31 Jan, 12 | by BMJ Group
About 10 months ago I blogged that an exodus of doctors from Portugal would be a sign of Portugal’s worsening economic situation. Medicine has always offered one of the few stable and prosperous careers. Most doctors are still in employment, and our income levels are usually above the national average as many doctors juggle professional commitments in both the public and private sector.
I was still unaware at the time that a bailout by the European Central Bank, the International Monetary Fund, and the European Union, would eventually become a reality. These have led to austerity measures that have had consequences for doctors.
Nearly one year on the economic situation has definitely worsened significantly. So have young doctors’ perspectives on their careers. The media spotlight on ”medical emigration” has reached unprecedented proportions. Furthermore, never have we witnessed so many young doctors venting their spleen on social networks like Facebook about their desire to leave the country and establish themselves elsewhere.
The gloomy financial outlook has implications for wages, professional stability, and the working conditions of doctors. Curiously, workforce planning problems may also end up affecting the future unemployment prospects of medical graduates.
In November 2011, I attended the annual ceremony of the hippocratic oath for Portuguese medical graduates (someone dear to me was due to swear the oath). The president of the Portuguese Medical Association told the audience that many newly qualified doctors would have to leave the country, and not necessarily because of the financial crisis.
For the first time ever he estimated that there would not be specialty training placements for all the graduates in 2012, and, in Portugal, a doctor cannot attain full registration unless he or she completes the first year of specialist training. In other words, a doctor who is not successful in securing a specialty training post is not eligible to work, and thus must either migrate or change profession.
How did this happen? “Numerus clausus,” the annual number of slots in medical schools, has increased tremendously in the last 10-15 years, without a corresponding increase in postgraduate training capacity.
Also, many candidates for specialist training nowadays are foreign doctors, as well as Portuguese doctors who qualified in universities abroad (particularly in Spain and the Czech Republic) and who now want to return. This contributes to the specialty training bottleneck.
Young doctors’ motivation levels are dropping. Many newly qualified hospital specialists are not being given permanent contracts following specialist training. Controversially, doctors who did not carry out general practice vocational training are being hired from South American countries (such as Colombia), to attenuate the shortages in primary care. And they are being paid more than Portuguese doctors who have carried out full general practice training.
Young Portuguese doctors are aware that they are likely not to find the professional stability, training conditions, and income levels enjoyed by previous generations, in a country that is not offering good prospects for raising a family.
Every month I hear about colleagues and young doctors who have settled abroad. Some even managed to secure employment before finishing medical school. Northern European countries are the preferred destinations. I know of colleagues who have got into specialty training programmes in North America.
A few days ago the French recruitment agency The Association for the Finding and Settlement of European Doctors (ARIME) came to Lisbon to recruit Portuguese doctors to work in France. Dozens of local doctors turned up, lured by the prospect of better income and professional development. It’s too early yet to talk about a mass exodus of doctors, but I have no doubts that young Portuguese doctors will increasingly compete on the global market. After all, young doctors are the ones who went on European exchange programs like Erasmus during medical school, and thus have intercultural awareness and speak foreign languages. They are prepared for the professional challenges of the 21st century.
Tiago Villanueva is a locum GP based in Portugal, and former BMJ Clegg Scholar and editor, StudentBMJ.