This year, 2,057 vacancies were launched for training in medical specialties, starting in January 2023. It was the highest number ever, having surpassed the barrier of two thousand. The president of doctors assumes the feat, not least because it was “from my mandates that this number has always increased”, but says he does not know until when it will be possible to maintain this training capacity, because “hospitals are increasingly depleted “, thanked the DN.
But good news, there are several alerts that arise. From the outset, says Miguel Guimarães, it is necessary to understand why, in the biggest competition ever for vacancies, 161 were left open? Or why, of the 2321 candidates, according to figures from the Central Administration of the Health System (ACSS), 438 refused any of these vacancies, especially with regard to two fundamental specialties, Internal Medicine (IM) and General and Family Medicine. Or why is it that the overwhelming majority of vacancies left open belong to units in the Lisbon and Tagus Valley Region (LVT), some are central hospitals?
Several issues mean that, and contrary to the tutelage, which on Tuesday issued a press note stressing above all that, in 2023, “SNS will train the largest number of specialist doctors ever”, the chairman argues that the important at this moment “is to understand what is happening with these specialties and with some of the great units in the country”. Or, in a more political view, where is the guardianship, “not this, because there is very little time, but the previous ones have been wrong to cause so many vacancies to be open”.
Miguel Guimarães argues that analyzing the situation may not be easy, but such results “have to be studied”. It is necessary to know whether “the current situation of the SNS and of some hospitals, specifically in Greater Lisbon, is keeping young medical graduates away from a clinical career”, he says. Or if, on the other hand, the problem may even lie in the specialties themselves, given that of the 48 tenders, only six had open positions, namely Internal Medicine (IM), General and Family Medicine (FGM), Clinical Pharmacology, Immunohemotherapy , Clinical Pathology and Public Health. But of the total of 161 vacancies left over, it must not be forgotten that 103 belong to units in Greater Lisbon, and these 90 are in the hospital career and 71 in primary care.
The chair recalls that two of the specialties with the most vacancies are, precisely, “the ones that are under the most pressure in the emergency services of hospitals, in the case of Internal Medicine, and with obligation in primary care, in the case of General and Family Medicine” . For this very reason, he underlined, “it is important that the situation be practiced, evaluated and tolerated, and there must be an explanation by the Ministry of Health about what may be happening”.
North Region was the only one with only three vacancies left
According to the data available to DN (see tables), of the 235 vacancies available for MI, 67 were vacant, 42 for LVT, and of the 574 for MGF, 71 were empty, 38 for LVT, but one a total of 200. On the other hand, in the North Region, of the 182 vacancies for FGM, only one remained vacant in Bragança and of the 79 for Internal Medicine, only two were not occupied, also in Bragança. In all, of these 251 vacancies, only three were left open.
To the question of why this disparity – is it because training is different in the North? Is it because the services are more organized? Or if it is even due to a more conservative view, in the sense that young graduates prefer to follow a clinical career – Miguel Guimarães replies: “It could even be due to a more conservative issue, that young people are trained in the North and want to stay with their families, but it is certainly not because training is different. Training is the same throughout the country. What can differentiate the North from the South region is the fact that there are more doctors running units, with a different view of management, and that being more attractive for services”.
What he considers to be the “top alert” is the fact that 438 young people have turned down any of the 161 vacancies that were left unfilled, expressing some concern whether this will be caused by “the way young graduates feel in relation to the SNS, in the sense of not feeling well treated and, therefore, they immediately look for other alternatives to the clinical career”, reinforcing: “This has to be studied, even to find solutions for the future”.
The document to which DN had access reveals that the Lisbon and Tagus Valley Region, along with Alentejo, were the most neglected by young doctors among the six specialties that were left with open vacancies. The map of vacancies (table to be seen below) reveals that in Clinical Pharmacology, of the 5 national vacancies, the two of the Centro Hospitalar Universitário Lisboa Norte, remained unfilled, in Immunohemotherapy, of the 20 national vacancies, 9 by and all in the LVT region, in hospital centers such as Lisbon North, Lisbon West and Lisbon Central.
The same happened in Internal Medicine, which of the 235 national vacancies remained with 67 open, 42 of which in the LVT region – suffice it to mention that the Lisbon North and Lisbon Central hospital centers had, respectively, 13 and 14 vacancies available and each one had 8 vacancies to be filled. In the Greater Lisbon area, Hospital Fernando da Fonseca (Amadora-Sintra) was only able to fill two of the 8 vacancies available. The DN knows that this result is raising great concern within this unit, as it is feared that this will jeopardize the future of the specialty. The Vila Franca de Xira Hospital was unable to fill any of the five vacancies it had and Garcia de Orta, in Almada, was left with an open vacancy of the four it had. Beatriz Ângelo, in Loures, had six and had three open.
