Lack of doctors, just when reinforcement is needed after Covid19
Despite the fact that Catarina Martins – the leader of the Left Bloc (BE) – regards the National Health Service (SNS) as ‘a pearl of democracy’ and its workers ‘heroes and heroines’, working conditions are poor and staff shortages in public health-threatening. Let’s first take a look at the situation at the doctor level.
More than 1 million users of the SNS do not have a family doctor, most of them living in the region of Lisbon and the Tagus Valley. A situation that hasn’t occurred since 2015.
The Minister of Health – Marta Temido – acknowledges that the number of general practitioners has sharply regressed but justified the shortage by the substantial number of retirements and an increase of 60.000 subscribers to the SNS – due to the demand for vaccinations.
In the first half of this year, more than 230 doctors retired from the SNS – 131 of whom were practitioners in general and family medicine – the minister revealed, whereas last year 653 doctors departed from public health service.
To counter this departure, she wants to open up an extra 400 vacancies for general and family medicine to provide some 650.000 Portuguese with a general practitioner. But whether these vacancies will be filled is the question.
About one-third of all vacancies for newly trained doctors in both hospital and primary care were left open last year. Some doctors preferred to wait for more lucrative positions in the private sector or even abroad, after finishing their internship.
Unfortunately, this has become the trend in recent years. ‘What confuses me is that everyone knows it but doesn’t do anything about it’, states Jorge da Cunha, secretary-general of the Independent Trade Union of Doctors. ‘The SNS isn’t attractive enough to keep young doctors in service as long as there are profitable possibilities in private practice’.
The tragedy is that there are fewer doctors at a time when significant reinforcement is needed to recover what is left undone during the pandemic. In the first year of Covid19, there were 46% fewer physical consultations in primary care, 30% fewer in hospital, and 25% fewer surgeries realized.
The Portuguese League Against Cancer estimates that over 1000 cancer cases (breast, colorectal, cervix) have been missed due to a halt in screening services during the pandemic. ‘The last 1½ year have been spent on counting fatalities from a virus that barely claimed the lives of half the number of people dying from cancer every year’, its spokesman complained.
Stay healthy Fique saudável (pic Público)
Patients have to wait 3 years to see a urologist in Vila Real or an ENT specialist in Leiria and 2 years to obtain an appointment with a cardiologist in Guarda. These extremes not only occur in the countryside, as the waiting list for a neurological consultation at Amadora Sintra – one of the biggest state hospitals in the country – exceeds more than a year.
The average waiting period for (non-acute) specialist care in Portugal is 4 months, varying from 6 months for an ophthalmologist to 6 weeks for an obstetrician. Patients who have to wait for more than five months have – by law – the right to be treated in the private sector. A costly buffer as the SNS, respectively the taxpayer must pay the bill.
The excessive waiting lists are – according to the independent trade union of doctors Sindicato Independente dos Médicos – mainly the result of the fact that specialists in state hospitals have to spend too much – almost half – of their time to emergencies. The majority of the specialists working in the SNS is therefore unsatisfied. Many want to abandon the service and either go into private practice or leave the country, where working conditions are better and the pay higher.
‘Wages are indeed low, excess hours abundant and career prospects nil’, explains Maria Ferreira of the Public Health Department of the University of Porto, who conducted an investigation under 15.000 doctors in northern Portugal. ‘Half of the recently qualified doctors is thinking of leaving the country after finishing their specialization and over 1200 doctors have already left in the past 3 years.’