions, but in any case, make the attainment of the diploma conditional upon the full completion of the thirty-six months of attendance, without providing for the retroactivity of the qualification’s effects to the date of the natural expiry of the course.

According to the referring court, this mechanism, although formally aimed at ensuring the trainees’ right to conclude the training path, produces, in violation of Art. 3 of the Constitution, a discriminatory effect for women. Indeed, the suspension imposed by pregnancy and maternity, the necessary recovery of the training period, and the wait for the extraordinary examination session would lead to a postponement of the attainment of the qualification, with prejudicial professional consequences, which would entail an unjustified difference in treatment compared to male trainees.

7.2.– The challenged provision would also be liable to discourage the full enjoyment of rights associated with maternity, as the prospect of a deferral of the qualification and the professional effects derived therefrom would be such as to induce those concerned to effectively renounce the protection mechanisms provided by the legal system. Such a dissuasive effect is deemed incompatible with the aforementioned constitutional principles referred to in Arts. 31, 32, and 37 of the Constitution, which mandate the protection of maternity, women’s health, and the interest of the child, and are aimed at ensuring conditions for conducting training and work activities compatible with family functions.

In this regard, the Regional Administrative Court for Lazio recalls the constitutional case law that has progressively valued the prohibition of discrimination related to pregnancy, maternity, and the overriding interest of the child (judgments no. 1 of 1987 and no. 285 of 2010), noting that maternity protection institutions are not intended solely for the protection of women, but also for the safeguarding of the mother-child relationship.

The court a quo specifically addresses judgment no. 211 of 2023, in which this Court held that a regulation concerning the winners of a competition for Deputy Inspector of the Penitentiary Police, which required, for appointment to the role, the attendance of a training course and the passing of the relevant final tests, was detrimental to the principle of equality and equal treatment. Specifically, the right recognized to female trainees, who could not participate in the course due to maternity, to attend a subsequent one, in the absence of guarantees regarding the timing of the latter's activation, appeared unsuitable to ensure timely entry into the role on par with other winners, with consequent delay in professional career directly attributable to the state of pregnancy.

Finally, the referring court recalls judgment no. 200 of 2020, by which this Court declared the constitutional illegitimacy of a regional regulation that precluded the hiring of women who were in a period of early work interdiction or compulsory maternity leave, holding that such a preclusion unreasonably compromised the constitutional principles of protection of maternity and the child.

Legal Analysis (Considerato in diritto)

8.– The Regional Administrative Court for Lazio, Third-Quater Section, by the aforementioned order (reg. ord. no. 208 of 2025) has raised, with reference to Articles 3, 31, 32, and 37 of the Constitution, questions of constitutional legitimacy of Article 24, paragraph 5, of Legislative Decree no. 368 of 1999, insofar as it does not provide that the legal effects of the diploma of specific training in general medicine, obtained following the recovery of the period of suspension due to pregnancy and maternity of the relative training course, shall be retroactive "to the date of the natural original expiry of the three-year training period (i.e., the date of the ordinary examination session).”

8.1.– The referring court reports that it is presiding over the appeal filed by a doctor enrolled in the 2020-2023 three-year specific training course in general medicine organized by the Lazio Region, who – having had to suspend the course attendance due to pregnancy and maternity – had obtained the diploma in the extraordinary session of May 2025, rather than in the ordinary session of December 2024, open to the other participants in the course.

The appellant was also a holder of a fixed-term convention contract, pursuant to Article 33, paragraph 4, of the ACN of 28 April 2022, which refers to Article 9, paragraph 1, of Law Decree no. 135 of 2018, as converted, susceptible to automatic conversion into an open-ended relationship, by effect of the mere attainment of the diploma, pursuant to Article 33, paragraph 12, of the aforementioned ACN.

Consequently, the postponement of the diploma examination, made necessary by the suspension of the training course for pregnancy and maternity, entailed, on the one hand, less seniority in the tenure of the open-ended contract and, on the other hand, due to the change in the collective contractual framework that occurred in the meantime, the application of a different conventional regulation from that referable to colleagues who had concluded the course within the ordinary timeframe.

