Tiago Villanueva: The aftermath of doctors’ industrial action in Portugal

Tiago_VillanuevaSenior doctors, junior doctors, pregnant doctors, doctors on holiday, and doctors from all around the country protested against the Portuguese government’s healthcare policies last week. The march took part on the 11 July in front of the Ministry of Health in central Lisbon. Over 90% of Portugal’s doctors took part in the two days of industrial action which ground the country’s health system to minimum services. The total number of doctors at the protest amounted to between 2000 and 4000 depending on the source. The protest enabled unions to meet with the Ministry of Health the day after the strike, and more meetings are due in July. The unions want to reach an agreement with the Ministry of Health before the 31 August on a number of issues for example, the 40 hour salary grid, collective hiring, and emergency department work issues. It is still too early to say exactly what is going to happen after the summer, but the Minister of Health said that the plan is to gauge the medical workforce shortages as soon as possible, to open up permanent positions for public tendering, and thus progressively cut down on commissioned locum work hours, even though they will continue to be necessary in the coming years.

The Portuguese doctors’ industrial action crossed borders and reached the ears of the main European medical organisations, who have sent letters to the prime minister and minister of health showing their concern towards current health policies, that circulated widely in social networks and listservers. Claude Wetzel, President of the European Federation of Salaried Doctors (FEMS), wrote that, “FEMS is concerned about the 2.5 million hours of medical services your government has given to external companies for the lowest price. These contracts carry a high risk to patients’ safety and some aspects are against European rules, especially the European Working Time Directive 2003/88”. João de Deus, President of the European Association of Senior Hospital Physicians added that, “throughout Europe we all know that poorly paid, non-specialized doctors are doing specialized tasks, cheap manpower in health services and quantity instead of quality indicators only leads to an increasing risk for patient’s safety.” Other organisations such as the European Junior Doctors Permanent Working Group or the Bulgarian Medical Association also expressed their support.

One of the critics of the doctor’s strike was renowned Harvard University Professor Michael Porter, who was in Lisbon to participate in a symposium on “health systems in times of crisis.” Porter knows Portugal well as he authored a report 20 years ago about the Portuguese economy, which was commissioned by the government at the time. In an interview to the Portuguese weekly broadsheet Expresso, he said that “it is the same old discussion. Each interest group in the system trying to protect the way things used to be, rather than looking at the future, thinking how to create a better system, in which everyone can prosper.” But nevertheless he also does not spare government policies and said that austerity measures “do not improve the value.” He called for “restructuring and reorganising the way that healthcare is delivered.”

A lot of developments are in store after the summer, but I wonder if the prime minister will not take advantage of the “rentrée” to carry out some cabinet “remodelling” in the health ministry.

Tiago Villanueva is a locum GP based in Portugal, and a former BMJ Clegg Scholar and student editor, Student BMJ. He can be followed on Twitter at @TiagoMGF