Almost Half a Million People in Portugal Live More Than an Hour From an Emergency Room, and Eleven Districts Cannot Keep a Doctor

Roughly 500,000 people in Portugal, about 4.7 percent of the population, live more than an hour's travel from a hospital emergency department. That figure sits near the front of a study the Ordem dos Médicos (Medical Association) presented in Guarda on Friday, and the rest of the document is built around it.

The study is called "Fixação de médicos em territórios de baixa densidade populacional" (Retaining doctors in sparsely populated territories). It was coordinated by the association's president, Carlos Cortes, and will go to political decision-makers including the Ministério da Saúde (Ministry of Health). Its central complaint is not that Portugal has done nothing about the shortage of doctors inland, but that what it has done has been piecemeal. "Portugal has too often responded with isolated, temporary and reactive measures," the document says. Filling a post once, or handing out a single incentive, "can solve a momentary need, but rarely builds permanence."

Eleven places where the problem is named

The study identifies eleven areas where doctors are hardest to attract and keep: the Azores, Beja, Bragança, Castelo Branco, Évora, Faro, Guarda, Madeira, Portalegre, Vila Real and Viseu. Two of those cut against the assumption that this is purely a story about the depopulated interior: Faro is the Algarve's district capital, and Madeira and the Azores appear for reasons of geography rather than emptiness.

What the association describes is a health service running at different speeds. People inland face long journeys, a break in the continuity of their care and heavier pressure on emergency departments, with hospitals frequently falling back on agency doctors hired job by job. The registry side of the same problem is already measurable: Lisbon and the Tagus Valley gained 49,000 people without a family doctor in a single year. "Geography cannot determine access to a doctor, the continuity of care, or the possibility of receiving specialist treatment," the document argues. Where it does, "formal equality stops matching people's lives and an asymmetric national health service quietly settles in."

What the association is asking for

The proposals are unusually concrete on money. The association wants a salary uplift tied to geographic location, paid both to doctors already working in low-density areas and to those who agree to move; an installation payment on arrival, to fund the move itself; and a loyalty payment triggered as a doctor completes five and then ten years in the territory.

Housing runs through the whole document: rent subsidies, protocols with town halls to provide accommodation at reduced cost or free of charge, help with buying a home or with the cession of land to build one, and faster licensing. On tax, it wants differentiated IRS (personal income tax) rates in the first years of practice inland, deductions tied to staying, and an IRS exemption on overtime beyond the mandatory legal limit, plus mortgage interest deducted on a main home and a reduction or temporary waiver of IMI (municipal property tax) in the first years of residence.

Beyond cash, it asks for service time to count for more towards career progression, and for medical internship posts in these areas to be recognised as priority territorial places, carrying extra weight in later competitions and a higher starting salary. It wants hybrid care in which stable chronic patients and prescription renewals are handled remotely, the boards of the Unidades Locais de Saúde (Local Health Units) given real autonomy to hire quickly, and performance indicators that account for older and more dispersed populations instead of penalising the units that serve them.

What this means for foreign residents

If you live in the Algarve, the Alentejo or the islands, the inclusion of Faro, Beja, Évora, Portalegre, Madeira and the Azores on this list is the practical takeaway. The difficulty of finding and keeping a family doctor in those places is not a local administrative failure you have run into by bad luck; it is a national pattern the profession's own body has now mapped and put in writing. If you are trying to register in the first place, our guide to how the SNS works sets out the steps.

Nothing here is policy yet. This is a professional association's submission, not a government programme, and several of its central asks, particularly the tax measures, would need to pass through the state budget to become real. The budget for 2027 goes to parliament in October, which is the next point at which any of this would have to show up as more than a proposal.