8.2.– In the opinion of the referring court, the challenged provision would violate Article 3 of the Constitution, producing an unjustified disparity in treatment of female doctors who had to suspend the specific training course in general medicine for pregnancy and maternity, recover the relative training period, and wait for the extraordinary examination session to obtain the diploma, compared to male colleagues who attended the same three-year training course and were able to avail themselves of the ordinary examination session.

Furthermore, the court a quo considers Articles 31, 32, and 37 of the Constitution to be violated, as the prospect of delay in obtaining the qualification would disincentivize the full exercise of rights associated with maternity, in contrast with the constitutional principles of protection of the family, health, and the working mother.

9.– Before proceeding to the examination of the issues on the merits, it is necessary to recall the relevant regulatory framework.

9.1.– The challenged Article 24, paragraph 5, of Legislative Decree no. 368 of 1999 is part of the regulation governing the specific training course in general medicine, which allows "the exercise of the activity of general practitioner within the National Health Service” (Art. 21 of Legislative Decree no. 368 of 1999).

The challenged provision provides that: "[t]emporary impediments exceeding forty consecutive working days for military service, pregnancy, and illness shall suspend the training period, provided that its total duration is not reduced due to said suspensions. The provisions on the protection of pregnancy referred to in Law no. 1204 of 30 December 1971, and subsequent amendments, as well as those on the performance of military service referred to in Law no. 958 of 24 December 1986, and subsequent amendments, remain in force.”

In particular, the regulation subsequent to the cited Law no. 1204 of 30 December 1971 (Protection of working mothers) and, specifically, Legislative Decree no. 151 of 2001 governs: the "maternity leave,” referring to the obligation of abstinence from work for the working woman, which normally has a duration of five months (Art. 16 et seq. of the cited Legislative Decree no. 151 of 2001); the "paternity leave” concerning the obligation of abstinence from work of the worker or the worker, intentional parent, in a couple of women resulting as parents in the civil status registers (judgment no. 115 of 2025), which has a duration of ten days (or twenty, in case of multiple birth: Art. 27-bis, of Legislative Decree no. 151 of 2001); the "alternative paternity leave,” which contemplates the right to abstinence from work of the worker, in alternative to maternity leave, in the cases provided for by Art. 28 of the same decree, and the "parental leave,” which attributes the right to optional abstinence of the worker (Art. 32 et seq., of Legislative Decree no. 151 of 2001).

9.2.– Such events – if they exceed forty consecutive working days (Art. 24, paragraph 5, of Legislative Decree no. 368 of 1999) – suspend the specific training course in general medicine which, pursuant to Articles 21-32 of Legislative Decree no. 368 of 1999, is organized by the regions and autonomous provinces; has a three-year duration; provides for a full-time commitment of participants, with an obligation of attendance at theoretical and practical teaching activities; and concludes with the issuance of a diploma of training in general medicine by the regions and autonomous provinces, in compliance with the model prepared by decree of the Minister of Health (Art. 24, paragraph 2, of Legislative Decree no. 368 of 1999).

9.3.– The regulation governing training courses must then be coordinated with the provisions that, in recent years, have allowed for the assignment to doctors in training of fixed-term conventional contracts to meet the need to ensure, in the context of a general shortage of doctors, general medicine services.

In particular, Law Decree no. 135 of 2018, as converted, established, in Article 9 (as most recently amended by Art. 4, paragraph 9, letter c, of Law Decree no. 202 of 27 December 2024, containing "Urgent provisions on regulatory terms,” with the amendments made during conversion by Law no. 15 of 21 February 2025), that, "[i]n relation to the contingent shortage of general practitioners, pending a comprehensive revision of the relative specific training system, graduates in medicine and surgery qualified for professional practice, enrolled in the specific training course in general medicine, may maintain the assignments already granted or participate in the assignment of conventional contracts, including temporary and substitution contracts submitted to the national collective agreement within the framework of the regulation of relations with general practitioners. Their assignment is in any case subordinate to that of doctors in possession of the relative diploma and to other doctors having, for any reason, the right to be included in the regional ranking, by virtue of another provision. The requirement of possession of the certificate of aptitude for the exercise of territorial health emergency remains firm for the assignment of contracts for territorial health emergency. The failure to obtain the diploma of specific training in general medicine within the term provided by the course of respective attendance, without prejudice to the suspension periods provided for by Article 24, paragraphs 5 and 6 of Legislative Decree no. 368 of 17 August 1999, entails the cancellation from the regional ranking and the forfeiture of any assignment granted.”

