The letter was delivered on 19 August at the Ministry of Health and is signed by 416 of the 1,061 doctors of Internal Medicine specialty from all over the country, according to the Independent Physicians Union (SIM).

Taking into account the labour demands, the doctors consider that the training of interns "is compromised", since they are constantly assuring emergency shifts, "working shifts that should be guaranteed by specialists, in clear breach of the criteria of training suitability of Internal Medicine (IM).

As they consider that the measures approved to date "are insufficient" for the resolution of the difficulties experienced daily in the provision of care, the doctors communicate in the letter that they will deliver individually and to the respective hospital administrations the draft refusal to perform more than 150 extra hours per year.

They will also hand in minutes of waiver of responsibility whenever they are assigned to work in an emergency room and the schedules of this service are not in accordance with the regulations.

"In this way, we demand better training and working conditions, remuneration that reflects our differentiation, compliance with the maximum limits for overtime and compliance with minimum care standards in the emergency teams, so that we can meet the level of demand required of us, ensuring the safety of our patients," they point out in the letter.

The doctors also point out that ICM is the medical specialty on which the hospital structures and Emergency Services are based throughout the country and warn that without the presence of interns, the ER scales would not be regularly filled.

"We have witnessed situations such as those at Hospital São Francisco Xavier (Lisbon) in which the ICM emergency services are repeatedly weakened and reduced to ICM interns", but also in other hospitals in the country where "there is an increase" in the use of interns to fill in the shifts of specialists in the emergency services, "as this practice has become a habit, to the detriment of their training, particularly with regard to the remaining care activity, such as consultation and hospitalization", they regret.

Thus, they point out, "little time is left" to fulfil "the minimum numbers" required in the curricula regarding the number of consultations, training in the numerous techniques required for the specialty, time for activities such as publishing articles and research work.

"This results in a deficient training, suffocated by the demands of emergency services and a growing demotivation," they warn. The doctors also say that this "spiral of dissatisfaction is getting worse every day and is common to several medical specialties".