Cuban doctors in Portugal: a legal and moral maze

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A government that adheres to hiring mechanisms that promote human trafficking, and that circumvents the entire process of validation of medical competencies and capacities implemented.

Portugal currently faces complex scenarios in different areas of society (such as health, education or justice) which, combined with institutional fragility, government instability and widespread incompetence and corruption, puts us at the level of a “banana republic”.

The particular health context, exacerbated by the shortage of human resources in the medical field, has become a critical issue challenging the National Health System (SNS). The need for medical services, especially in rural and less developed areas, puts significant pressure on Portuguese doctors, many of whom have migrated to other countries in search of better working conditions.

In order to address this lack of human resources, it is essential that the Portuguese Government carefully assesses alternatives and solutions to address the shortage of human resources in health. This should naturally include hiring foreign doctors, but in an ethical and transparent manner, and also defining greater investments in training and retaining local doctors, with improved working conditions.

The agreement between Portugal and Cuba for the hiring of doctors raises questions of ethics but also of government interference. Doctors are paid only a residual portion of the amount that is paid by Portugal to Cuba, in other words, Portugal pays Cuba and only a part of that amount reaches the professionals who are working on national territory. If we add to this variable the limitation of freedoms imposed on them, we are clearly facing a case of modern-day “human trafficking”.

But if on the ethical and moral side this process already makes us apprehensive, we can also add interference or incompetence.

The Government contacted the two entities that have to pronounce on the recognition of the diploma, the CEMP (Council of Portuguese Medical Schools) and the Order of Physicians. Following this request, the reaction of the representatives of these entities and the words of the Minister of Health himself, we realize that we have a new PS moment. With the justification that the objective is to “streamline procedures” in the recognition of “future doctors” by the Order, it became clear that this is also a procedure of facilitation and favoritism, without the proper validation of the competences of the qualification of these doctors to practice in Portugal, a total injustice to the hundreds of doctors who are already on Portuguese soil today awaiting that same validation.

To better contextualize this interference or attitude of absolute power, it is crucial to understand the process of qualification of doctors in Portugal.

Anyone wishing to practise medicine in Portugal must meet two requirements to register with the Ordem dos Médicos: have their course recognized by any of the eight Portuguese medical schools and demonstrate that they can communicate in Portuguese.

O first requirement then starts with the recognition of competences, which can be done in two ways:

A doctor from the European Union has automatic recognition in Portugal under EU law. To register with the Portuguese Medical Association you will only need to take a medical communication test.

Doctors from other geographies need to have their academic and clinical knowledge assessed by Portuguese medical schools and then by the Portuguese Medical Association.
With the exception of applicants from countries where Portuguese is the official language, all applicants start by taking an initial communication test at the medical schools themselves.

If you are a foreign applicant from outside the EU, you must then take the three-step Medical Entrance Test:

A curricular assessment, consisting of a written test in the major areas of medical knowledge, which is the responsibility of the Medical Schools and where half of the candidates fall by the wayside;

A practical test with the patient, called the ‘face test’, for candidates who passed the first phase;

Finally, candidates have to submit a master’s dissertation, which is also required of Portuguese students leaving medical courses with a master’s degree.

Data only started to be centralized and organized in 2019, but by January 2022, of the more than 1600 applications submitted for admission of foreigners, only 700 had been accepted.

The entire qualification process has been done by the medical schools to ensure that successful candidates have recognized knowledge to practice medicine to the same high standard imposed on domestic students.

O second requirement takes place after the completion of the Medical Schools process with approval, which takes about a year, where candidates must undergo a medical communication test, required by the Portuguese Medical Association and held at the Camões Institute under the Ministry of Foreign Affairs.

The President of the Portuguese Medical Association, Miguel Guimarães, said a few days ago in an interview that: “If you can’t speak Portuguese, you can’t practice. You have to talk to patients and write in clinical journals.”

Once you have successfully completed all the requirements, you can register with the Portuguese Medical Association, which only grants you the immediate possibility of practicing general practice. For equivalences to specialties, this assessment is exclusively up to the colleges of the Order and is a completely different league.

After contextualizing the procedure for the qualification of doctors, we realize that the government and the Minister of Health, in addition to adhering to hiring mechanisms that promote human trafficking, also circumvent the entire process of validating medical skills and abilities implemented by the competent entities. And they still ignore and disrespect hundreds of doctors who immigrated to Portugal, who have complied with the rules and who are waiting for the certification process.

As the Minister of Health is a doctor by profession, shouldn’t he be aware of the qualification process? If he is aware of it, why is he proposing that it not be complied with? If the recognition of specialties is even more complex than that of general medicine, how can the government aspire to import 300 doctors directly into specialties? And what about the doctors residing in Portugal who are waiting for opportunities to evolve into their specialties?

I would tell him to wait for the next episodes, but given the “absolute power” management that this government has done, we can say with high conviction that this may be another process worthy of the Banana Republic.

Amnesty asks government to respect human rights when hiring Cuban doctors

State to hire 200-300 Cuban doctors for primary health care – minister

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