NATIONAL REPORT PORTUGAL
October 2024
The health sector in Portugal has worsened in last 18 months, especially our National Health Service (NHS). Due to the lack of doctors, obstetrics and pediatric emergency rooms are often closed, forcing pregnant women and children to travel many miles and dozens of babies are being born in ambulances. Citizens without family doctor raised to almost 1.7 million, the surgical waiting list has increased, and doctors are also lacking for palliative and in the end-of-life care.
Doctors in Portugal are among the lowest paid in the European Union and continue to work hundreds of overtime hours per year, above legal limits. The new Health Ministry appointed six months ago, published unilaterally, two Decree-Laws (DL), without doctors’ agreement. The first, delayed the process for hiring new doctors in the NHS and consequently half of doctors who completed their training in March, are still to be placed. The other, changed the method of payment for overtime work beyond legal limits. In this case, doctors will be paid as normal work with allocation of supplements through a complex system of counting hours.
Moreover, abusive measures such as pre planned vacation cancellation will be applied to those who work in emergency rooms until the end of the year, in increasingly smaller teams and at the limits of exhaustion. Therefore, doctors keep quitting the NHS in exchange to the private sector, outsourcing and emigration. Doctors in Portugal are calling for a 30% pay increase to recover the loss of purchasing power since troika in 2008, and to improve working conditions. We have new data regarding the increase in violence against doctors and other health professionals, which led the Council of Ministers to approve a heavier penal framework for violent acts. However, no preventive measures have been taken regarding the issue.
Sindicato Independente dos Médicos (SIM)
SIM signed a negotiating protocol with this new government in July 2024, starting with the review of the evaluation system, medical residency training and specific rules for organizing medical work and ending with salaries grid. It has been agreed an increase of the monthly supplement for around 300 doctors who have the Health Authority responsibility, from €200 to €300 this October and to €400 from January 2025. There was a promise that salary grids discussion will start in December 2024.
Federação Nacional dos Médicos (FNAM)
FNAM accepted all the issues tabled in the proposed protocol, but the new Ministry of Health refused to integrate solutions to attract doctors to the NHS, such as immediate starting of salary negotiation for application in January 2025, which should be discussed until the end of September, before State Budget approval for next year. The Ministry has been intransigent bynot accepting either the review of normal weekly working period towards the 35-hours, reintegration of medical residents into medical career, the reinstatement of a working regimen with exclusive dedication to the NHS, optional and properly compensated, and recovery of vacation days taken during the troika era. These measures would not have any negative impact in State Budget. Thus, FNAM called doctors for strike in July 23-24 and in September 24-25 with strong adherence. On September 24th doctors from all over the country, alongside pregnant women and patients, acted together in a rally in front of Health Ministry in Lisbon against the NHS chaos, demanding improved salaries, career progression and working conditions, and a true investment in public, universal, accessible and quality NHS for the entire population.
Ordem dos Médicos (OM)
The government imposed to Ordem dos Médicos, in line with other professional boards, a new statute, with inclusion in the disciplinary bodies a set of elements outside the profession, between 30 and 60%. It will also incorporate a provider of clients/users and significant changes in governing bodies, with a supervisory board, which will act as a board of directors and control over the president and other directors. Despite numerous meetings with previous government and parliamentary groups, this was imposed unilaterally. Portuguese medical unions and the medical board continue demanding effective change in health policies, implementation of structural measures to support the NHS, and better health care delivery, which include improvement of medical careers, working and pay conditions.