Why 1,200 Portuguese Doctors Are Rejecting Specialty Training—And What It Means for Your Healthcare

The Portugal National Health Service faces a compounding crisis as nearly 1,200 newly qualified doctors have refused specialty training placements over the past three years, starving the public system of precisely the expertise it needs to clear backlogs, staff emergency rooms, and assign family physicians to the 1.6 million residents currently without one.

Why This Matters

• Immediate impact: 469 doctors declined specialty slots in 2025 alone—up from 307 the year prior—worsening shortages in Medicina Geral e Familiar, Medicina Interna, Pediatria, and Obstetrícia.

• Economic drain: The SNS closed 2025 with a €2.7 billion deficit, partly driven by reliance on €231 million worth of contract physicians charging premium hourly rates.

• Service collapse risk: Over 1.1 million people wait for specialist consultations, 267,000 for surgery, and emergency wait times have hit 17 hours in some hospitals.

The refusal to enter residency programs—termed "internato médico" locally—strikes at the heart of workforce renewal. These doctors hold medical degrees and have passed national exams, but they are opting out of the three-to-six-year specialty training required to practice independently in fields such as cardiology, psychiatry, or general practice. Without this pipeline, the SNS cannot replace the 570 specialist physicians who retired in 2025, nor staff the urgent-care rosters that legally require specialists under 50 years old.

The "Wrong Specialty, Wrong Location" Trap

A survey by the Administração Central do Sistema de Saúde (ACSS) in March reveals the crux of the problem: two out of every three doctors who declined a training slot did so because they failed to secure their preferred specialty. Another key factor was geographic mismatch—candidates could not get assigned to the hospital or health unit they wanted, often for family or quality-of-life reasons.

Contrary to popular assumptions, salary and relocation costs ranked lower as deciding factors. The doctors are not primarily driven away by money; they are held back by a rigid allocation system that forces them to choose between career ambition and personal circumstance.

Applied to 507 physicians who skipped the 2024 placement cycle, the ACSS study received 254 responses. More than 80% said they intend to retake the national access exam to improve their score and secure a slot in the specialty and location they actually desire, even if that means postponing training by a year or more.

"The analysis shows that the decision not to enter specialty training immediately stems mainly from structural constraints of the access model, particularly the inability to obtain placement in the desired specialty, rather than from any devaluation of specialized training itself," the ACSS concluded.

What This Means for Residents

For anyone living in Portugal and relying on the public health system, the cascading effects are already visible:

• Family medicine drought: By January 2026, 1.6 million residents had no assigned family doctor, an increase of 35,000 since the current government took office.

• Surgical and consultation backlogs: The 1.1 million-person waiting list for specialist consultations grew 13.6% year-on-year in 2025, and surgical wait lists rose 3.3% to 267,000 cases.

• Emergency room closures: A shortage of accredited specialists forces periodic closures of urgent-care units, including maternity wards, as only 14,000 of Portugal's 66,000 registered doctors are public-sector specialists under 50 and eligible for all emergency shifts.

• Premium-rate "tarefeiros": Unable to hire permanent staff, the SNS spent €174 million on contract physicians through September 2025—professionals who charge substantially more per hour than salaried doctors and often deliver less continuity of care.

The Ministry of Health has promised to open all necessary training slots and budgeted for modest per-capita increases in specialist availability in 2026, but officials have conceded that wait-list elimination is impossible given workforce constraints.

A Generational Shift in Career Calculus

Carlos Cortes, president of the Ordem dos Médicos, attributes part of the trend to a generational change in how young physicians view their careers. "Today's new doctors have a different posture toward specialty choice than what happened 10 or 20 years ago," he told Lusa. "They have greater mobility and freedom to define their own path."

That freedom includes working as an independent contractor, emigrating to complete residency abroad—Italy now offers Brazilian-trained doctors fast-tracked recognition until 2029, and France has appointed an envoy to recruit foreign physicians—or even pivoting to a different profession entirely.

Cortes emphasizes that the same factors deterring doctors from specialty placement also deter them from SNS careers: "People do not feel attracted to the SNS and believe that in certain hospitals and services they will not have adequate conditions for training or for developing their activity as specialists afterward."

The Ordem dos Médicos formed a working group in 2025 to investigate root causes and recently agreed with the ACSS to commission a deeper study. "We want to present a consistent and robust document to the Ministry of Health to resolve this matter, which worsens year by year," Cortes said.

Specialty-Specific Shortfalls

The 2025 residency match revealed acute imbalances in critical fields:

• Medicina Geral e Familiar: 229 of 690 slots went unfilled, despite this specialty being the backbone of primary care.