The aforementioned Article 9 thus allows for the establishment, on a fixed-term basis, of a conventional relationship between the general practitioner (hereinafter: GP) and the National Health Service (SSN).

9.4.– In general, conventional contracts between GPs and the SSN are classified, by established case law, as para-subordinate employment relationships (Court of Cassation, Labour Section, order no. 30702 of 29 November 2024 and Civil Sections United, order no. 20344 of 21 October 2005).

Their regulation is defined by Article 48 of Law no. 833 of 23 December 1978 (Establishment of the national health service), Article 8 of Legislative Decree no. 502 of 30 December 1992 (Reorganization of the discipline in health matters, pursuant to Article 1 of Law no. 421 of 23 October 1992), as well as by the ACNs stipulated between the representation structure of the regions, called the Interregional Structure for Conventional Health Workers (SISAC), and the category trade union organizations.

The assignment of contracts for the functions of GP takes place through a ranking based on qualifications, prepared annually at the regional level, the formation criteria of which are regulated by collective bargaining, to which it is equally delegated to regulate the procedures for the assignment of conventional contracts (including those under Art. 9, paragraph 1, of Law Decree no. 135 of 2018, as converted), access priorities, criteria for transfers, and conditions for the exercise of the profession.

9.5.– The ACNs also provide, with specific reference to the contracts under Article 9, paragraph 1, of Law Decree no. 135 of 2018, as converted, that these, despite being fixed-term, do not terminate at the natural end of the contractual duration, but automatically transform into open-ended relationships from the date of the attainment of the diploma.

In particular, pursuant to Articles 33, paragraph 12, of the ACN of 28 April 2022 and 33, paragraph 11, of the ACN of 4 April 2024, as well as the ACN of 15 January 2026 – and, in similar terms, in the other previous ACNs – the general manager confers the definitive contract for the single primary care role "with effect from the date of attainment of the diploma of specific training in general medicine, subject to the acquisition of the self-certification of the qualification.” This is an act bound in both an (whether it occurs) and quando (when it occurs), given that the transformation is not left to the discretion of the administration, but operates automatically upon attainment of the diploma, so that the date of the latter represents the moment of constitution of the commencement of the open-ended contract. Similarly, Articles 63, paragraph 21, and 72, paragraph 15, of the ACN of 28 April 2022, of the ACN of 4 April 2024, and of the ACN of 15 January 2026 provide for the same transformation, respectively, for territorial health emergency contracts and for those of assistance in penitentiary institutions.

The same mechanism is also contemplated for doctors enrolled in the training course pursuant to Article 12, paragraph 3, of Law Decree no. 35 of 30 April 2019 (Emergency measures for the health service of the Calabria Region and other urgent measures in health matters), converted, with amendments, into Law no. 60 of 25 June 2019, according to which "[u]ntil 31 December 2021, graduates in medicine and surgery qualified for professional practice who have already been found suitable for the competition for admission to the three-year specific training course in general medicine, who have been assigned, within the scope of the conventional functions provided for by the national collective agreement for the regulation of relations with general practitioners for at least twenty-four months, even if not continuous, in the ten years preceding the date of expiry of the submission of the application for participation in the competition for access to the specific training course in general medicine, have access to the aforementioned course, through a reserved ranking, without a study grant.” The aforementioned term of 31 December 2021 was then extended to 31 December 2022 by Article 1, paragraph 426, of Law no. 178 of 30 December 2020, containing "State budget for the financial year 2021 and multi-year budget for the three-year period 2021-2023.”

