The number of users without a family doctor increased by 29% in one year, now reaching almost 1,7 million, due to retirements and the lack of capacity of the National Health Service (SNS) to attract specialists.
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 a year later.
In view of this, 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 same period, official data indicate.
For Saturday, marches are scheduled in Lisbon, Porto and Coimbra against the "degradation of the SNS", called by several unions and with the participation of user movements, an initiative to claim a "serious investment" in this public service.
For the president of the Portuguese Association of General and Family Medicine (APMGF), 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 family doctors recent graduates 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 told the agency Lusa Nuno Jacinto.
The lack of family doctors is, warned Nuno Jacinto, 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 .
A study by researchers Pedro Pita Barros and Eduardo Costa on human resources in health, released in February this year, indicates that about one in four doctors is over 65 years old, an aging of the class that will result in a vacancy of around 5.000 pensions by 2030.
“The aging of physicians affects hospital specialists as well as primary care physicians. Estimates from 2011 suggested that around 75% of GPs were over 50 years old. This problem was further aggravated by a wave of early retirements that emerged as a result of the austerity measures implemented after 2011», warned the document.
This is an argument that has also been used by the Government to justify the increase in people without a family doctor, with the Secretary of State for Health Promotion, Margarida Tavares, recently recognizing that, in addition to 2021 and 2022, 2023 and 2024 will still be available « these will be years of a large number of doctors retiring».
According to the executive, the lack of specialists in general and family medicine mainly affects the region of Lisbon and the Tagus Valley, the Algarve and the Alentejo, but the president of APMGF warned that the shortage is already felt in the Center and even in the North, where «there started to be some places where there was no lack of doctors and now they are lacking».
The Government has opened all 978 vacancies in general and family medicine, to retain recent graduates, but also to attract specialists who are not on the SNS, but has already admitted that only 200 to 250 of the 355 doctors are placed in public health units which are now their specialty.
“It is good that the Government has opened all the vacancies available. It is the first time that this has happened and it is a good sign, because it means that the guardianship assumes the true dimension of the problem», replied Nuno Jacinto, noting that «there is a lack of almost a thousand family doctors» in the SNS.
The president of the ANMGF agrees that it would be "unrealistic" to think that all 978 vacancies would be filled, but he stressed that the opening of all available places "has to be a measure that has to be maintained in the medium and long term so that it can stabilize" , considering that the realistic goal is now to hire more than 300 doctors who finished the specialty in the last exam season.
«We are not going to say that we are going to look for a thousand family doctors all of a sudden, because they do not exist, but we have to be ambitious and say that, at least, all those who have finished the specialty we want to hire», said Nuno Jacinto, for whom the doctors are currently family «look at the SNS with some sadness and disenchantment».
According to the head of the ANMGF, the feeling of family doctors that «their work does not have the appreciation and respect it should have» has contributed to this.
In practice, this is due to the «lack of a focus on primary care, first of all, on the salary scale», as well as career stagnation, the inadequacy of the evaluation system, which should have a 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.
This lack of attractiveness of the SNS is also felt by new doctors, assured Lusa by the president of the National Commission of Internal Physicians of the Independent Doctors Union (SIM), for whom this is due to precarious working conditions, but above all to the salaries charged in the public sector.
«In 2022, the amount paid to a new specialist was 16,03 euros per hour gross», said Mónica Paes Mamede, considering this salary «low», 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, he underlined.
«The social and private sector are in the same country as the public sector and have, as a rule, much higher pay and 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, assuring that she has already noticed «a big difference» since a long time ago. six years old, when he started working in the public sector.