• Medicina Interna: Nearly half of the 204 available positions remained vacant—a specialty essential for hospital medicine and complex chronic-disease management.

• Pediatria, Ginecologia/Obstetrícia, Psiquiatria, Anestesiologia, and Saúde Pública all reported persistent vacancies.

Meanwhile, lucrative specialties such as Dermatologia, Oftalmologia, and Otorrinolaringologia fill quickly, reflecting economic incentives that pull talent away from the understaffed, high-pressure fields the public system needs most.

In December 2025, the Federação Nacional dos Médicos (FNAM) denounced hiring delays that left 250 newly qualified specialists without contracts, warning that shortfalls in family medicine, internal medicine, obstetrics, psychiatry, and pediatrics expose "failures in governance" at the Ministry of Health.

How European Neighbors Are Responding

Portugal's predicament is not unique—Italy, Spain, and France all face specialist shortages and aging medical workforces—but their policy responses differ in scope and urgency:

• Italy has waived diploma revalidation for Brazilian doctors through 2029 and offers housing, airfare, and competitive salaries to foreign specialists, particularly in emergency medicine, geriatrics, and anesthesiology.

• Spain exempts non-EU doctors from nationality requirements for three-year contracts in understaffed regions like Madrid and offers incentives to prolong the working lives of senior physicians nearing retirement.

• France has regularized undocumented foreign doctors already practicing, deployed mobile health centers to underserved rural areas, and dramatically increased medical-school enrollment to address "medical deserts."

A Eurofound report underscores that better pay and working conditions are decisive: Romania's preemptive salary hikes for doctors and nurses reduced emigration intentions and boosted public-sector recruitment, while Latvia offered lump-sum signing bonuses and housing support to specialists willing to work outside the capital.

Portugal, by contrast, opened a specialist-hiring round in December 2025 that the FNAM deemed "manifestly insufficient" in both vacancies and terms, perpetuating the pull of private practice and foreign markets.

The Budget Reality

The Orçamento de Estado for 2026 projects a consolidated SNS deficit of €1.13 billion, marginally better than the €1.35 billion estimated for 2025, but still far short of what would be needed to overhaul pay scales, upgrade hospital infrastructure, or guarantee desirable training placements.

Total SNS expenditure in 2025 reached approximately €18 billion—equivalent to the entire yield of Portugal's income tax—yet emergency departments remain understaffed, surgical theaters sit idle for lack of anesthesiologists, and cardiology wait lists ballooned 140% in the first half of 2025 alone.

The April 2026 revision to Tempos Máximos de Resposta Garantidos (TMRG) has sparked controversy by extending guaranteed-response deadlines to 30 days for "very priority" patients (up from a technical panel's recommendation of 15 days) and 60 days for "priority" cases (versus 45 days recommended). Critics warn the change effectively codifies delay and may push more patients into already overwhelmed emergency rooms.

Impact on Expats & International Residents

Foreign nationals and recent arrivals relying on the SNS should understand that securing a médico de família is increasingly difficult outside major urban centers, and that private health insurance or subscription-based clinics may be necessary for timely specialist care.

The 1.6 million-person gap in family-doctor coverage disproportionately affects rural areas, the interior, and the Alentejo, where population density is low and postings are considered less attractive. If you register for SNS coverage but remain unassigned after several months, consider hybrid arrangements with private providers or inquire about "consulta aberta" walk-in slots at your local health center, though these are also strained.

For elective procedures—hip replacements, cataract surgery, non-urgent dermatology—expect wait times measured in months or years unless you qualify for priority status or opt for private care. Employers increasingly offer supplemental health plans precisely because public timelines have become untenable for routine interventions.

Structural Fixes on the Horizon?

The Ordem dos Médicos and the ACSS are collaborating on a comprehensive study expected to propose targeted reforms, potentially including:

• Flexible residency placements that allow candidates to rank multiple specialties and rotate between hospitals.

• Enhanced stipends or housing allowances for trainees posted to underserved regions.

• Fast-track licensing for foreign-trained doctors, similar to Italy's model.

• Retention bonuses for specialists who commit multi-year contracts to the SNS after completing residency.

Until those measures materialize, however, the SNS will continue bleeding talent at both ends—losing retirees faster than it trains replacements and watching newly minted doctors walk away rather than accept mismatched placements.

The government has pledged to recruit up to 1,111 retired physicians in 2026 to plug immediate gaps, but pensioners working on short-term contracts cannot substitute for a steady influx of young specialists committed to long-term public service.

As the SNS deficit widens and wait lists lengthen, the question is no longer whether Portugal can afford to reform its residency system—it is whether the country can afford not to.