August 2015
Medical Education and
Human Resources for Health in Portugal
Diogo Fernandes da Silva ANEM/PorMSIC - Portugal Universidade do Porto
pormsic-portugal@ifmsa.org
For the past 20 years, Portugal has faced a big lack of practicing physicians, mostly due to a cap on the formation of medical doctors to about 500 per year. Over that time, the government steadily increased this number by around 400%, which definitely was the biggest increase in the OECD recently, with over 2000 new medical students yearly. If raising the cap on the number of students formed each year was, at the beginning, the obvious and easy solution, it quickly became the problem: • Decrease in the quality of medical education in Portugal: Over the last 20 years, and despite the exponential increase in the number of medical students, only 3 new medical schools were created; they can accommodate around 400 students, only a quarter of the total number. This has obviously increased the student/tutor ratio to intolerable levels, making clinical rotations in some cases impossible or even useless; • The number of new medical doctors exceeds the availability of post-graduate residency spots: One of the best quality assurance measures of the health system in Portugal was the fact that every medical graduate had to go through postgraduate training before they can practice in Portugal. However, the system accommodates around 1500 residents per year, which is far less than 2000 graduates. This has created an enormous burden on Portuguese hospitals, and has ultimately led to a drop in the postgraduate education. Slowly but surely, the possibility of not being able to provide all graduates with a residency spot is becoming imminent; • Migration of health workers: ultimately, the deterioration of the Portuguese pre- and post-graduate medical systems, will force an ever increasing number of medical graduates to leave Portugal, seeking better education and working conditions. While this problem persists and becomes more serious, www.ifmsa.org
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we now know that its origin ceased to exist. Portugal is nowadays the country with the 5th best ratio in the OECD (with 4.1 doctors/1000 inhabitants). The government partnered with specialists in human resources for health and studied about the planning of human resources for health in Portugal, which indicated that the number of medical students needed per year to meet the needs of the Portuguese health system was 1175. Keeping all this in mind, PorMSIC has organized a campaign over the last 10 years, calling for the sustainable reduction of the medical students cap in order to achieve the proposed value of 1175 per year. On the short term, this would increase the level of preand post- graduate medical education, and guarantee every medical student a residency spot. However, succeeding governments have ignored our proposal, arguing that it is an impossible measure that would be poorly accepted by the general population who still feels the impact of the lack of medical professionals. There are areas in Portugal, where the population unfortunately still faces a large shortage of medical professionals. However, this is a problem related to the management of health human resources, not a question of quantity of human resources. Basically we are choosing quantity over quality (when quantity is not even needed)! In order to overcome this difficulty, we have readapted our strategy, not only to target stakeholders directly (as we have been doing over the years unsuccessfully), but also to mold the opinion of the general population, through informative campaigns on social media, TV and magazines. PorMSIC will keep pursuing this goal: fighting for the improvement of medical education, and consequently, the quality of our National Health System, which is intricately connected with the reduction of medical students.