Tiago Villanueva: Am I happy about leaving Portugal and clinical medicine?

Tiago_VillanuevaAbout a month ago, I left my family, friends, and comfort zone in Portugal to take up the job of BMJ editorial registrar at The BMJ‘s editorial office in London.

You might think that I’m just another of the many doctors trying to escape the Southern European misery and grim career perspectives.

But let’s get things clear. Firstly, most Portuguese doctors are not leaving Portugal because they can’t find work or earn enough money to survive. They are doing so mainly for other reasons, related mostly to accessing a stronger market for professional and career development.

Second, there’s still a considerable shortage of GP’s in Portugal, so people like me remain valuable assets to the Portuguese national health service. I left my job as a locum GP voluntarily. I was not forced to leave, I was not made redundant, and I didn’t become unemployed. And I would be able to continue to make a living if I had stayed in Portugal, unlike many other people who are forced to move elsewhere out of necessity.

But, if there was a right time to leave the country and take some risks, now was the time. It was becoming increasingly harder to work as a GP in Portugal, and my motivation was dwindling. My last pay cheque was roughly a third of what it was when I started working as a locum GP about two and half years ago, and my working conditions had worsened significantly. Recently, many computers at my GP practice were broken. As it would sometimes take weeks for technical support to come to the rescue, I would often have to try out as many as four different rooms before finding one with a computer that worked. And even if the computer worked, I would always have to double check if there was enough toner in the printer, because toner cartridges were increasingly in short supply. This generated a lot of stress, particularly when I had a five hour session ahead, patients were queueing up and I couldn’t start working. Recently for the first time, I had to buy paper to print out prescriptions and exam requests because all of a sudden there was none at the practice, which like all GP practices in the Portuguese national health service, are state owned and rely on the regional health administration to replenish stocks.

Having said this, my stress levels have plummeted since I started working at The BMJ, where everything seems to run so smoothly. So in a way, I feel relieved about leaving Portugal, but at the same time I will miss many of my patients, to whom I felt I really made a difference. It hurts to think about one patient who told me he prayed to God everyday that I would stay in the practice forever, without knowing that I would be gone in a few weeks time (I didn’t have the courage to tell him I was leaving soon).  There are important consequences for the Portuguese health system when doctors leave the country. One of them is increasing fragmentation of care and, possibly, provision of worse care. Having worked as a full time “stable” locum GP, I found out that my hours were split between three different doctors, who may not be fully trained GPs (you can work as a “GP” in some types of practices in Portugal, without having carried out the four year GP training programme, but that is not possible in the UK), as it remains difficult to find formally trained GPs to work as full time and longterm locums.

But unlike most of my Portuguese colleagues who have left or are currently leaving the country in search of greener pastures, I will not be seeing patients in the UK. It would be great to work one day or a half day as a GP in London alongside my work at The BMJ, but I realised it would not be feasible. It seems that apparently even doctors trained in other European Union member states are required to do an observership and sit the Royal College of General Practitioners’ examinations in order to be included in the performer’s list of GP’s in London, which is not compatible with a full time job at The BMJ. Additionally, the cost of malpractice insurance in the UK is astronomical compared with Portugal. But, I would like to return to clinical medicine at some point. In the meantime, I am feeling motivated and enjoying the start of my year as editorial registrar, which is allowing me to learn new things everyday and gain new skills. I also feel I continue to be a GP at The BMJ, even if that means applying my medical knowledge in a different way.  And just because of that, the move to the UK and the sacrifices it entailed have already been worth it.

Tiago Villanueva is the current BMJ editorial registrar, and former BMJ Clegg Scholar and editor, studentBMJ.