Tiago Villanueva: The worrying future for junior doctors in Portugal

Tiago_VillanuevaThe future of junior doctors’s careers in Portugal has recently been all over national television. It comes just a few weeks after I blogged about the potential brain drain of doctors in Portugal. It has all come to head because of a recent conference organised by the “Association of Junior Doctors” and the Faculty of Medicine of the University of Porto entitled “What is the future for junior doctors?” which has been widely picked up and discussed in the media.

As I wrote in my recent blog, for the first time ever in Portugal, about 200 newly qualified doctors may not be able to secure a specialty training post. This means that they may not even be able to work as a non-specialist, who is often known in Portugal as an “undifferentiated doctor,” and whose scope of professional opportunities is limited. These graduates will either have to wait another year to reapply for specialty training or move to a non clinical job (and I wonder if there will be any), or pursue specialty training in a different country. But this conference raised a few more points of concern. For instance, it may be necessary to start reducing the total number of medical school placements, as the recommended number has already been reached. There are currently about 1800 places available in the country’s eight medical schools, but the recommended number stands at 1200 as postgraduate training capacity in hospitals and in primary care health centres is limited.

In reality, reducing the number of medical school places is a politically sensitive issue, as the general public still perceives that there is a considerable shortage of doctors in Portugal and the medical regulator is often considered protectionist  when it calls for a decrease in the total number of students admitted every year to medical school.

And it is not only the issue of training too many graduates that could force many to leave the country to put their clinical skills to use. There is also concern about lowering the quality of undergraduate medical education. For instance, the new building that houses the Faculty of Medicine of the University of Porto already hosts 290 students per year, but it was designed to host 190. This may potentially lower the quality of training, as students will have less clinical exposure and fewer opportunities for practical training. This is also a worry for other countries, particularly in the European Union, whose member states are geographically close and recognise Portuguese medical qualifications. Portuguese doctors will not be competitive in the international job market if they have serious training gaps.

Ironically, Portugal continues to have shortage of GP’s and a shortage of doctors in many areas of the country outside of the capital Lisbon, or the country’s other metropolitan area, Porto. Lisbon and Porto have over five doctors per 1000 inhabitants, well above the European average, while some areas like Bragança, Vila Real, Santarém, Leiria, or Beja have fewer than two doctors per 1000 inhabitants. And Coimbra, a university city which is the Portuguese version of Oxford or Cambridge, has a staggering figure of over eight doctors per 1000 inhabitants. So overall, Portugal apparently doesn’t have a shortage of doctors, but rather they are not equally distributed. And there is of course the chronic problem of a shortage of GP’s, which is not exclusive of Portugal. I’ve just returned from the spring meeting of the European Union of General Practitioners and Family physicians, which took place in Ireland, where I heard that about 90% of newly qualified GP’s in Ireland are leaving the country— although I can’t verify this figure. The most popular ports of call seem to be Canada, Australia, and New Zealand. Considering that GP’s in Ireland earn a reasonable salary (at least much more than in Portugal), this is a good example of how persuading GP’s to stay, particularly in less attractive areas, must encompass a combination of financial as well as other types of professional and personal incentives. Many Portuguese doctors may subsequently end up taking up GP jobs in Ireland and other European countries, while many doctors from Colombia and other South American countries have been recruited in the last few years to take up posts as primary care doctors in Portugal. This is a vicious food chain! I now understand why I receive so many job offers to work in Ireland.

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