A major row has ensued since Manuel Heitor, minister in charge of higher education, announced the opening of three extra university courses in medicine, to start within the next two years (click here).
It isn’t simply that entities like the General Medicine Council, the Council of Portuguese Medical Schools and the association of family doctors believe there is no need for these courses (presented as a solution to Portugal’s lack of trained medical personnel), but that enormous exception has been taken to Mr Heitor’s justifications for them.
In interview with Diário de Notícias last Friday, the minister explained that “in Portugal all doctors are trained in the same way” when perhaps this is unnecessary.
“The point is that to train an experienced family doctor it is not necessary, perhaps, to have the same level and duration of teaching as a specialist in oncology, or a specialist in mental health”, he told DN.
This is why he ‘insists’, he said, on what he called “expanding the training base in health – whether medical, nursing or health technicians”, which he believes should be done “in conjunction with the diversification of the offer, also valuing other medical professions, such as family doctors”.
Whether one totally understands Mr Heitor or not, the gist is clear: he believes family doctors could be taught and prepared for work more quickly than cancer specialists – and he would like to see this happening ASAP.
Making matters even worse, he told DN this is already what happens in the UK (which British doctors have been quick to refute – see below).
The problem with Mr Heitor’s explanations is that essentially they made no sense.
Miguel Guimarães of the General Medical Council stresses that the course in Medicine is “completely independent of post-graduate training”. In other words “it has to stay as it is, as it is the world over. If we kill the holistic vision of Medicine, we are killing Medicine in itself, so we have to defend Medicine. We cannot let the minister think that Medicine can be broken up so that some have a complete course, and others half a course, etc etc…”
Henrique Cyrne Carvalho, president of the Council of Portuguese Medical Schools (CEMP) put the furore into a nutshell: Manuel Heitor is an engineer, looking at a situation from an engineer’s point of view.
“The training of our doctors in general and family medicine is fundamental. It has to take place with rigor and quality for everything to function in the most efficient way possible”, he told DN.
His predecessor Fausto Pinto, now director of Lisbon University’s Faculty of Medicine, explains “teaching medicine is not the same as teaching mathematics. It could be this that the minister doesn’t understand…”
And while none of the medical specialists believe that training more doctors will lead to increasing numbers willing to work in the national health service, Fausto Pinto suggested a very different agenda. In contributing to “the impoverishment of medical education” Portugal could end up with an increased supply of doctors who are simply “exploited by medical companies to become cheap labour”.
If this is the real reason for the plan “then let it be said”, he challenged in conversation with Público.
In Fausto Pinto’s opinion the best way to improve the numbers of doctors willing to work in the public system is to “reinforce current faculties of medicine, increase their competitiveness and their capacity to attract (students)”.
Meantime, the country’s association of family doctors is calling for an urgent meeting with health minister Marta Temido to clarify what really is on the table.
Mr Heitor’s comments that ‘GPs are already trained differently in the UK’ galvanized the British Medical Association (BMA) into an immediate and excoriating statement.
Entitled “BMA responds to Portuguese minister’s comments about UK general practice training”, it said: “It’s completely inaccurate to describe GP training in the UK as less demanding than for other medical specialties, which does a severe disservice to our highly-skilled family doctors working in practices across the country.
“To practice as a GP in the UK, medical graduates – who receive the same university education regardless of which branch of medicine they wish to pursue – must complete two years of foundation training which forms the bridge between learning as an undergraduate in medical school and the transition into caring for patients on the frontline of the NHS. Completion of a minimum of three years General Practitioner Specialty Training on a GMC approved programme, passing the Membership of the Royal College of General Practitioners assessments, and gaining a Certificate of Completion of Training from the GMC are then required.
“Assurance processes are in place to ensure doctors who move to the UK from abroad, or demonstrate equivalent knowledge, skills and experience, also meet these high standards. UK General Practice Specialty Training is an intellectually rigorous medical training programme, which enables doctors to gain the skills and experience required to make a huge and vital contribution to healthcare in the UK, providing expert care and treatment to millions of patients”.
There has been no comeback from Manuel Heitor yet, but given the fervour of opposition to his plan, the three courses announced for Aveiro, Vila Real and Évora may well not end up happening.