Medical Oncologist, Portugal

Unfortunately, for those who work as doctors in Portugal, it's a time of conflicting feelings, but the negative ones frequently prevail.

As a doctor I feel I am being exploited daily. The workload is increasing in an exponential manner. Even if we have time allocated for both research and for clinics, the clinical load is so huge that we don't have time for research or other medical pursuits. Nor do we have time to improve our competencies. Oncology requires continuous learning to keep abreast of the latest advances in our field. But there's no time to study.

Instead, we find ourselves bogged down by a growing bureaucracy. Digital solutions have the potential to help, but if we depend on 8 to 10 informatic applications to manage each patient, it becomes a nightmare. However, managers don’t seem to care about the burden it imposes on clinicians and how it impacts office work and patient care. The pandemic allowed us to work occasionally from home. But it comes with the expectation that we're always available. And because we have remote access to files, we are spending more and more time at home finishing all the work we couldn't manage in the office.

Oncology is a speciality with too many files and too much paperwork. It can be overwhelming at times. Many of the newer oncology drugs awaiting approval in Portugal are not reimbursed by the health system. So we must apply for special authorization to use it. This means lots of paperwork (documents for internal approval and for the national authority). Most of the time, the requests are refused and we need to explain this to patients. We see their anger and despair and we try not to show them our own despair. I have cried sometimes: when patients ask about options, and I tell them how much a drug costs in the private sector. They cannot afford it.

I often get angry by the responses we get from evaluators when we ask for these new treatments, implicitly questioning our integrity, independence, and knowledge. As an economic crisis is emerging, social conditions are worsening and support from the system is diminishing.

I am an absolute believer in a healthcare system available to all and that leaves no one behind. Unfortunately, the national health care system in Portugal is very sick. We see no structural investment in the system, no advances in technology, yet we see untold sums of money wasted every day. Portugal has abandoned its 'professional training of excellence ' programme and the government is trying to abolish the quality requirements for professional practice. Wages today are miserable and we're losing our purchasing capacity. Many colleagues are leaving the system (even abandoning clinical practice all together), because of the low salaries and the loss of hope in improving work conditions.

Even if I don't see a solution for any of this, I remain committed to the dream of a quality and accessible healthcare system available to all. I want to be part of a solution, but there's a need for lots of work and commitment from everyone. I'm just not sure how long I can wait.