SNS Agency Doctor Bill Hits New High at Nearly EUR 250 Million — Algarve and Oeste Top the Spending Table

Portugal’s Serviço Nacional de Saúde spent EUR 266.8 million on outsourced medical and nursing staff last year, a 15.6 per cent increase over the previous year and nearly 30 per cent more than in 2023, according to data from the Administração Central do Sistema de Saúde (ACSS) released on Tuesday.

The figures lay bare the scale of the public health system’s dependence on temporary contract workers to keep hospitals running — a reliance that critics say is both financially unsustainable and a symptom of deeper structural problems in how the SNS recruits and retains permanent staff.

Agency Doctors Account for the Vast Majority

Of the EUR 266.8 million total, the overwhelming share — EUR 249.7 million — went to agency doctors, commonly known in Portugal as médicos tarefeiros. This represents a 17.3 per cent increase compared to the prior year and underscores the acute shortage of physicians willing to work full-time within the public system.

These doctors, who are typically paid significantly more per hour than their salaried counterparts, are brought in to fill gaps in hospital rotas, particularly in emergency departments, obstetrics and anaesthesiology — specialities where recruitment has been most difficult.

Spending on outsourced nurses fell slightly to EUR 10.4 million, down 2.3 per cent, while expenditure on other health professionals dropped 10.7 per cent to EUR 6.7 million.

6.7 Million Hours of Contract Work

In total, the SNS contracted 6.68 million hours of outsourced work last year, a 5.2 per cent increase over the prior period. Agency doctors alone worked 5.78 million hours, while nurses contributed 468,773 hours and other professionals 443,989 hours.

The data reveals significant regional variation. The Unidade Local de Saúde (ULS) do Algarve is the single largest spender on contract staff, at roughly EUR 21.6 million, followed by ULS do Oeste at EUR 14.7 million. Both regions have long struggled to attract permanent medical staff, partly due to high housing costs in the Algarve and the relative isolation of hospitals in the Oeste region north of Lisbon.

A Symptom of a Deeper Crisis

The spending comes against a backdrop of persistent warnings from health sector unions and professional bodies that the SNS is losing doctors to the private sector and to other European countries. Salaried public hospital doctors earn significantly less than their counterparts in private practice, and working conditions — particularly in emergency departments — are frequently cited as a major factor driving departures.

The problem is self-reinforcing: as permanent staff leave, remaining doctors face heavier workloads, which in turn encourages further departures, forcing hospitals to rely ever more heavily on expensive agency cover.

The Government has acknowledged the challenge and has taken some steps to improve conditions, including pay supplements for doctors working in underserved areas. However, the latest spending data suggests that these measures have not yet been sufficient to reverse the trend.

Financial Sustainability Under Pressure

The nearly EUR 267 million bill for outsourced staff is a significant line item in the overall SNS budget and adds to the fiscal pressures facing Finance Minister Joaquim Miranda Sarmento as he navigates a return to deficit spending. Every euro spent on premium-rate agency doctors is an euro that could theoretically have been spent on permanent hiring, equipment or facility upgrades.

The data also raises questions about value for money. Agency doctors are typically paid two to three times more per hour than permanent staff for equivalent work, meaning the SNS is effectively paying a substantial premium for a workforce model that most health economists consider inferior to stable, long-term employment.

With the Barreiro maternity ward closing permanently this week due to an inability to staff obstetrics rotas — and similar pressures building at hospitals across the country — the spending figures serve as a quantitative measure of a qualitative crisis that shows no sign of abating.

Sources: Lusa, RTP, ACSS

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