SP lost 2,200 doctors from health centers in 8 years, research shows

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A survey carried out by Cosems-SP (Council of Municipal Health Secretaries of the State of São Paulo) released this Thursday (20) points out that the Basic Health Units (UBS) in São Paulo have lost more than 2,200 doctors in eight years.

The research compares data from the first half of 2014 — when the Mais Médicos program was in effect, implemented under Dilma Rousseff (PT) — with the same period in 2022, with figures from its replacement, Doctors for Brazil, in effect. for about 3 years in the government of Jair Bolsonaro (PL).

The work used information from the 645 municipalities in São Paulo and also analyzed recent data from last September.

According to 850 municipal managers reported in May and June, the absence of doctors is the main problem currently faced in primary health care, according to the council.

In 2014, there were 2,469 vacancies occupied by professionals linked to Mais Médicos in the state.

In the first half of this year, 222 doctors were hired at Médicos pelo Brasil — a 91% drop in occupied jobs.

The number of vacancies offered also decreased, according to the survey, from 2,558 to 801 – a reduction of almost 70%.

The number of municipalities served in the comparison between the two programs, on the other hand, went from 380 to 277 — a reduction of 27%.

The Ministry of Health denies that there is a loss of medical provision in Brazil, since the two programs remain in force and are able to hire professionals.

“Doctors for Brazil aims to gradually replace Mais Médicos. The replacement will take place gradually, without harming the population,” he says.

Specialist in public management, nurse Clara Carvalho, municipal secretary of health in Mogi Mirim (151 km from SP), says that the lack of interest of doctors in joining the program has three reasons.

The first is that it does not guarantee more points to recent graduates in the residency process. The low salary and the fact that he does not hire foreign professionals, as happened at Mais Médicos, also weighs heavily.

“New graduates were interested in working in primary care. Now they prefer to earn BRL 1,600 in each 12-hour shift [de hospitais ou postos de pronto-atendimento]”, it says.

Last week, the federal government opened applications for hiring 312 tutoring physicians, who guide professionals who have already graduated, to be linked to the current program. The starting salary is R$15,750, but with benefits it can reach R$22,700, if the professional chooses to work in remote communities.

Without being able to reinforce their staff with general practitioners, says the secretary, municipalities do not reach goals and are without resources to hire other professionals who integrate family health programs, such as dentists and physiotherapists.

Carvalho estimates that he would need 15 more general practitioners to implement enough family health teams to serve all 95,000 inhabitants of Mogi Mirim.

The municipality currently suffers from a lack of professionals, which causes a delay of up to 60 days for residents to get an appointment with a general practitioner. “Up to 30% do not show up on the day of the consultation due to the delay. Until then, they have already solved the problem in another way”, says the secretary.

The lack of doctors made available by the ministry, says the council, means that municipal managers have to increase the remuneration of professionals to be able to hire, which overloads the expenses of municipalities, which already invest more than 25% of their budgets in health.

The doctor and professor Ana Maria Malik, coordinator of FGVSaúde, says that the municipalities face direct competition between them, from social organizations and even from health operators in contracting manpower, including for primary care.

Therefore, in addition to salaries, programs such as Doctors for Brazil and the municipalities themselves need to offer other attractions to professionals, such as structure, support and training.

“The change in health policy made a difference, but it cannot be said that it was just that”, he says. “At Mais Médicos there was a support program that no longer exists.”

President of Simesp, the São Paulo Physicians Union, Victor Vilela Dourado says that the speech to keep the professional in his place of work never left the paper in both programs.

For him, both were wrong for not promoting career plans. “The current one took attractive proposals from the previous one, such as the score for residents, without creating others. Therefore, the turnover of professionals in both is high.”

Reply

According to the Bolsonaro government, the Doctors for Brazil program guarantees better working conditions, wages and benefits for professionals, expanding care, especially in the most remote areas of the country.

In a note, the Ministry of Health says that in total 21,500 doctors will be offered against 18,240 in the previous program, to serve 5,233 municipalities, against 3,815 before.

“The smaller, more remote and vulnerable municipalities, which previously had 163 vacancies, now have 358.”

According to the federal government, currently, 3,300 doctors are working under the new program and by the end of the year, another 5,000 vacancies must be filled.

For the state of São Paulo, 2,318 vacancies will be offered. “Currently, adding the two programs together, 1,460 doctors work in basic health units in 319 municipalities in the state.”

The State Department of Health says that the CIB (Bipartite Intermanager Commission), a body that brings together health managers from the state and municipalities in São Paulo, requested measures from the Ministry of Health, since September 2021, in two official letters, on non-compliance with care. comprehensive health care in the units.

The state ministry says that with the loss of vacancies for professionals, about 912,000 people may be without a guarantee of medical care in the state.

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