Twelve open vacancies and none filled in the competition
In the national competition for recent specialists of the first period of 2025 for General and Family Medicine, published by the Central Administration of the Health System, the 12 vacancies opened for the Alto Alentejo Local Health Unit went completely unfilled. This outcome reflects the generalized lack of interest among recent graduates in settling in a sub-region marked by deep territorial asymmetries and prolonged distances from the major urban centers of the coast.
The situation repeated itself at the beginning of 2026, when the competition of the second period of 2025 allowed filling only two of the eight vacancies opened for General and Family Medicine in the Alentejo as a whole, additionally leaving deserted the only available vacancy for the specialty of Public Health in the ULS of Alto Alentejo, according to data reported by the Central Administration of the Health System and broadcast by Rádio Televisão Portuguesa.
To try to reverse this trend of medical desertification, the Diário da República published in 2025 Notice no. 27433-A/2025/2, through which the Ministry of Health opened 17 vacancies for specialized training in the medical internship of the ULS of Alto Alentejo. Of these, seven were channeled specifically for General and Family Medicine, distributed unequally across Campo Maior with three positions, Portalegre with three, and Elvas with only one.
Sixteen new positions and five underserved vacancies
In the 2026 national competition procedure, Orders no. 5965/2026 and no. 6094/2026 of the Diário da República assigned 16 jobs for General and Family Medicine to the ULS of Alto Alentejo. Of these created places, five explicitly received the regulatory status of underserved vacancies, a classification intended to attract clinicians to areas with greater difficulties in filling positions.
According to official information released by the Alto Alentejo Local Health Unit in 2026, these five underserved family medicine vacancies were surgically allocated to the Personalized Health Care Units of Alter do Chão with one vacancy, Avis with one, Castelo de Vide with one, and Ponte de Sor/Montargil with two.
The same competition plan also included positions without underserved status for the units of Crato, Fronteira/Sousel, Gavião, and for the Family Health Unit of Nisa, distributing the hiring effort across several municipalities while maintaining uncertainty regarding the effective occupancy rate by doctors.
Nearly thirty percent of patients without an assigned doctor
Official records extracted from the SNS Transparency Portal in March 2026 show that 26,163 patients without an assigned family doctor were recorded in the ULS of Alto Alentejo. This contingent represented exactly 23.51% of the total universe of 111,271 registered patients in the entire area of influence of the health sub-region.
In regional comparative terms released by the National Health Service in 2026, this percentage of 23.51% constituted the second most severe situation in the entire Alentejo territory. The value was only surpassed by the Alentejo Litoral with 29.93%, but remained well above the realities of Central Alentejo with 7.4% and Lower Alentejo with 15.31%.
Despite the scale of the problem, SNS data show that the global list of patients without a family doctor in Alto Alentejo recorded a slight contraction of 4.3%, dropping from 27,304 registered patients in June 2025 to 26,121 patients recorded in June 2026.
The paradox of demand in a heavily aging population
The intuitive and most obvious reading would assume that the continuous demographic loss in Alto Alentejo would proportionally reduce the need for family doctors in local health centers. However, statistical data published by the National Statistics Institute in 2025 reveal the reverse, showing that the sub-region's aging index reached the drastic mark of 250.2 elderly people for every 100 young people.
This value for Alto Alentejo in 2025 far exceeds Portugal's national average, set in the same year at 188.8 elderly people for every 100 young people, and assumes an even more accentuated expression in specific municipalities such as Alter do Chão, whose index rose to 268.0, and Arronches, which recorded 251.9 elderly people per 100 young people.
Sustaining this scenario of care pressure, historical data from the Fundação Francisco Manuel dos Santos and PORDATA show that regional demographic aging has deep roots, having evolved from 128 elderly people per 100 young people in 2001 to 215 in 2013, until surpassing the threshold of 250 in 2025. Consequently, the remaining elderly population maintains pressing needs for chronic care, attested by a medical consultation utilization rate of 67.2% among patients without an assigned doctor in the ULS of Alto Alentejo in 2026.
Demographic decline and the generational risk of clinicians
The population dynamics of Alto Alentejo are characterized by a demographic erosion without parallel in the country. According to National Statistics Institute indicators for 2024, Alto Alentejo was the only of Portugal's 26 NUTS III sub-regions to record a negative effective growth rate of the resident population, set at -0.21%, in stark contrast to the positive demographic growth of 1.16% verified nationally.
This emptying trend has lasted for decades: between the 2001 and 2021 Censuses, published and analyzed by the National Statistics Institute, Alto Alentejo lost 17.4% of its resident population, dropping to around 104 thousand inhabitants and recording the most pronounced demographic drop among all Alentejo sub-regions.
To this scenario of demographic desertification is added the aging of the health professionals themselves. Combined data from the National Statistics Institute and the Medical Association for 2025 indicate that the national proportion of doctors over 65 years old increased from 13.8% in 2013 to 26.6% in 2024, heightening the imminent risk of unfilled vacancies and mass retirements in the peripheral health centers of the interior.
The consultation limit and the impact on daily life
The structural incapacity of the system to anchor clinicians in proximity units translates into severe administrative restrictions on the ground. To contain excessive influx and unsustainable pressure on primary care, the Portalegre Health Center formally determined on September 1, 2026, the imposition of a maximum limit of only 10 consultations per day for medical and nursing response destined for sporadic patients and those without a family doctor.
This daily restriction radically alters the daily routine of hundreds of elderly patients who depend on health centers for the renewal of chronic prescriptions and elementary clinical monitoring. In a sub-region where effective population growth is negative and the proportion of elderly people continues to scale against younger ones, the primary care access funnel forces a rethinking of the effectiveness of hiring incentive measures applied by the Central Administration of the Health System and the ULS of Alto Alentejo.
Sources: Central Administration of the Health System (2025, 2026), Diário da República (2025, 2026), SNS Transparency Portal (2026), National Statistics Institute (2024, 2025), PORDATA / Fundação Francisco Manuel dos Santos (2025), Medical Association (2025) and Alto Alentejo Local Health Unit (2026).