Health Systems in Transition - Portugal

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Health systems in transition Portugal 101
4.2.5 Physicians’ career paths
When medical doctors finish their graduate medical education, after 6 years of
undergraduate studies, the residency year and 4–6 years of specialty residency,
they become an assistant physician, the lowest step in the NHS graduate
physicians’ hierarchy (the others are graduate assistant physician and senior
graduate assistant physician). Promotion within the NHS hospital hierarchy is
based on both the number of years and the positions available in the structure.
The hospital boards are responsible for these decisions.
4.2.6 Other health workers’ career paths
The majority of the health staff working for the NHS are civil servants, and have
a standard civil servants’ career path, with some particular features. Those who
are not civil servants have individual contracts, which are regulated by private
labour market rules.
As for the physicians’ careers, a nursing career is considered to be a special
career within the public service. In 2009, the nursing career was reviewed and
two categories were created: nurse and principal nurse (enfermeiro principal ).
To be a principal nurse, it is mandatory to have a specialization and to have
practiced within the field of specialization for at least 5 years (Decree-Laws
No. 247/2009 and 248/2009, of 22 September 2009). Access to both nurse and
principal nurse positions is achieved by applying to competitive calls. In 2014,
the Family Nurse was recognized as a preferred profession for the provision
of nursing care in the community and primary care settings (Decree-Law
No. 118/2014, of 5 August 2014), and 35 primary care units (both FHUs and
PHCUs) were selected to pilot the inclusion of a Family Nurse in the practice
(see section 5.3). However, this experience is yet to be piloted, so there is no
evidence of the possible impact of Family Nurses on the NHS.
Unlike other health staff, dentists and most pharmacists do not work for the
NHS, and they do not have a clearly defined career path.
Since 2010, there has been a tendency for health workers, mainly physicians,
to both retire early and work for the private sector or to practice in both public
and private sectors. Additionally, some professionals choose to practice
abroad, where they can find higher salaries and better working conditions. The
Ministry of Health is trying to overcome this trend by providing more attractive
working conditions.