Challenges and strategies to improve the availability and geographic accessibility of physicians in Portugal

Abstract

BackgroundShortages of physicians in remote, rural and other underserved areas and lack of general practitioners limit access to health services. The aims of this article are to identify the challenges faced by policy and decision-makers in Portugal to guarantee the availability and geographic accessibility to physicians in the National Health Service and to describe and analyse their causes, the strategies to tackle them and their results. We also raise the issue of whether research evidence was used or not in the process of policy development.MethodsWe analysed policy and technical documents, peer-reviewed papers and newspaper articles from 1995 to 2015 through a structured search of government websites, Portuguese online newspapers and PubMed and Virtual Health Library (Biblioteca Virtual em Saúde (BVS)) databases; key informants were consulted to validate and complement the documentary search.ResultsThe challenges faced by decision-makers to ensure access to physicians were identified as a forecasted shortage of physicians, geographical imbalances and maldistribution of physicians by level of care. To date, no human resources for health policy has been formulated, in spite of most documents reviewed stating that it is needed. On the other hand, various isolated and ad hoc strategies have been adopted, such as incentives to choose family health as a specialty or to work in an underserved region and recruitment of foreign physicians through bilateral agreements.ConclusionsHealth workforce research in Portugal is scarce, and therefore, policy decisions regarding the availability and accessibility of physicians are not based on evidence. The policy interventions described in this paper should be evaluated, which would be a good starting point to inform health workforce policy development.Electronic supplementary materialThe online version of this article (doi:10.1186/s12960-017-0194-3) contains supplementary material, which is available to authorized users.

Time trends in the regional distribution of physicians, nurses and midwives in Europe

“…Various countries are introducing policies and programmes to attract and retain health professionals in rural and underserved areas [4,14,17,18]. Frequent measures include financial incentives for physicians to move and establish a practice in rural areas (ibid.).…”

“…Frequent measures include financial incentives for physicians to move and establish a practice in rural areas (ibid.). Others are non-financial in nature, including improved work-life balance, additional training opportunities and professional support through telemedicine, establishing educational institutions in rural areas, and admitting health professional students from rural backgrounds since these individuals are more likely to practice in rural areas following graduation [18,19]. However, the success of these interventions remains unclear, largely due to a lack of data availability [14], and the majority of policies that targets the physician workforce.…”

Spatial Access Matters: An Analysis of Policy Change and Its Effects on Avoidable Infant Mortality in Portugal

“…Therefore, a significant proportion of mothers live far from maternity units and are more likely to face spatial barriers to healthcare services (see Figures 2 and 3) [29]. The impacts of these inequalities are compounded by the spatial maldistribution of healthcare professionals in Portugal, with high regional differences in the number of physicians per 1000 inhabitants; in 2011, the Northern and Lisbon/Vale do Tejo regions had 74% of the country's physicians for 65% of the population, while the Central, Alentejo, and Algarve regions had 18%, 4%, and 4% of physicians for 23%, 7.5%, and 4.5%, of the population respectively [30]. The demand and pressure of human resources is related to an aging workforce and the overall shortage of human resources, which remains a major obstacle to the optimal functioning of the NHS [29,31].…”

Fatores que influenciaram o processo de formulação de políticas de recursos humanos em saúde no Brasil e em Portugal: estudo de caso múltiplo

“…This is a multiple case study on the policy-making process for human resources for health in Brazil and Portugal, developed in three phases: (I) and (II) analysis of the political contexts for human resources for health in the two countries 10,11 and (III) the focus of this article, analysis of the policymaking process and the factors that influenced it, from the perspective of the respective actors.…”

“…The study presents some limitations that are inherent to the case study method, like the impossibility of extrapolating the findings to another context (external validity). To ensure the findings' credibility (internal validity), the methodological steps were followed rigorously: a tested interview questionnaire and triangulation of data sources used different data collection procedures for analysis of the context 10,11 . Finally, the inferences were based on scientific evidence prior to the current study.…”