In what is ultimately a gamble, Portugal’s AD government has decided to crack down on the universe of ‘agency doctors’ (doctors who have often left the SNS state health service, in order to work, often in the same hospital, for a great deal more money per hour, and with the added benefit of being able to pick and choose their hours of work).
From January next year, life for these doctors (on whom the country’s A&E departments have come to rely) will become a great deal less alluring, says Expresso.
Critics warn the new rules could send these medical professionals into the private sector – thus, this is the gamble.
Essentially, what the government hopes to achieve is a return to the SNS of hundreds of (former SNS) doctors.
There are currently 4,000 agency doctors working within the SNS health service – almost three times more than a decade ago. They cost the service a small fortune:
“In 2024, payments to doctor service providers exceeded €200 million for the first time, sounding alarm bells at the finance ministry – and just in the first eight months of this year, they have reached €162 million, which is 19% more than spent in the same period last year”, Expresso cites official data.
The new legislation will make it impossible for a doctor to leave the SNS (for any reason) and continue working in the state health service as an agency doctor. There will need to have been a period of three years between leaving the SNS and returning in a freelance capacity.
The main change, however, is the introduction of a system of ‘incompatibilities’ which also prohibits, except in exceptional circumstances and cases of ‘imperative necessity’, the provision of services to doctors who, after completing their specialist training, have not applied for positions in the SNS, or who, having applied and been selected, do not sign a contract.
“The law explains that all doctors who, in the last three years, have terminated their relationship with the SNS through ‘termination, revocation by mutual agreement, unilateral termination or early retirement’ are thus in a situation of incompatibility.
“Doctors employed by local health units (ULS) who have requested exemption from emergency duty or who have shown themselves to be unavailable to work overtime because they have already reached the annual limit set by law (150 or 250 hours) will also no longer be able to work” as agency doctors, writes Expresso.
There will be a transition period for the new rules to come into place, and service contracts in force in January must be adapted within a maximum period of three months.
Doctors who have left the SNS before the entry into force of the -law cannot be hired for one year from the date of their departure, Expresso adds.
There is more: the rates paid to agency doctors will be reduced (again to make the option less attractive). Right now, agency doctors can be paid anything from €50 an hour to double that during critical times (Christmas/ summer holidays); regular doctors get less than €40 an hour.
Health minister Ana Paula Martins stresses the whole idea is “to minimise the asymmetry that we have today between doctors contracted to the SNS and those who work for service providers (…) There are situations in which we have reached costs per hour that are unsustainable”, she adds, reinforcing the ‘fast track’ that the new system has written into it for ‘re-absorbing agency doctors’ who were originally contracted to the SNS.
Syndicate ‘outrage’
Unsurprisingly, doctors syndicates (FNAM and SIM) are ‘outraged’. They were not party to this law: there was no ‘negotiation’, albeit they were heard (a week ago), when they immediately voiced their indignation.
A number have suggested the new rules will simply send doctors and specialists ‘fleeing to the private sector’. The Order of Physicians has warned against ‘demonising agencies on which the SNS system relies’ – but that is the whole point: matters should not have been allowed to get this cock-eyed.
Nuno Rodrigues of the traditionally ‘centre right’ SIM (independent syndicate of doctors) admits that the strategy “makes sense (…) combatting this monster that has been allowed to grow demonstrates political courage”. SIM however does not agree with the ‘prohibitions’ written into the law, preferring a softer approach, like reducing income tax for SNS doctors who agree to work overtime (beyond the statutory limits).
The problem is that it is difficult to deal softly with a practice that has been allowed to get so alarmingly out of hand. Expresso goes back over how agencies have essentially ‘taken over’. Initially, the plan was for agency doctors to be used for critical moments/ specific needs. It was only in the last 20 years that they started being used to meet permanent needs, “mainly to fill gaps in the schedules of under-resourced emergency services” – and so the country fell into the insane spiral of offering its contracted doctors comparatively low wages and long hours, while paying small fortunes for the same people when they left the SNS to work for service providers – not having to work for anything like the same number of hours .
Source: Expresso/ SIC