9.6.– On the other hand, the ACNs do not mention, for the purposes of the automatic transformation of the fixed-term contract into an open-ended contract, the most recent regulation, under Article 2-quinquies of Law Decree no. 18 of 17 March 2020 (Measures for strengthening the National Health Service and economic support for families, workers, and companies connected to the epidemiological emergency from COVID-19), converted, with amendments, into Law no. 24 of 24 April 2020, according to which, "[a]s of 1 January 2025, doctors enrolled in the training course in general medicine are permitted to establish a fixed-term conventional relationship with the National Health Service” (paragraph 1); likewise, the assumption of "temporary or substitution contracts for general practitioners under convention with the National Health Service” is permitted, as well as enrollment "in the lists of the medical guard and the tourist medical guard” (paragraph 2).

Such regulation, therefore, does not replace the previous legislation, but stands alongside and adds to it.

10.– That being stated, it must be specified that the complaints moved in today’s judgment are focused exclusively on the condition of trainees holding fixed-term contracts, susceptible – on the basis of current legislation – to automatic transformation into open-ended relationships with the mere acquisition of the diploma of specific training in general medicine.

In particular, the referring court complains that the challenged provision – in providing for the suspension of the training course in general medicine and, then, the recovery of the corresponding period, in the presence of an impediment exceeding forty days, which is also the mere compulsory maternity leave that well exceeds such duration – discriminates against women, in that it does not provide that the diploma obtained in the first useful extraordinary session, after the recovery of the suspension period, is considered as acquired in the ordinary session, for the purposes of the legal effects deriving from the transformation of the fixed-term contract into an open-ended relationship.

11.– Thus delimited the petitum, the questions raised with reference to Art. 3, for unreasonable disparity of treatment, and Arts. 31, 32, and 37 of the Constitution are well-founded.

11.1.– The impediment to the continuation of the training course deriving from pregnancy and maternity and the need to recover it for the time corresponding to the period of suspension determine, in the absence of an adequate corrective mechanism, the impossibility of sitting for the final diploma examination together with the other participants in the course and the need to wait, based on Article 16 of the Decree of the Ministry of Health of 7 March 2006 (Fundamental principles for the unitary discipline in the matter of specific training in general medicine), for the regions or autonomous provinces to call extraordinary examination sessions. In particular, paragraph 2 of the cited regulatory provision establishes that "[t]he regions and autonomous provinces may [emphasis added] also provide for further examination sittings for trainees who have suspended attendance following [...] pregnancy [...]; in this hypothesis, the examination sittings must be called according to criteria of economy and opportunity.” Furthermore, the subsequent paragraph 3 of the same Art. 16 provides that, "[f]or reasons of uniformity of judgment, the final examination commissions must provide for the same composition also for subsequent extraordinary sessions, without prejudice to the possibility of proceeding to new appointments in case of impediments of the commissioners.” In essence, trainees who had to suspend and then recover the training course for pregnancy and maternity cannot participate in the subsequent ordinary examination session and can do nothing but wait, in a situation of uncertainty, for the fixing of the extraordinary examination date.

In this way, the summation of the period of training recovery of duration equal to the suspension made necessary by pregnancy and maternity, to which any period of parental leave can legitimately be added, and the time elapsed correlated to the wait for the extraordinary examination session, the calling of which does not entail for the administration any constraint in either an or quando, determines a delay in the acquisition of the diploma and defers the moment in which the open-ended conventional relationship is established, with discrimination against women who could not continue course attendance due to abstinence for pregnancy and maternity.

On the other hand, Legislative Decree no. 151 of 2001 itself – to which the challenged provision refers in recalling Law no. 1204 of 1971 and subsequent amendments – expressly prohibits, in Art. 3, paragraph 1, "any discrimination for reasons connected to sex, according to what is provided by Legislative Decree no. 198 of 11 April 2006, with particular regard to any treatment less favorable by reason of the state of pregnancy, as well as maternity or paternity, even adoptive, or by reason of the entitlement and exercise of the relative rights.” No differently, Art. 25, paragraph 2-bis, of Legislative Decree no. 198 of 11 April 2006 (Code of equal opportunities between man and woman, pursuant to Article 6 of Law no. 246 of 28 November 2005), provides that "[i]t constitutes discrimination, pursuant to this title, any treatment or modification of the organization of working conditions and times which, by reason of sex, age, personal or family care needs, the state of pregnancy as well as maternity or paternity, even adoptive, or by reason of the entitlement and exercise of the relative rights, places or may place the worker in at least one of the following conditions: a) disadvantageous position compared to the generality of other workers; b) limitation of opportunities for participation in corporate life or choices; c) limitation of access to mechanisms of advancement and career progression.”

