Person wearing hospital blues and a stethoscope

More than 2,400 doctors and nurses in the National Health System (SNS) are foreigners, as are 1,312 operational assistants, most of them from Spain and Brazil, according to the latest 2022 statistics from the Migration Observatory.

This trend contrasts with the first decade of the 21st century, when there was a strong presence of professionals from Portuguese-speaking African countries (PALOP), a preponderance replaced by workers from the European Union, especially Spaniards, who account for around a third of the Ministry of Health’s foreign human resources.

The majority of the Ministry of Health’s foreign human resources in the last decade came from Spain (33% in 2011, gradually decreasing to 19.6% in 2022), Brazil (13.5% in 2011, gradually increasing to 24.9% in 2022) and Angola (from 8.2% in 2011 to 8.6% in 2022).

In 2021 and 2022, the number of foreign human resources working for the Ministry of Health increased, to a total of 3,958 in 2021 and 4,055 in 2022 (representing 2.7% of the total number of human resources in the SNS), recovering from the decline recorded since 2004, the year with the highest number of staff (4,490) and the highest relative importance in the total number of human resources in the Ministry of Health (3.5%).

Foreign doctors represented 5.8% in 2021 and 5.6% in 2022 of the total number of doctors in the NHS, while foreign operational assistants represented 4% in 2021 and 4.3% in 2022 of the total number of operational assistants in the NHS, increasing their relative importance.

Foreign nurses, on the other hand, have decreased to half of those registered two decades ago and have maintained their relative importance since 2015, representing 1.3% of the Ministry of Health’s nurses.

The SNS’s foreign human resources are mainly doctors – who accounted for 62% of the total in 2015, although they lost relative importance in 2022 when they accounted for 43% – with a total of 1,729 in 2022.

Doctors are followed by foreign operational assistants (1,312 in 2022), foreign nurses (677) and foreign human resources in other professions in the Ministry of Health (337).

The number of operational assistants of foreign nationality in the Ministry of Health has increased significantly over the last decade – from 413 in 2011, 1,071 in 2020, 1,243 in 2021 and 1,312 in 2022 -, surpassing the number of foreign nurses integrated into the NHS since 2019.

The number of foreign doctors fell in 2020 to 1,256, 584 less than the previous year, representing the lowest absolute number in the last decade, but recovered in 2021 and 2022 to 1,747 and 1,729, respectively.

“Compared to other OECD countries, Portugal is far from being a preferred destination for the migration of health professionals,” reads the document from the Migration Observatory.

Among the causes identified were difficulties related to overqualification in the national labor market, through requests for recognition of foreign academic degrees in the field of health and complementary training programs already in a Portuguese context.

While immigrants have taken on a role as health care providers, namely to make up for shortages in the supply of health professionals, the Portuguese are comfortable with the scenario of the immigrant being the doctor in the health service, according to respondents to the Special Eurobarometer on the integration of immigrants in the European Union (2017 and 2021).

In this study, among the 27 member states of the European Union, Portugal came fourth (alongside Luxembourg and Spain) among the most favorable countries in this indicator, with 92% of those surveyed declaring that they felt comfortable having an immigrant doctor (55% totally comfortable and 37% tending to be comfortable), only 5% tending to be uncomfortable and 1% totally uncomfortable.

Fewer foreign nurses in the NHS due to lack of conditions

The number of nurses of foreign nationality in the National Health Service (SNS) almost halved between 2006 and 2022, a drop that the President of the Portuguese Nursing Association justifies by the lack of working conditions in Portugal.

The latest report from the Migration Observatory, with data up to 2022, points out the loss of relative importance of nurses in the Ministry of Health’s total foreign human resources, which fell from 1,054 in 2006 to 677 in 2022.

In 2010 they represented 22.5% of the total foreign human resources, rising to only 17.1% of that total in 2019, which rose between 2019 (572 foreign nurses) and 2020 (635), representing 19.7% of the total, in 2021 (669), with less relative importance of 16.9%, and in 2022 (677), weighing 16.7% in the total.

“In recent years, it has been an unattractive market for foreign nurses, due to the working conditions in Portugal and the low level of appreciation for nurses,” explained Luís Filipe Barreira, the President of the Nurses’ Association, in a statement to Lusa.

This reduction in the number of foreign professionals in the SNS is accompanied by an export of Portuguese nurses, he said, pointing out that they are looking abroad for better salaries, careers and working conditions.

Luis Filipe Barreira recalls the latest figures from the Organization for Cooperation and Development (OECD) which, out of 21 countries, place Portugal in 19th place among the lowest paid in European terms.

“It’s not an attractive country, neither for those who are here, nor for those who want to come,” concludes the President of the Portuguese Nursing Association.

But Portugal has no shortage of nurses, he points out, noting that enough nurses are trained every year to meet the country’s needs, but that there is no policy for retaining these professionals.

Another reason for the country’s lack of attractiveness, he says, is the ratio of nurses to inhabitants, with Portugal being “far below” the OECD average.

In contrast to foreign nurses, the number of operational assistants of foreign nationality in the Ministry of Health has increased significantly over the last decade.

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