Driven by workforce shortages and an aging population, medical migration is increasingly common in countries belonging to the Organization for Economic Cooperation and Development, where the number of foreign physicians has risen 86% over the past 20 years. Portugal is no exception, recording a 9.4% increase between 2021 and 2024.

But the country experiences a two-way migration flow: the number of Portuguese physicians emigrating is also increasing.

Requests for certificates needed to work abroad — issued by the Ordem dos Médicos (Portuguese medical council) — have risen since 2022. In 3 years, more than 2700 physicians have requested the document.

Most emigrating physicians head to stronger European economies. In addition to higher salaries, the EU offers easier credential recognition, geographical proximity, and freedom of movement.

Intensive recruitment initiatives from countries such as France, Belgium, and Germany are relatively common. That was the case for Alberto Pais de Sousa, who, along with his wife — also a doctor — was approached during residency in Portugal by a company seeking healthcare workers for France.

At the time, Portugal was in the midst of a severe economic crisis, which led to a bailout supervised by the “troika” — the European Commission, the European Central Bank, and the International Monetary Fund — between 2011 and 2014.

Rising unemployment and strict austerity measures, including salary cuts and loss of benefits, triggered an exodus of qualified professionals, especially recent graduates, including physicians.

“It was a socially turbulent and financially difficult period for the country,” de Sousa said. He and his wife chose to complete their specialties before leaving. Both had secured concrete job offers by the time they applied for registration with the Ordre des Médecins in France.

“The biggest challenge is the migration itself. Leaving the country where you were born, trained, speak the language, and have your family and professional networks — and arriving somewhere completely unknown, where everything is new. The language, the culture, the system: everything is new,” he said. He noted that integrating into the clinical team, which included many international colleagues, was not difficult.

The multicultural nature of the medical team was also a positive point for Carolina Aleixo, who is completing her radiology residency in Berlin, Germany.

After studying for many years at a German school in Portugal, she said Germany had always been part of her academic and professional plans. For her, one of the biggest differences in medical practice between the two countries is patient interaction.

“In Portugal, there is more closeness — more conversation, more contact. In Germany, colleagues tend to maintain more distance,” she observed. “It’s a very noticeable difference.”

Although close interaction is not standard in Germany, many patients react positively when treated that way, she said.

Another striking difference is the timing at which residents take on responsibilities. “In Portugal, residents take longer to assume some responsibilities, which come much earlier in Germany. Portuguese doctors have a longer preparation period.”

Bilingual since childhood, Aleixo believes fluency in German has helped earn patients’ respect and avoid discriminatory episodes.

“When I speak, you can’t tell that I’m not German. That only becomes apparent when people see my name. I think that has made a difference.”

Even though he arrived in France without full fluency, de Sousa said he “never felt doors closing because he was foreign.”

“For starters, there was no pay discrimination — which is positive because in some countries it really exists as an institutionalized practice. I always felt welcomed from the beginning. In fact, if I hadn’t felt well received, I wouldn’t still be here today,” he said.

Both de Sousa and Aleixo agree that distance from friends and family is one of the biggest challenges for those who emigrate — an option with major personal consequences.

“When a person decides to emigrate, it goes far beyond professional reasons. Anyone who thinks otherwise is very mistaken,” de Sousa said.

“I think making the decision is the easy part. The challenge is staying. Going abroad for 6 months or a year is almost like doing an Erasmus [European university exchange program]. But going and staying for 10 years is something entirely different,” he added.

Foreign Physicians in Portugal

With the Serviço Nacional de Saúde (SNS) — Portugal’s National Health Service — under significant strain and struggling to recruit and retain staff, the country has been receptive to foreign-trained physicians. Nearly 4800 foreign doctors are currently registered to practice in Portugal.

Those trained in EU/ European Economic Area member states or Switzerland have notable advantages: they do not need a visa and follow a much faster recognition pathway in Portugal. For these graduates, the process is primarily document review, with no required examinations, though a Portuguese communication test is still needed.

(Click here for details about practicing medicine in Portugal as a foreign-trained doctor.)

In Portugal since 2013, Thomas Wilcke, a pediatrician trained in Germany, said the procedures to practice in the country were relatively simple. He obtained recognition of both his medical degree and specialty. The hardest part, he said, is rebuilding one’s career in a new country.

“At first, someone arriving as a fully trained pediatrician may think that’s enough to be valued. It’s not, and that’s due to several factors, including a certain cultural mismatch for those who haven’t followed the same path locally,” he said.

After more than a decade working in Portugal’s public system, Wilcke said he has witnessed a progressive deterioration of the SNS in recent years, especially as many professionals have left. “In my department, we went from 22 pediatricians to six,” he said.

“Many pediatric services in Greater Lisbon now close at night and on weekends, and the same is happening in obstetrics,” he added. Wilcke works exclusively in the public sector.

However, exclusive dedication to the SNS is unusual among foreign physicians. According to data published by the newspaper Público, only 17.6% of foreign doctors work in the public system. Spaniards form the largest group, followed by Brazilians.

Doctors trained in Brazil face a longer path to gain the right to practice in Portugal. Recognition generally takes more than a year and involves three stages: a practical exam, a theoretical exam, and submission of a final work.

For Naiara Ribeiro, the process took even longer due to delays caused by the COVID-19 pandemic. In Portugal since 2023, she said the country’s need for physicians means there is a wide range of job openings, accessible even to newcomers.

Although she entered the job market quickly, difficulty validating her Brazilian residency has been a major barrier to career advancement. “I think there is still some degree of protectionism,” she said.

Delays and challenges in recognizing specialties obtained outside the EU are a frequent complaint among foreign physicians and are considered one of the biggest barriers to professional practice in Portugal. Currently, most doctors who did not graduate in the EU are registered as general practitioners without a recognized specialty.

In Ribeiro’s view, a problem common to both Portugal and Brazil has become increasingly visible: rising hostility toward healthcare professionals. Data from Portugal’s Directorate-General of Health — confirm this trend. In 2024, there were 2581 reported incidents of violence against healthcare workers, a 9% increase from 2023.

“Many patients are becoming more aggressive, resistant, and reactive. They arrive at appointments practically shouting, demanding one thing or another,” she said. She works in a hospital where consultation rooms are equipped with panic buttons to alert the security team.

“Unfortunately, this is a problem in both countries,” she added.

Giuliana Miranda holds a master’s degree in science communication from Unicamp, a Brazilian research university. A journalist specializing in health and science since 2010, she worked for more than a decade at Folha de S. Paulo, one of Brazil’s major national newspapers, and has contributed to publications in Brazil and abroad, including Superinteressante and Galileu (science magazines) and The Telegraph (UK).

This story was translated from Medscape Portuguese edition.