11.2.– Such discrimination translates into prejudice with permanent effects on the discipline concerning transfers.

The ACNs regulate, in fact, the relative requests exclusively on the basis of seniority of open-ended contract, having regard to: the primary care role (Art. 34, paragraph 7, ACN 28 April 2022, ACN 4 April 2024 and ACN 15 January 2026), territorial health emergency (Art. 63, paragraph 8, of the same ACNs), and contracts in penitentiary institutions (Art. 72, paragraph 4, of the same ACNs).

The delay that occurs in maturing conventional seniority compared to colleagues who were able to conclude the course within the ordinary timeframe creates, therefore, a structurally detrimental position and entails a gap that, over time, is not destined to attenuate, but crystallizes for the entire duration of the professional career.

Add to this that, since the open-ended contract is conferred with effect from the date of attainment of the diploma, any change in the collective contractual framework that occurred between the ordinary and the extraordinary examination session determines the subjection of the trainee to a conventional discipline different from that applicable to colleagues who concluded the course within the ordinary timeframe. In the case that gave rise to the present judgment, the extension of the course meant that the diploma was obtained during the validity of the ACN of 4 April 2024, which – unlike the ACN of 28 April 2022 applicable to the other course colleagues – introduced the single primary care role (Art. 31 et seq.), eliminating the distinction between cycle-of-choice assistance and hourly-activity assistance and imposing an exclusive full-time commitment in a single company, with permanent effects on the modalities of exercise of the profession and the workload.

11.3.– A lower seniority in the open-ended conventional relationship and the application of a different regulation governing such relationship cannot (and must not) be the consequence of the choice to have children, all the more so in the context of a regulatory setup that leaves to the purely discretionary evaluation of territorial bodies the choice of an and quando to call extraordinary examination sessions (as provided by the cited Art. 16 of the Ministerial Decree of 7 March 2006).

Faced with a regulation that provides, in favor of certain fixed-term contracts, for transformation into open-ended relationships, by effect of the sole acquisition of the diploma of specific training in general medicine, the difference in treatment between women who must suspend the course for pregnancy and maternity and the other enrollees in the same course finds no legitimate justification.

Such cannot be considered the need to guarantee the completion of the training path, as such an instance can well be realized without prejudicing the parity of treatment. Similarly, it is not possible to invoke the need to preserve an orderly formation of the ranking, since in the regulatory fragment under examination the trainees have already been inserted in the ranking and have obtained a fixed-term contract following a competitive procedure.

12.– The irremediable conflict of the challenged regulation with the prohibition of discrimination realizes at the same time a violation of Arts. 31, 32, and 37 of the Constitution.

The protections correlated to pregnancy and maternity are, in fact, a crossroads of multiple constitutionally relevant principles (judgments no. 158 of 2018 and no. 205 of 2015): Art. 31 of the Constitution, which protects maternity and childhood; Art. 32 of the Constitution, which protects the health of the mother and child; Art. 37 of the Constitution, which imposes working conditions compatible with the family function and ensures the mother and child "special adequate protection” (judgments no. 205 of 2015 and no. 361 of 2000).

Consequently, protection instruments such as the suspension of training activity, aimed at protecting the recalled interests and, specifically, not only the woman’s health, but also the "overriding interest of the child” (judgment no. 115 of 2025, which recalls judgment no. 285 of 2010), taking into account his biological needs and those "of a relational and affective character connected to the development of [his] personality” (judgment no. 116 of 2011; in the same sense, judgments no. 115 of 2025, no. 285 of 2010, no. 332 of 1988 and no. 1 of 1987), cannot – as, instead, is found in the challenged norm – reverberate negatively on the position of the working woman who, by effect of the recalled suspension, suffers an immediate prejudice in her para-subordinate work relationship.

