Northern states of Brazil lose up to 60% of recent medical graduates

The internalization and expansion of medicine courses in the country have not guaranteed the establishment of doctors in regions less assisted by these professionals. Even with the increase in the number of graduates, some states lose up to 60% of recent graduates.

The expansion of medical courses intensified in the country from 2013 onwards, with the Mais Médicos law, on the grounds that the opening of medical schools in underserved regions would make it possible to retain professionals.

This policy, however, did not guarantee the establishment of doctors in these places and, today, medical entities fear that a billionaire dispute between educational groups could increase the concentration of these professionals in the South and Southeast of the country.

The dispute, which reached the Federal Supreme Court (STF) at the end of June, took place after hundreds of private colleges began to seek, and obtain, injunctions that authorize them to open medical courses without meeting the regional criteria established by the Mais Médicos law. .

The injunctions also go over a 2018 moratorium, made under the Michel Temer (MDB) government, preventing new authorizations for vacancies in medicine until April 2023. The suspension was intended to contain the advancement of poor quality courses in the country.

“What you see in Brazil is the creation of a real business in the opening process, with exclusive private interest”, says José Hiran Gallo, president of the CFM (Federal Council of Medicine).

A survey carried out by CFM identified that states with the lowest proportion of doctors have a high migration of recent graduates.

In Acre, for example, of the 240 students who graduated in medicine between 2018 and 2021, 62.9% went to other states to make their first medical registration to start working in the profession.

Acre is the second unit of the Federation with the lowest density of these professionals. While the country has an average of 2.74 doctors per thousand inhabitants, the state registers 1.41 doctors per thousand inhabitants.

For medical entities, the policy of expansion of courses did not guarantee the retention of professionals for not having created the other conditions sought by doctors.

“What keeps the doctor in a region today is not the graduation, it’s the medical residency. Those who graduate want to have a specialization. There are few options for residency in these regions, so the professional goes to the big centers, does the specialization and stays there”, says José Eduardo Dolci, scientific director of AMB (Brazilian Medical Association).

The improvement of medical distribution in the country, according to the entities, depends on the integral internalization of medicine.

“The doctor needs to have infrastructure to care for patients, with a public network that offers beds, exams, procedures. The state also needs to guarantee adequate remuneration and stability via public tender”, says Gallo.

The search for a residency of excellence was what motivated doctor Guilherme Menezes, 24, to leave Aracaju after graduating in medicine at UFS (Federal University of Sergipe).

“I only tried the residency at USP because it offers the best education. In Sergipe, there are good residencies, but São Paulo is still the reference in the field of orthopedics. I wanted to specialize where there were better opportunities”, he says.

Menezes says he would like to return to work in Sergipe, but fears that he will not find good conditions to practice the profession. “The structure in some places only allows you to do the basics”, he says.

“The precarious structure of health services also puts the doctor at risk. Medicine does not depend only on the doctor, it is necessary to have equipment, a team”, he adds.

Expansion of courses and vacancies

The increase in vacancies and medical courses in the country has intensified in the last decade.

The number of medical schools has more than doubled since 2010, from 181 to 376 in 2020, according to data from the Higher Education Census.

During this period, the number of newly trained doctors also jumped from 12,705 to 24,046.

As a result, the density of doctors in the country increased, from 1.91 doctors per thousand inhabitants to 2.74 doctors per thousand inhabitants in June 2022.

But the proportion of professionals in the North and Northeast is still below the average for the country.

The low density of doctors in these regions is the argument used by educational groups fighting in court to circumvent the 2018 moratorium. In the lawsuits, they argue that the restrictions imposed by the Mais Médicos law prevent private initiative.

“The opposition of medical entities to the opening of new courses is corporatist, defends professionals who are already in the market, trying to reduce competition between doctors”, says Paulo Chanan, president of Abrafi (Brazilian Association of Sponsors of Colleges).

The entity, which mainly represents smaller educational institutions, says that the search for injunctions was the only way to defend “free competition”.

The competition dispute led the Anup (Association of Private Universities), which brings together large educational groups, to file a lawsuit with the STF to prevent the analysis of these injunctions.

There are almost 180 requests for preliminary injunctions being processed in the country’s federal courts, which add up to the permission to open up to 20,000 vacancies in medicine.

“They are destroying a public policy through injunctions”, says Elizabeth Guedes, president of Anup.

According to a survey by the association, the shares exploded in 2021.

“In 2019, there were four requests. The following year, 36. In 2021, it reached 96 and this year alone there are 40. As each judge and court has an understanding, the Mais Médicos law is at risk”, says Guedes.

Colleges have already obtained authorization

The favorable injunctions guarantee to the faculties that the MEC (Ministry of Education) follows the analysis protocol for the opening of the courses. Thus, technicians from the portfolio assess the political-pedagogical project, the structure and the faculty made available by the institution.

After obtaining the injunction, three faculties obtained authorization from the MEC to open new courses. 403 vacancies were opened in this way at UniFTC, in Feira de Santana (BA), at the Faculty of Education of Jaru (RO) and at Centro Universitário Dom Bosco, in São Luís (MA).

In the last two, there are students enrolled for the first class of the courses.

In a note, Centro Universitário Dom Bosco said that the opening of the course fulfilled all the regular procedural phases of evaluation of the MEC and that it obtained the maximum concept for the release.

The other two institutions did not respond to the Sheet. When contacted, the MEC also did not respond.