After comparing French and American surgical lives, then diving into the realities of surgery in New Zealand, we kept the same simple questions in mind as we turned south of Europe:
What does it actually feel like to be a surgeon in Portugal?
We are not interested in policy or slogans but in the daily reality: hours worked, time off taken (or not), nights on call, family life, and what the system quietly protects or quietly erodes.
Dr Joao Pedro Marques, an ophthalmologist dedicated to vitroretinal surgery based in Coimbra, Portugal, generously answered our questions with refreshing candor, and what emerged is a system that sits somewhere between the general European social contract and the economic realities pushing surgeons to stretch themselves thin.
A Two-Track Life:
Most Portuguese surgeons live dual professional lives.
In the public system (the Portuguese National Health Service), contracts typically range from 20 to 40 hours per week, covering clinic, wards, operating rooms and emergency duties. But that’s rarely the whole story as many surgeons add 10 -20 hours of private practice on top.
The result? A familiar number: 50 to 60 hours per week.
Not outrageous by surgical standards but notably, this workload isn’t driven by institutional demand alone. It’s driven by compensation. The public system provides stability, training, and meaning; the private sector provides financial oxygen.
Personal time, unsurprisingly, is the variable that gets squeezed.
Legal Limits Exist Until Reality Intervenes
On paper, Portugal has safeguards: there are caps on extraordinary hours (150 hours), on working after night shifts, and physicians can legally decline excess work after certain thresholds. Age-based protections also exist: doctors over 50 can refuse night shifts and over 55 can refuse day-long emergency duties.
In practice, though, enforcement depends heavily on specialty, staffing, and hospital size. Large university hospitals tend to respect these rules. Smaller departments, especially those struggling with manpower, less so.
As in many systems, protections are strongest where there are enough people to make them viable.
Vacation Is Sacred And Actually Taken
Surgeons working in the NHS start with 22 paid vacation days, gaining one extra day for every ten years of service. And unlike in some systems where vacation exists mostly in theory, in Portugal it is culturally protected and genuinely used. Coverage is expected and there is no guilt in taking hard earned vacation days. As Dr. Marques says, “The Portuguese take their vacation days very seriously”.
The same respect applies to parental leave (120-150 days), bereavement leave (20 days for a spouse or a child, 5 for parents and in-laws, 2 days for siblings and grandparents) and even pregnancy loss, with some of the most generous policies in Europe. These leaves are guaranteed and taken without professional penalty.
For American surgeons reading this: yes, it really works like that.
Training: Structured, Supervised, and Surprisingly Hands-On
Surgical residency in Portugal lasts 5 to 6 years, depending on the specialty. Supervised surgical training exists from day 1 in all surgical specialties.
Each resident is paired with a senior mentor who follows them throughout training, not as a gatekeeper, but as a guide: clinically, surgically, and academically. At the same time, residents rotate across subspecialties, teams, and teaching styles.
There are no formal fellowships within Portugal. Instead, subspecialization happens organically within hospital teams or through 1 or 2 year fellowships abroad, after which many surgeons return home.
Teaching is collective. Senior residents teach juniors. Attendings teach residents. Peer-to-peer learning is valued, and the culture is generally generous with knowledge.
Call Is Supervised When Resources Allow
In university hospitals, on-call work follows a clear rule: a senior physician is always present. Two residents never cover alone.
Call is compensated financially, though modestly, especially for nights and holidays. Safeguards against excessive call exist and are respected, again mainly in larger departments.
The system works best where staffing allows it to work.
Disconnecting Is Encouraged But Not Always Practiced
Officially, if you’re not on call, you’re not required to answer emails or calls at night or on weekends.
Unofficially? Like everywhere, power dynamics matter.
You can ignore a late-night call from a supervisor. Whether you actually do is a personal calculation. The system permits boundaries; culture doesn’t always reinforce them.
Interestingly, there are few deeply embedded social norms encouraging life outside the hospital. Protection exists, but it is structural rather than cultural.
Burnout: Present, but Uneven
Burnout is rising in Portugal, as it is globally. That said, it appears unevenly distributed. Some specialties are hit harder than others; ophthalmology, for example, seems relatively spared.
Formal institutional support remains limited. As in many countries, burnout is acknowledged but not yet systematically addressed.
What Portugal Gets Right, And Where It Still Struggles
When asked what best protects surgeons’ well-being, the answer was clear:
- Vacation that is real
- Generous continuing medical education time (15 paid days)
- Strong protections for family and life events
Where does the system struggle?
Two familiar pain points:
- Research time : physician-scientists largely do research on their own time.
- Salaries : the reason private practice becomes a necessity rather than a choice.
And what could other countries learn from Portugal?
Perhaps its quietest strength: a universally free public health system, independent of insurance status, wealth, or diagnosis. For surgeons, this creates moral clarity even when financial clarity is harder to come by.
No Perfect System Only Honest Trade-Offs
Portugal doesn’t offer an idealized surgical life. Surgeons work hard. They juggle systems. They sacrifice time.
But it does offer something increasingly rare: predictable protections around life events, time off that is respected, and a public mission that remains intact.
As we keep collecting these stories from around the world, one truth keeps surfacing:
No system is perfect. Every country makes trade-offs: between access and autonomy, protection and productivity, vocation and viability. What changes from border to border is not whether surgeons work hard (we all do), but what each system chooses to protect: time, training, family life, financial security, research, or simply the ability to care for patients without first asking who will pay.
Listening to how colleagues elsewhere train, work, rest, and raise families helps us step back from what we assume is “normal” and see it for what it is: one version among many. These perspectives are not about ranking systems or declaring winners, but about making the invisible visible, and reminding ourselves that the way we practice medicine is not inevitable. It is designed and design can be rethought.
Healthcare systems are often compared through outcomes, costs, or waiting times. Far less often are they compared through the lives of the people who hold them together. Surgeon well-being is not a luxury variable as it shapes training, safety, retention, innovation, and ultimately patient care. By sharing these international perspectives, we hope to widen the conversation: not about working less, but about working sustainably.
The future of surgery will be global.
Understanding each other is a good place to start.
%20(2560%20x%201076%20px).jpg)
.jpg)
.jpg){kind=avatar}
