Health Systems in Transition

Health systems in transition

Portugal

60 km (Law No. 66-B/2012, of 31 December 2012). Most NHS staff are civil

servants and all new posts have to be approved by the Ministry of Finance.

However, there increasing numbers of workers are under individual contracts,

which do not confer upon them the same rights as those of civil servant status.

In addition, rules for civil servants are clearly becoming closer to those of

private labour relations.

The

numerus clausu

s for accessing medical schools varied in the last four

decades between approximately 180 and 1800, but this significant increase

in the number of new medical students was not guided by any planning

of long-term need for physicians. Although there is a shortage of GPs (see

section 4.2.2), there are strict limitations in terms of internship places, which

depend on the reported capacity of NHS health care facilities (primary care

centres and hospitals). Despite the existence of an active constraint on the

number of postgraduate medical training places, the number of junior doctors

increased from 6728 in 2011 to 8515 in 2014 (+27%), particularly in training

programmes for GPs and family medicine (+70%), which shows the effort that

is being made to address the limitations in primary care. It is widely recognized

that there is a shortage of GPs and that this situation is likely to worsen in

the future, as current GPs start to enter retirement. Recent decisions of the

Ministry of Health regarding training vacancies indicate a willingness to deal

with this issue.

In recent years, several frameworks of medical training (currently Ordinance

No. 224-B/2015, of 29 July 2015), including new access rules, organization and

governance, with a transitory period, were approved. Institutional cooperation

with all entities involved in medical training led to an increase in the training

capacity. The ACSS and the Portuguese Medical Association jointly decide on

the number of specialized medical training places: the Medical Association is

responsible for certifying each institution’s competence to receive a resident

for postgraduate medical training and the ACSS is responsible for recruiting

and placing the new doctors. Besides the accreditation of postgraduate medical

training, the Medical Association is responsible for the accreditation and

granting of licenses to practise. There is no periodic re-licensing of doctors,

although the Medical Association has already indicated openness to do so in

the future.

According to the EU Directive 2005/36/EC, of the European Parliament

and Council, of 7 September 2005, which provided for the mutual recognition

of professional qualifications in the EU Member States, there are seven

professions whose recognition is automatic: doctors, dentists, nurses, midwives,