Deficit of family doctors in SUS is between 45,000 and 65,000, says entity president

The area of ​​primary care will need a special look from the Luiz Inácio Lula da Silva (PT) administration, in the opinion of the president of the Brazilian Society of Family and Community Medicine, Zeliete Linhares Leite Zambon.

According to her, there is a lack of professionals, career incentives and investments.

In the expert’s opinion, for good health management, the government should invest in primary care, in community health agents, in the training of family and community doctors, in addition to increasing the resolution of primary care and returning to Nasf professionals (Family Health Support Center).

Is there a lack of family doctors in the SUS? In the SUS alone, the deficit ranges from 45,000 to 65,000 family and community doctors. We only have 10,000 of these professionals.

What is the deficit attributed to? First, there was no such professional within graduation. Since 2014, with the change in the national curriculum guideline for medical courses, a specialist professor in family and community medicine has become mandatory, including the subject of primary care transversal to the entire course. If we make an account, it will take at least ten years to form the necessary number of these specialists.

By the time we graduate, we’re going to need more, because the population is increasing. The specialty turned 41 on December 5 [Dia Nacional do Médico de Família e Comunidade], but the format was different. As of 2002, it started to be in the assistance format, to solve all primary care problems, which is equivalent to 85% of people’s health problems. The role of primary care has also changed. Before, we had a vision of prevention. Today, it is prevention, cure, diagnosis, rehabilitation.

How could the country encourage the option for family medicine? We have an emergency need for medical supplies in primary care. This urgency brought about several programs, such as Mais Médicos and Provab (Program for the Valuation of Primary Care Professionals), in which graduates leave graduation and receive a scholarship worth much more than the residency scholarship, R$ 4,000. . Provab’s was R$ 10,000; Mais Médicos exceeded R$ 11,000; and Doctors for Brazil [substituto do Mais Médicos], about R$ 15 thousand. This discourages recent graduates from going on to residency in family and community medicine.

How do you evaluate the Bolsonaro administration in relation to the health of the family? Horrible. Regarding the Family Health Strategy, there was a decrease in investment. Also due to the freezing of funds for health and education, investment in resolvability decreased, because it cut funds for the flow of support to family health. This in itself has already diminished the incentive for primary care.

In family and community medicine, for the first time, there has been no stimulus for residency scholarships in this specialty since the beginning of Pró-Residência [Programa Nacional de Apoio à Formação de Médicos Especialistas em Áreas Estratégicas]. This makes it clear that the government had no intention of valuing family and community medicine. Within Médicos pelo Brasil, the Agency for the Development of Primary Health Care was created with the motto of training for family and community medicine. In fact, it took a long time to start the course, which happened recently. Even so, there should be a continuous evaluation of this process by Médicos pelo Brasil. The program, which is a mix of provision with training and, in the end, qualification of specialists in medicine and the community, took a while to be put into practice. Just throwbacks.

What is the impact of the health crisis on family medicine? As there was no planning of what this work would be like, there was no investment, improvements or maintenance of existing policies. This made people go to the emergency room more often, suffer from chronic diseases such as high blood pressure and diabetes, and have more strokes and heart attacks.

The economy causes more expenses in the secondary and tertiary sectors, because there is no care in managing people’s health. Family and community medicine began to become very private. There was already an appeal from the private system for this professional, who was highly valued there. In addition to the government not training more family doctors and reducing spending on primary care, it lost specialists in family and community medicine to the private sector, which greatly worsened the quality of primary care.

What are the entity’s expectations in relation to the Lula government? We know it will be a difficult year due to budget issues. We hope that this government is clear that primary care must be the coordinator of the entire health system. It is necessary to invest in primary care, in the training of family and community physicians, to increase the resolution of primary care, to return to Nasf professionals and to invest in community health agents, in innovation and in information systems. This is the logic of good health management.

And we hope this government will listen to the experts in family and community medicine. Activate us, look for the Society [Brasileira de Medicina de Família e Comunidade], which we have directions to give. We hope that specialists in family and community medicine are valued, that they have a career plan, incentives for training.

Just as we encourage emergency physicians with larger grants, we must encourage those who do residency in family medicine to also have larger grants, a medical career process and fixation within the Family Health Strategy.

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Zeliete Linhares Leite Zambon

President of the Brazilian Society of Family and Community Medicine. Graduated in medicine from the Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, family and community doctor, master in health teaching sciences from Unifesp. She has an Executive MBA in healthcare management from Einstein. She is the teaching coordinator of the medical course at Faculdade São Leopoldo Mandic.