Covering public care and family? “Everyone in the same thing, like softness”
Currently, about 1.6 million users without a family doctor in Portugal – an increase of more than 30,000 since January 2025. This reality reflects the frequent failure of competitions in the situation of general medicine and family medicine (MGF), with hundreds of vacancies to fill even in national and commission competitions, and chronic symposiums between vacancies.
Pedro Lopez Gapeverar and George Emile Dias *
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In the past two years, three major competitions for MGF have been held. In May 2023, 978 vacancies were opened, of which only 313 were filled (about 32 %), with 665 vacancies. In 2024, a new model of decentralized competitions by local health units (ULS) allowed 904 vacancies in MGF, with only 279 (about 30 %). Finally, in December 2024, an unusual national competition for newly worked out 225 vacancies, but only 63 (about 28 %) were filled.
These numbers confirm the continuation of the low occupancy rate, especially in chronic deficit areas such as Lisbon, Wadi Tajos, Lingo and Alghara, where the rates of holidays exceeding 80 % were recorded. This is the inability to attract and fix doctors in these areas not only derives from the lack of realistic planning, but also from the incentive incentives currently in force, which remain changing in nature, and is not attractive and not logical often.
Despite the general promises to review the incentive system to determine the needy areas, these changes have not been achieved. Competitions are still launched based on administrative vacancies, without effective integration with the clinical and social needs of the population or with the professional expectations of doctors in an early profession.
At the same time, ULS- despite the possibility of increasing the integration of rapid care and little accompanying, with the loss of know-how in regional management structures and increased bureaucratic complexity, i.e. in the process of employing and integrating new professionals.
In this context, the SNS 24 line, in different locations, has become NHS, even when there was no evidence of the inability to respond to primary health care (CSP) for sharp requests. This transition, based on the unrestricted clinical algorithms of CSP, shows that the continuity of care, the central MGF column, and interferes directly with the clinical management of units, which makes it difficult to properly reference and longitudinal follow -up to users -installed aspects to reduce deaths and use resources better.
The introduction of the C USf form, as a solution to the difficult areas, lacks organizational, contractual and functional clarity. The legitimate doubts about the expression of ULS continues, ensuring property rights to access multidisciplinary teamwork, which is essential in the family health model.
All this adds to the lack of effective mechanisms to replace possible vacancies by doctors who changed the professional project. Not to respond to these requests to disappointment and abandoning NHS, even by professionals who are still excited about public service.
It is necessary to liberate NHS from the bureaucratic obstacles to employment, which contradicts the lightness of movement in the private sector. The system must maintain vacancies permanently, and ready for occupation by interested doctors, without relying on the startingrs in the competition and administrative decisions in the event.
The NHS response cannot be based on emergency tools – such as the SNS 24 line or CAC – without making sure that these solutions have been scientifically validated, transparent in their implementation and subject to a strict analysis of its effects, especially about the most vulnerable users.
SNS sustainability requires strategic planning based on data and incentives effective and accountability for the management and evaluation of care continuity. Without these circumstances, competitions will continue to be repeated with abandoned vacancies, health centers with doctors in exhausting or working with incomplete teams, and a system that causes users to separate solutions instead of enhancing proximity response.
* The health space of the USF, ULSSA coordinator, MGF graduate assistant. Master in Health Services and Economics Management; A pediatrician and gastroenterologist, Lucidas Hospital, Porto. The article was originally published on HealteNews.
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