Staffing shortages rock Portugal’s emergency obstetric services

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Lisbon — Hospitals of the Portuguese National Health Service (SNS) have faced a series of problems involving emergency obstetrics and gynecology services. Due to a shortage of professionals, including specialized clinicians, obstetrics departments in several parts of the country have had to close or severely limit services in recent weeks.

While it has always been difficult to plan working hours during the summer vacation period in Europe, the situation has worsened this year with a further increase in COVID-19 cases among healthcare teams.

The shortage of clinicians caring for the population has led to chaos in emergency rooms and delivery rooms. In response, the Portuguese Ministry of Health created a special committee to monitor the situation and promised to hire more medical professionals as a medium-term solution.

Even Santa Maria Hospital, Portugal‘s largest hospital, located in the capital, failed to escape trouble. The hospital’s obstetrics department was unable to accept any patients arriving via ambulances from the Portuguese National Institute for Medical Emergencies (INEM) for 18 hours.

In the Algarve, in the south of the country, the obstetric emergency department of Portimão hospital was closed for almost a week. The department reopened on June 20.

Disruptions to normal working procedures have affected several hospitals in various parts of the country, particularly at night and on weekends.

In the early morning of June 8, a baby died at Caldas da Rainha hospital in central Portugal, where the obstetric emergency department was closed. The Portuguese Attorney General’s office has opened an investigation to investigate the case.

From public to private

Obstetrics and gynecology emergency departments and delivery rooms have the minimum number of specialists they need to operate. The size of the teams and the minimum number of clinicians required vary depending on the services offered and the annual birth rate of the service.

When they cannot ensure the number of professionals required, emergencies end up closing.

“When you’re working on a sharp wire, you just have to miss one or two [clinicians] that everything goes wrong,” explained Ana Reynolds, MD, an obstetrician and co-chair of the department of obstetrics and gynecology at the Faculty of Medicine of the University of Porto, in Porto, Portugal, during an interview with the espresso newspaper.

Although official statistics indicate that there is no shortage of specialists in Portugal, many clinicians choose not to work in the SNS.

According to the Portuguese Medical Association, only 897 of the 1,871 obstetrics and gynecology specialists registered with the association work under the SNS. This means that less than half of obstetrics and gynecology professionals are in the civil service.

More and more young professionals are choosing not to work in public hospitals. “Many young clinicians prefer to work in the private sector. There they get better working conditions, higher pay and professional stability that the SNS is unable to offer,” the Medical Association pointed out. Portugese.

The question of age also weighs on the balance of SNS teams. By law, clinicians can stop working night shifts at age 50. At age 55, clinicians can choose to stop visiting the emergency room altogether.

An article published in May in the journal Acta Medica Portuguesa presented a demographic and professional analysis of specialists in obstetrics and gynecology registered in Portugal. The study demonstrates that the issue of an aging workforce in the NHS contributes to problems in emergency rooms.

“In Portugal, specialists in obstetrics-gynecology are not lacking in absolute numbers. However, there is a high number of specialists over the age of 55, and they have the right to stop providing services in the wards. This, together with regional disparities, contributes to the persistent shortage of these professionals in several institutions, notably public hospitals,” the study reports.

Resources and training

Marta Temido, the Portuguese Minister of Health, announced the creation of a special committee to monitor the situation. The objective is to better integrate the hospitals of each region, allowing a better distribution of resources.

Temido also said the government is working to improve the country’s capacity to train medical professionals. At a conference to launch the plan, however, she made it clear that they might need to seek medical professionals from other countries.

“We do not rule out hiring foreign clinicians and, if we have difficulty training specialists here [in Portugal]we will also consider training them in other countries,” Temido added.

In addition to more immediate solutions to problems in emergency rooms, the government also announced a medium-term plan to hire more professionals for the SNS. This includes 1600 positions for newly trained specialists in various medical fields.

The government has also expressed openness to reviewing overtime pay rates for SNS clinicians.

This article has been translated from the Portuguese edition of Medscape.

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