Still in Internal Medicine, it is important to highlight the regions of the Center, which of the 41 vacancies available left 8 unfilled, the Alentejo, which of the 11 vacancies filled only three, leaving 8 open, and the Algarve, which had nine for University Hospital Center and had two to occupy.
General and Family Medicine had 574 vacancies and 71 remained unfilled
In the MGF specialty, whose total launched for 2023 was also the highest ever, 574 vacancies, 71 remained to be filled, these 38 in LVT, out of a total of 200, 14 in Alentejo, out of 26, 6 in the Center region, out of a total of 114, and only two were left open in the North region, Bragança, out of a total of 182. The Azores region also experienced difficulties, of the 18 available, only six were filled, leaving 12 deserted.
Of the other specialties with open vacancies, such as Clinical Pathology, where there were 3 national vacancies, seven remained unfilled, six in LVT and one in Alentejo. In Public Health, of the 50 vacancies available this year, only five were left open, three in Alentejo and two in the Centre.
Faced with this reality, Miguel Guimarães says that as chairman and doctor, his first appeal goes to young people who do not want to specialize. “Current and future medicine focuses on specialization. Therefore, I appeal to all doctors who work in clinics to opt for a specialization”.
On the other hand, and on the vacancies left open in LVT and whether these have to do with the higher standard of living, the doctors’ representative assumes that it may be “a hypothesis, but this also happens in other regions, such as the Algarve”. , noting that “the vacancies left open in the Interior are also a major concern. “If you were a minister or president of the ACSS and looked at the Interior, you would be in a panic, with the vacancies left open and with the number of doctors who are being retired or will reform in the next three years in these regions. At this point, I would already be studying the problem and looking for solutions”.
And these cannot stop just by trying to pay doctors something more, “other incentives must be found for needy areas, which, today, as you can see, are not just in peripheral areas, 200 or 300 km from the big centers, but also already in these regions. Just look at Lisbon. That is why I have been defending that it is necessary to find a special line of support, whether in health, housing and education. There must be competitive conditions for these regions to guarantee doctors” , argued.
This year, 222 graduates from other years entered the specialty
According to the ACSS, this was the year in which the largest number of doctors were able to choose the training they wanted, with up to 222 graduates who had not applied for the specialty in previous years and who opted to choose one of the available vacancies. The numbers also indicate that 89% of the candidates were placed in the specialties, out of a total of 2321 initial candidates, it is not known, however, if there were candidates who gave up. But for the ACSS “it means an increase in the attractiveness of entry into specialized training compared to the previous year”.
It should also be noted that the number of internal doctors who passed from general training to specialized training corresponds to 66 more than in relation to last year. In the press release, the Ministry of Health body also highlights the number of people placed in Pediatrics (102), more than double the value registered in the last two years, since 2012, in which only 47 interns were hospitalized, and in Gynecology-Obstetrics ( 53), where it was an increase of 10% compared to the previous year.
Over the last ten years, placements in the specialties of Psychiatry (72) and Child and Adolescent Psychiatry (14) have also increased by 62%, which, says the ACSS, “evidence of a progressive investment in the provision of mental health care to Portuguese and in the qualification of the SNS”.
In relation to 2021, the national map of vacancies presented a total of 1938, 18 of which are exclusive to the Ministry of Defense, but of the total 50 were left unfilled, most also in central areas of the country. In total, there were 2462, although close to 600 dropped out before or during the process.
Of this total of 50 vacancies, 31 concerned the specialty of Internal Medicine, ten of which are at the Centro Hospitalar Universitário Lisboa Norte. In General and Family Medicine, there were 14 to be filled in, the majority in Lisbon and the Tagus Valley and in the Alentejo. There were also four vacancies for immunohemotherapy in Lisbon and Alentejo and one for a pathology clinic in Alentejo. Already at the time, the Order of Doctors referred to be an “unprecedented and heartbreaking” result, revealing the seriousness of the situation that the SNS is going through.
This year, the chairman reiterates that it is urgent to “meet the expectations of doctors and the Portuguese, who ask for a stronger SNS, with effective technical and human conditions for quality medicine”.