Doctors Reject 20% of Portugal’s Training Slots, Straining Patient Care

Portugal’s latest round of specialist training placements for doctors has delivered a curious mix of record-high offers and record-low take-up. On paper the country opened more training places than ever, yet one in every five remains empty. Behind the headline lies a deeper story of workload pressure, career uncertainty and the still-unfinished overhaul of the Serviço Nacional de Saúde.

Missing Doctors Cast Long Shadow Over Promising Numbers

The government hailed the 2025 competition as a step forward: 1 854 young physicians secured posts, three more than last year, and 33 specialties filled every single slot. That upbeat narrative, however, co-exists with the stubborn reality that roughly 20 % of the 2 331 positions offered were ignored. The contradiction is most glaring in Family Medicine, where 386 vacancies—more than half the total on offer—went begging. Internal Medicine also struggled, leaving 132 places deserted, while Pathology, Public Health, Intensive Care and Emergency Medicine recorded double-digit gaps. The pattern suggests Portugal is supplying seats but failing to supply incentives.

Why Medical Graduates Are Saying No

Fresh graduates describe a working life dominated by double shifts, unpaid overtime and a career ladder whose rungs appear permanently out of reach. A survey by the Ordem dos Médicos last year found 25 % of trainees already in burnout and more than half at risk. Professional associations blame the exodus on a mix of fixed-term contracts, pay levels well below private-sector rates and the perception that managerial targets outweigh clinical learning. In this year’s competition, 283 candidates—12 % of those eligible—resigned before even choosing a specialty, a symbolic vote of no confidence in public-sector medicine.

The Regional Angle: Where Shortages Hurt Most

The map of unfilled slots traces a familiar divide. Lisboa e Vale do Tejo and the northern districts—home to Portugal’s densest populations—were hit hardest. Urban hospitals long thought to be magnets for graduates now compete with private clinics offering flexible schedules and higher pay. Meanwhile, interior regions such as Trás-os-Montes and parts of the Alentejo continue to rely on rotating teams or outsourced night cover. The net effect is that waiting lists lengthen in the capital while smaller towns wonder how long their emergency rooms can stay open.

How Government Plans to Reverse the Drain

The Health Ministry insists 2025 is a turning point, pointing to legislation that will align fees for hired-in doctors with staff doctors, cap the use of agencies and introduce housing incentives for rural postings. A new convention model aims to secure a family doctor for every citizen by authorising social-sector and private-run primary-care units—the so-called USF C network—to begin operating later this year. Negotiations are under way to allow 1 070 retired physicians to return on part-time contracts and to open 1 400 senior-grade promotions by 2028. Officials also promise faster recognition of foreign qualifications, hoping to tempt back Portuguese doctors now practising in Switzerland, the UK and Spain.

Looking Back: Five Years of Worsening Vacancies

Historical data show the current shortfall is not an aberration. In 2021 just 50 posts were left unused; that figure grew to 161 in 2022, 307 in 2024 and now 466 in 2025. The overall fill rate fell from 86 % last year to 80 % this year, even as the absolute number of places edged higher. Family Medicine’s fill rate did improve to 39 %, up from the previous two cycles, but that small victory is overshadowed by the scale of unmet demand.

What Comes Next for Patients and Practitioners

Unless the announced reforms translate into tangible change on the ward, the cycle of overwork, burnout and early departure will persist. For patients, the stakes are immediate: every abandoned training post delays the moment a new specialist arrives at the local health centre or hospital clinic. For policymakers, success will be measured less by press-release numbers than by whether next year’s cohort sees the public service as a place to build a career rather than a stop-gap. Portugal’s health system has rarely lacked ambition; its challenge now is to make that ambition attractive enough for the doctors it still struggles to keep.