Effectiveness of an incentives package to attract and retain physicians to underserved areas: a case study from Portugal.

Background: Physician shortages in underserved areas constitute a common challenge for governments and policymakers worldwide, including in European countries. The health sector in Portugal is characterized by geographical asymmetries in the distribution of physicians and the difficulty in retaining these professionals in certain areas of the country. In 2015, the Portuguese government created an incentive package to attract and retain physicians in underserved areas. In this case study, we describe the process that led to the creation of the incentives package, its main features, and the physicians that have benefited from it, and assess the effectiveness in terms of retention of physicians in the National Health Service (NHS) and the underserved areas.

Case presentation: Decree-Law no. 101/2015, published on 4 June, established the terms and conditions for awarding financial and non-financial incentives for physicians who work in underserved areas. It has been a fundamental instrument for attracting and retaining professionals to areas of geographical need, especially in the inner territories, seeking to fill needs and reduce asymmetries in the distribution of resources. In 2017 and 2021, the incentives package was reviewed to meet NHS demands and physicians' expectations.

Conclusions: The incentives package implemented in Portugal effectively deployed physicians to underserved areas. The several amendments to the package led to a 14-fold increase in physicians benefiting from the incentives and a 59% retention rate of these physicians in the same underserved health institution. However, the difference between the retention levels of physicians under the incentives package and those not covered is minimal. The financial and non-financial incentives need to be reviewed to better suit physicians' needs and expectations, as well as those of the NHS.