Portugal’s primary care crisis as GPs depart

“Come to France, tax free,” the advertisement reads. “You’ll enjoy an annual income of €120 000-€200 000, as well as free accommodation!” Tiago de Barros Mendes, a GP (médico de família) in Portel, a rural municipality in the inland Alentejo region of Portugal, receives these kinds of emails and notifications every day.

The Alentejo has a dependency ratio of 66, meaning that for every 100 people of working age it has 206 people who aren’t productive. The region sees high morbidities of old age, such as diabetes and hypertension, and rising rates of obesity. Large migrant Roma communities, who may have never seen a doctor before their arrival in Portugal, further add to the burden on practices such as Mendes’s, which is run from a central clinic with seven rural extensions, each staffed by a lone GP with nurse support.

The nearest emergency services are 40 km from the central practice at Portel, so primary care clinics routinely see acute cases such as heart attacks and strokes. “This is the definition of rural and isolated medicine,” says Mendes. GP provision is better in the north of Portugal, where training colleges are clustered.

Such additional pressures are common throughout Portugal. Practices such as Mendes’s are used to the inflexibility of the SNS (Serviço Nacional de Saúde, Portugal’s national health service), with employment contracts that dictate long hours and low pay. SNS GPs are all salaried and make on average €45 900 (£38 700; $49 300) a year, which is below the European average for a family doctor. (For comparison, the average salary of a self-employed “Hausarzt” in Germany is €252 000 a year, which compares with €84 472 for a salaried GP; …