Article 24, paragraph 5, of Legislative Decree no. 368 of 1999, in making weigh on her, in terms of prejudicial consequences, the effects of choices that find protection in the nest of multiple constitutional principles, highlights the discriminatory traits of the diversity of treatment.

Nor can it be silenced that the indirect and inevitable effect of regulations – such as the one challenged – that discriminate against the working woman in relation to pregnancy and maternity is that of disincentivizing the very choice to have children (in an analogous sense, judgment no. 211 of 2023), in open contrast both with Art. 31 of the Constitution, which commits the Republic to facilitate the formation of the family, and with Art. 37 of the Constitution, which requires to "ensure to the mother and child special adequate protection.”

This Court has already affirmed that "maternity must not find reluctance for the fact that the mother is a working woman” (judgment no. 310 of 1999), all the more so in a country – like ours – in which "the birth rate is among the lowest in Europe” (judgment no. 159 of 2025).

13.– To further illuminate the reasons for constitutional illegitimacy of the provision under examination also concurs the comparison with other precedents of this Court, which have progressively elaborated a framework of protections of the working mother aimed at neutralizing the prejudicial effects deriving, on the professional position, from the abstinence for pregnancy and maternity.

In this sense, it was deemed constitutionally illegitimate not only "norms that comport, by reason of maternity, a substantial economic impairment of the worker” (judgment no. 361 of 2000, which recalls judgments no. 310 of 1999, no. 3 of 1998 and no. 181 of 1993), but also those that determine permanent and unrecoverable damage at the level of career (judgments no. 211 of 2023, no. 200 of 2020 and no. 361 of 2000).

In this perspective, this Court has ensured protection even to persons not yet entered into the world of work and who suffered a "discrimination by reason of the state of pregnancy and maternity, which substantiated itself in the loss of chance, linked to an effective entry into the work sphere” (judgment no. 200 of 2020). The regulation in that case challenged limited itself to leaving in the ranking, in view of a subsequent and merely eventual scrolling, persons who could not have been placed in the role by reason of pregnancy and maternity. Similar regulation appeared "in irremediable contrast with [the] prohibition of discrimination connected to the state of pregnancy and maternity, as well as to the care of the child, understood as valorization of a peculiar affective and relational bond (judgment no. 158 of 2018, which recalls judgments no. 61 of 1991 and no. 423 of 1995),” which induced this Court to extend the protection also "to the father worker, when the conditions indicated by Art. 28 of Legislative Decree no. 151 of 2001 recur” (again, judgment no. 200 of 2020).

All the more, then, must the violation of the prohibition of discrimination be highlighted in the case of trainees who, after having already been selected on the basis of a ranking and after having acquired a para-subordinate work contract, suffer, as a consequence of pregnancy and maternity, a prejudice compared to the times of transformation of the fixed-term relationship into an open-ended one.

14.– The framework delineated by constitutional jurisprudence intertwines, on the other hand, also with the union principle of equal treatment between man and woman in the matter of occupation and employment, which finds its most completed expression in Directive 2006/54/EC of the European Parliament and of the Council, of 5 July 2006, regarding the implementation of the principle of equal opportunities and equal treatment between men and women in the matter of occupation and employment. Art. 15 of the cited source establishes, in particular, that, at the end of maternity leave, "the woman has the right to resume her own work or an equivalent post according to terms and conditions that are not less favorable to her, and to benefit from any improvements in working conditions that would have been due to her during her absence.”

Precisely in reference to this provision the Court of Justice (first section, judgment 6 March 2014, case C-595/12, Napoli against Ministry of Justice) held that the exclusion from participation in a course, due to abstinence for maternity, and "the consequent prohibition from participating in the conclusive examination of the same,” from which derives "the loss of the opportunity to benefit, like […] colleagues, of better working conditions,” must "be considered as integrating unfavorable treatment pursuant to Article 15 of Directive 2006/54” (point 33). The "violation of such principle is all the more flagrant,” specifies the Court of Justice in the recalled pronouncement, "in that, as observed by the referring judge, the circumstance that the beginning of the subsequent training course constitutes an uncertain event derives from the fact that the competent authorities are not obliged to organize said course at predetermined deadlines” (point 37).

