WONCA Europe

Portugal

National delegate (Europe Council member)
Ana Nunes Barata (hippokratespt@gmail.com)
National Exchange Coordinator
Nina Monteiro (hippokratespt@gmail.com)
Young GPs organization website  
Page last updated on March 15, 2015

 

Country

Portugal has a population of about 10 million people. The portuguese health care system is a public sector responsible for providing and financing health services for the entire population. Responsability for these services rests primarily within the 3 health regions - North, Centre and South with about 1745, 1143 and 2187 specialists, respectively. Portugal is a Southwestern European country, a member of the European Union since 1986, and a founding member of the Euro Zone since 1999.

Portugal is famous for its warm welcome, beaches and ocean, good food and wine, nice weather and low-cost living.

A nice place to visit.

 

Healthcare system

Primary health care in Portugal has provided since the 70's health centres where doctors work side by side and as a team with nurses and other health technicians. Doctors working in a health centre hold responsability for a file with about 1500 to 1800 people. They are organized by families, so they can be integrated in a bio-psycho-social vision. In a file, we have different health programs and provide services, such as adult, child and maternal health, family planning, diabetes, hypertension, minor surgery, nutrition, home visits and on-call service. The last years, there has been some changes underway in the system of primary care. We have two main organizing systems - 'USFs' (family health units) and 'ACES' (health centres groups, recently established).  

Role of the GP in the Primary Health System Portuguese GPs/Family Doctors have got to be able to aquire competences, so they can:
 
1. Be the first contact with Health Care System, dealing with all kind of health problems, no mater age, gender or any other individual caracteristics
2. Provide care along the years, according pacient's needs
3. Cordinate health care, promoting a better use of health resourses and interacting with other specialities
4. To be able to make a 'think-decide' process determined by prevalence and incidence of the comunity pathologies
5. Develop an aproach centered in the individual that interacts with is family and his comunity as well as to be aware of all possible dimensions of the disease process - somatic, psycological, social and cultural
6. Establish an appropriate comunication, based on a pacient-doctor relationship - so many times terapeutical and time prolonged.
7. To simultaneously handle acute and chronic diseases in a pacient
8. Approach a pathology in the different phases of presentation
9. Promote health and well being

 

The official services to provide health care to the portuguese population of around 10 million people are arranged in a National Health Service (NHS).
 
In addition to the NHS, there are several health subsystems, created as part of various ministries, banking, insurance and other institutions to provide health care to their employees or associates. The beneficiaries of these subsystems can also use if they wish, the entire network of the NHS.
 
Several health organisations and private providers complete the range of health care available. They provide services to people privately or through agreements or contracts with either the NHS or with some of the above subsystems. 
 
GPs may work in any of these.
 
Similarly to the UK, our NHS has the equivalent to Primary Care Trusts, one for each region of Portugal (5 in total), which are responsible for local health centres and hospitals.
 
Each health centre has one or more Family Health Units, each of which have 4 to 8 doctors working as a team with nurses and secretaries.
 
A family physician working in a health centre has responsibility for about 1500 to 1800 people, organised by families, so patients can be integrated in a bio-psycho-social vision of healthcare.
 
A typical surgery provides the following services: Consultations in 20 minute appointments; urgencies seen the same day; telephone consultations; minor surgery procedures; family planning and antenatal care; child health surveillance and immunisation; adult health/diabetes/hypertension surveillance.
 

Organizations of GPs

 

It is obligatory for new GPs to become members of the College of Family Physicians, which is part of Portuguese Medical Association (Ordem dos Médicos). This is done by sitting a viva; a surgery assessment of clinical skills with a real patient; and a presentation of a Curriculum vitae, a detailed written assignment where the trainee describes all the work done during the 4 years of training.
 
Although not compulsory, it is strongly advised for all GP's to become a member of the Associação Portuguesa de Medicina Geral e Familiar. Our Association works for the development of education and research.
 

Medical education

During graduation, we have contact with Family Medicine at 1st, 5th and 6th years. Just after we graduate, we attend a multiple choise seriation exam that will give us the opportunity to choose our specialty training a year later. During this year, we make a foundation training by rotating though different specialties, including Family Medicine.

General Practicioner specialty training ('MGF' - General and Family Medicine) is at present 48 months long, in wich a senior specialist is going to take a continuous role in GP training of each resident, by being his/her tutor.
 
It consists on various rotacions, including some at health centre (obligatory) and other at the local hospital (obligatory - Pediatrics, Gynaecology/Obstetrics, Psychiatry and Emergency - and three optional).
 
Depending on the region of Portugal, there is a final exam at the end of each year or rotation.
 
The training program also predicts short rotations to aquire competence in specific procedures as well as curricular formation defined by each region.
 
At the end of GP training, there is a final exam that consists in three parts: curricular discussion, practical exam (patient's interview, organizacion and discussion of the information taken) and theoretical exam.
 
To become a GP in Portugal, it requires:
- 6 years of Medical School. There are nine medical schools in Portugal (two in the capital city, Lisbon; two in Oporto; one in each town of Aveiro, Braga, Coimbra, Covilhã and Faro);
- In the final year of medical school, students have to sit the Exam of Access to Speciality, which will provide the mark for then choosing their specialty;
- Compulsory registration on Ordem dos Médicos, the doctors' regulatory body;
- 1 year of training (starting in January, after graduation), rotating by several specialties, including general practice, in a hospital chosen by the resident's preference and allocated by final mark at medical school. We call this the Common Year, as it is the same for all residents;
- At the end of the Common Year, you can choose your specialty/place of training, which will be allocated according to the mark you had on the Exam.
 
General and Family Medicine speciality training takes four years. It consists of 28 months in a GP training practice and an 18 month rotation in approved hospital posts.
 
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