Opinion – Antonio José Pereira: Medicine inequalities in Brazil

The Medical Demography Survey 2020, carried out by FMUSP (Faculty of Medicine of the University of São Paulo) in partnership with the CFM (Federal Council of Medicine), found that Brazil has already reached the impressive mark of 500,000 physicians, a historic record, with an average 2.38 professionals per 1,000 inhabitants — the highest number and density of physicians ever recorded.

According to the survey, the most recent available on the sector, in the last five decades the number of doctors increased 11.7 times in Brazil, while the population grew 2.2 times. A scenario that looks positive for health, but it just does. Hypothetically, there are enough doctors to serve the entire Brazilian population, but in practice they are poorly distributed, which makes access difficult for the population.

The OECD (Organization for Economic Cooperation and Development) indicates an average of 3.5 doctors per 1,000 inhabitants in the world today, but Brazilian capitals, especially those in the South and Southeast, reach an impressive 5.65 per group of one thousand residents. As we know, regions furthest away from large centers suffer from a shortage of health professionals, and it would be necessary to implement public incentive policies to achieve homogenization of this scenario.

The 2020 Medical Demography also pointed to something that we easily see in the corridors of medical centers and hospitals, and that was proven in recent research focused on managers: the majority of professionals are white and young men. There is no diversity in Brazilian medicine, especially in leadership positions.

In early October, journalist Mônica Bergamo, a columnist for this newspaper, published the results of a survey carried out by the CBEXs (Brazilian College of Health Executives). Focused on area managers — managers, directors, presidents, partners, supervisors, coordinators or superintendents —, their study consulted 1,532 professionals to identify that 56% are men, 40% are between 36 and 45 years old, 78% are white and 51% are in the state of São Paulo, which concentrates just over 20% of the Brazilian population.

That is, people who lead health decisions and trajectories, who plan, hire, decide on purchases such as medicines and equipment and define what information will be shared with society do not represent the demographics of Brazilian society.

More than that, they are not even present in the entire national territory.

Naturally, this inequality is a consequence of Brazilian history, which carries its provincialism forward and cultivates patriarchal, sexist and racist characteristics. Paths are made difficult and doors are closed long before the underprivileged compete for a job opening.

The Inequalities column of sheet reinforced that, “although 54% of the Brazilian population is black, only 46% of higher education students declared themselves black or brown in 2019. In other words, Brazilian universities, including public ones, continue to be more restricted, whiter and elite than they should.”

Released in June this year, a survey by CEMPRE (Central Register of Companies) by the IBGE (Brazilian Institute of Geography and Statistics) indicated that women ended 2019 earning and occupying less space than men: 44.8% of salaried employees were women. And while they received, on average, BRL 3,188.03, their salary totaled BRL 2,713.92, that is, women received about 85% of the average salary of men.

At HCFMUSP, women have always had equal opportunities to advance, and this is very likely one of the secrets of the institution’s success.

Of our nearly 21,000 employees, 60% are women and among the top management positions —Executive Directors, Nucleus Directors and Clinical Staff Directors—, we have a rate of more than 55% women. It’s not a gender issue; it is, rather, to privilege competence in an unrestricted way.

This commitment must, of necessity, continue. We must continually seek better positioning and equal chances.