15.– Highlighted the discriminatory and harmful character of multiple constitutional interests of the challenged regulation, it is necessary, in the furrow of Art. 37 of the Constitution, to identify the remedy suitable for ensuring "special adequate protection,” taking into account that "[t]he absence of conjunctions between the two adjectives "special” and "adequate” demonstrates that these are inseparable profiles, which interpenetrate and reinforce each other” (judgment no. 205 of 2015).

In particular, to neutralize the prejudice constituted by the delay in the acquisition of the diploma of specific training in general medicine, it is necessary to refer the moment of its acquisition to the date in which the ordinary examination session took place for all the other participants in the course, for the legal purposes correlated to the transformation of the fixed-term contract into an open-ended relationship.

Such protection results shaped on the "specificity of the position of who will have to benefit from it” (again, judgment no. 205 of 2015) and, at the same time, "adequate” to realize full protection, without undermining the instance of ensuring the completeness of the training preceding the acquisition of the diploma.

On the other hand, recourse to the same remedy was also had in a previous affair that presents similar traits compared to the current one, even if in a different regulatory context.

In the case object of the present judgment, consideration comes to the delay in the automatic transformation of a para-subordinate work relationship on a fixed-term basis into an open-ended one, due to the necessary recovery of the training period suspended for pregnancy and maternity as well as the uncertain moment of the calling of the extraordinary examination session for the acquisition of the diploma; hence the prejudice represented by the postponement of the commencement of the definitive contract to which the trainee already had title, even if under condition.

In the previous case, consideration came to a delay in the entry into the role of winners of a competition, due to the impossibility of participating, by reason of pregnancy and maternity, in a training course that conditioned, together with the passing of the relative final tests, the very entry into the role, which forced mothers who won the competition to wait for the uncertain activation of the new training course.

Well, this Court – after having held that the "mere recognition of the right to participate in a training course organized on a subsequent and uncertain date,” without the administration being "bound to activate [it] according to pre-established deadlines,” harms Art. 3 of the Constitution and the full realization of the fundamental right to parity of treatment between men and women – has healed the wound, attributing to the entry into the role the same commencement, for legal purposes, referred to the other winners of the same competition (judgment no. 211 of 2023).

The same remedy can well operate also with respect to the discipline today under examination.

16.– For the reasons exposed, Art. 24, paragraph 5, of Legislative Decree no. 368 of 1999 must be declared constitutionally illegitimate, in the part in which it does not provide that the diploma of specific training in general medicine, obtained in the first useful date after the recovery of the period of suspension for pregnancy and maternity of the relative training course, be considered as acquired in the ordinary session provided for the other participants in the same course, for the purposes of the legal effects correlated to the transformation, in compliance with the current discipline, of a fixed-term conventional contract with the SSN into an open-ended one.

FOR THESE REASONS

THE CONSTITUTIONAL COURT

declares the constitutional illegitimacy of Article 24, paragraph 5, of Legislative Decree no. 368 of 17 August 1999 (Implementation of Directive 93/16/EEC on the free movement of doctors and the mutual recognition of their diplomas, certificates and other evidence of formal qualifications, and of Directives 97/50/EC, 98/21/EC, 98/63/EC and 99/46/EC amending Directive 93/16/EEC), in the part in which it does not provide that the diploma of specific training in general medicine, obtained in the first useful date after the recovery of the period of suspension for pregnancy and maternity of the relative training course, be considered as acquired in the ordinary session provided for the other participants in the same course, for the purposes of the legal effects correlated to the transformation, in compliance with the current discipline, of a fixed-term conventional contract with the National Health Service into an open-ended one.

So decided in Rome, at the seat of the Constitutional Court, Palazzo della Consulta, on 12 March 2026.

Signed:

Giovanni AMOROSO, President

Emanuela NAVARRETTA, Reporting Judge

Igor DI BERNARDINI, Chancellor

Deposited in the Registry on 12 May 2026

 

The anonymized version is consistent, in the text, with the original.