In Portugal, the profession of hospital administrator, then called “provider”, is expressed in the “Regimento do Hospital de Todos os Santos” of 1504. In 1948, Coriolano Ferreira, as head of the Administrative Services of the Hospitals of the University of Coimbra, relaunched the profession through the foundation of the magazine Hospitais Portugueses. From the first issue, it says what comes next:

“We need not only the buildings and their contents, but above all good doctors, good nurses and good administrative staff. The technical training of doctors and nurses is given to their own schools. But the administrative staff, this is the one who, until today, has nowhere to learn or anyone to teach (…). Among us, with two or three exceptions, we live in the full domain of amateurism and improvisations that, although well intentioned, spoil a lot of money that is the blood of the nation (...).”

On April 27, 1968, the Hospital Statute and the General Regulations for Hospitals were published, establishing for the first time the business nature of the hospital and the development of human resources, starting the careers of physician, nurse, administrator and pharmacist:

“Hospital administration (…) has become the task of professionals, with careful preparation and adequate status, since the mobilization of financial and human resources in health services reaches a huge volume and the losses resulting from poorly informed management can be extremely important , both from an economic, social and human point of view.”

In 1980, the career of Hospital Administration was finally regulated. In this career, hospital administrators belong to a single staff in the Ministry of Health, being paid as senior technicians. Only through competition can they be appointed in service commission to positions in hospitals, earning as third, second or first class administrators.

In parallel, the Hospital Administration career is developed in degrees (four). The base of the career is the 4th degree and the progression is made by competition after 3 years in the previous degree, and positive evaluation by the Evaluation Committee. In the case of the 1st degree, the presentation and discussion of work in the context of analysis by the Evaluation Committee is also required.

It may seem strange to many, but the valuation mechanism has no direct impact on compensation. For example, we may have hospital administrators in 1st grade (top of career) and have a start-of-career salary. In other words, to earn as a hospital administrator, you will have to apply and stay in a hospital. Since 2001, no competition has been opened in hospitals — for nearly 20 years, hospital administrators have had no progression with remuneration. Even so, the last evaluation “in degrees” is from 2008.

This clarification comes in connection with the recent dispatch of the Assistant Secretary of State and of Health. Most of my colleagues targeted by the dispatch were still in a 4th degree situation (a kind of trainee) for more than 20 years.

It is an order that deserves our recognition. Not because it allows salary increases or because they are applied retroactively, because it doesn't!! I repeat, does not allow. Just for being fair and recognizing these professionals, many of them with proven experience in places of high responsibility.

I understand the ignorance of many and the populism of others in the statements that were being made. Something is certain, who knows that lies just for their own benefit or for a class just defines themselves. Poor of those who need a lie to win an argument. On the other hand, it is important to highlight that hospital administrators have always defended worthy careers for other health professionals. We do not expect different behavior from these for us.

After 40 years, unlike other professions in the health area, the career of Hospital Administration has not been revised. Often, due to the shame of the administrators themselves in relation to other careers in the sector.

Thus, they have not been evaluated for years, they have not had competitions, they have no income, individual employment contracts are not fully integrated into the career, etc., etc., with a clear impact on the quality of management of institutions, where too many continue to prevail. curious and parachutists.

In 1952, the magazine Hospitais Portugueses said: “A hospital administrator doesn't act overnight. It needs in-depth study, combined with great natural conditions. We are far from the time of amateurs who learned their craft in their own places of command (…).”

Let's be clear, in 2020, the choice remains evident for the management of health units: prepared professionals or curious/parachutists. We agree that it is essential to review the training of health service managers, their recruitment, assessment and ongoing training. Therefore, we defend the review of the hospital administration career. Not for our own convenience, but because we believe it is essential to the development of universal access to healthcare.

Now, as Coriolano Ferreira said in the first edition of Hospitais Portugueses, in 1948: “Intuition and good will are necessary, but insufficient.” The path of proper management of health services is made through the professionalization of management functions. It is on this path that we believe, encouraged by the example of the past, which ennobles us, and obliged by the need to respond to the population, health professionals, families and every citizen.

The article can be read at the Public Hospital in November/December 2020, or on here