According to the SNS, the number of patients without a family doctor has increased by 29% in one year, now reaching almost 1.7 million people.
The situation is said to be due to retirements and the lack of capacity of the National Health Service (SNS) to attract experts.
According to the SNS transparency portal, in April 2022 a total of 1,299,016 million users did not have a family doctor assigned, a number that increased to 1,678,226 in April this year.
Due to the lack of doctors available, the number of users monitored by these general and family medicine specialists dropped from around 9.1 million to just over 8.8 million in the last year, with patients presumably using emergency services, or private medical care when possible, instead.
On Saturday, marches by several unions are scheduled in Lisbon, Porto and Coimbra against the “degradation of the SNS”, an initiative to claim a “serious investment” in this much needed public service.
For the president of the Portuguese Association of General and Family Medicine (APMGF), Nuno Jacinto, this situation is due, simultaneously, to a wave of retirements of specialists that has been taking place in recent years and to the lack of attractiveness of the SNS to retain recent graduate family doctors and to attract those currently out of public service.
Faced with these two factors, "the entire system that should be based on primary health care shifts the focus to hospitals and emergency services, which also lack human resources and are not designed for this type of response", he said.
The lack of family doctors is forcing users to access the SNS “through a place where they should not enter” – hospitals -, “perverting” the entire system and overloading health professionals in general.
According to the head of the ANMGF, Mónica Paes Mamede, the feeling of family doctors that “their work does not have the appreciation and respect it should have” has also contributed to the situation.
In practice, this is due to "the lack of investment in primary care, first of all, in the salary scale", as well as career stagnation, the inadequacy of the evaluation system, which should have progression based on merit, and the a “very rigid contracting model based on 40 hours, which does not allow doctors the flexibility that exists, for example, in the private sector”, he said.
“In 2022, the amount paid to a new specialist was 16.03 euros per hour gross”, surely an extremely “low” salary, taking into account all the clinical responsibilities that a specialist has, as well as the requirement of the profession at various levels. The new specialists are responsible for all the clinical decisions that are taken about their patients, they work in 24-hour shifts and with rotating schedules on weekends and holidays.
“The social and private sectors are in the same country as the public sector and pay, as a rule, much higher and the working conditions are also more attractive”, said Mónica Paes Mamede.
If there is no increase in salaries, "there is a risk of having an increasingly weak SNS", warned the president of the National Commission of Internal Physicians of the SIM.