Tiago Villanueva: Is there going to be a brain drain of doctors in Portugal?

Tiago_VillanuevaI have already been invited twice this year to give a talk about emigration of doctors out of Portugal. I find this a sign of the difficult times we’re going through in Portugal. Doctors, like every citizen, have been subject to relentless austerity measures and to progressive impoverishment. But we’re not currently seeing doctors leaving the country in droves. Nurses, however, are a completely different story. Portugal is currently the second country (after Spain) to have the most nurses registered in the UK’s Nursing and Midwifery Council and the number of Portuguese nurses in the UK has grown over 40 fold in the last six years.

The mass emigration of Portuguese nurses is due chiefly to low pay and lack of employment opportunities. I worked with some great nurses and administrative staff, who, all of a sudden, were offered under four euros per hour to do their job in primary care settings. Some of them ended up leaving the country, or simply not working, because they realised that they would end up paying so much to get to work that their income wouldn’t make it worthwhile.

Portuguese doctors are not yet leaving the country in the same way that nurses are because unemployment for doctors is still residual, and pay is still high. It’s interesting to note that Portuguese doctors don’t even make it into the top 20 countries providing doctors to the UK, unlike other Southern European nations, or even wealthy Northern European countries. Ironically, there are more German doctors registered with the UK’s General Medical Council than doctors from Greece, Italy, or Spain.

But that may change very soon, because of reports that there will be no specialist training posts for all newly qualified doctors starting next year, and that 200 to 300 recent graduates may not be entitled to any post at all. You could argue that doctors who fail to find a training post could find alternative types of employment, like locum work or non-training posts, while waiting for an opportunity to apply again for specialist training. But that is not possible in Portugal, because here doctors are only awarded clinical autonomy (permission to practice clinical medicine without supervision) after they conclude the initial foundation year (which all newly qualified doctors must go through) and the first year of concrete specialist training. In other words, many newly qualified doctors in the coming years may face imminent unemployment if they fail to secure a specialist training post, don’t move to another country to pursue specialist training, or find employment outside clinical medicine.

I believe the exodus of doctors in Portugal will accelerate in coming years, but not to the extent of nurses. One of the best things medical students and trainee doctors can do right now is to prepare for an era of international mobility by becoming “global doctors.” But, the catch of getting a taste of this global world of medicine nowadays is that Portuguese doctors may not want to return home for good. I know many colleagues who I met during medical school and GP vocational training who today are based outside Portugal. What was supposed to be a stay of just a few weeks or a few months during specialist training ended up as a permanent stay. And why? Because, among other reasons, they have realised that the working conditions in Portugal have deteriorated, and the training, pay, and professional development conditions in the host country were extremely appealing. The grass may sometimes actually be greener on the other side after all.

Tiago Villanueva is a locum GP based in Portugal, and  a former BMJ Clegg Scholar and editor, studentBMJ.