MEC keeps blocking new medical courses amid pressure from companies

The government of Luiz Inácio Lula da Silva (PT) will have the challenge of reformulating the regulations on the creation of medicine courses in the country amidst a scenario of legal disputes, the resumption of the Mais Médicos program and pressure from educational companies with an eye on a lucrative market .

The new management of the MEC (Ministry of Education) revoked in the first week of the year an ordinance edited at the end of the lights of the Jair Bolsonaro (PL) government that brought new regulations on the subject.

In this way, a rule from the end of the Michel Temer (MDB) administration, in 2018, when a five-year lock was implemented for the creation of new courses – the deadline ends in April.

The act of the PT government is a new chapter of an imbroglio that has dragged on for a longer time, since 2013. When Mais Médicos was created, in the government of Dilma Rousseff (PT), the opening of new medicine courses was conditioned to public calls to serve certain cities, where there was a supposed greater demand for these professionals.

The Lula government has already announced that it will resume Mais Médicos. There are no details on how the training of new professionals will be dealt with in this policy.

Questioned, the MEC did not say what it plans for the matter. The Minister of Education, Camilo Santana (PT), said on social media that he revoked Bolsonaro’s rule for medical courses out of prudence, so that “a careful and safe assessment of its terms is made”. Another justification is that Bolsonaro’s measure would not have gone through the portfolio’s legal advice.

In 2018, the argument for the Temer government measure was the concern with the quality of education. The act barred the opening of the MEC protocol to authorize new courses and also new public calls.

Those involved in the subject, however, saw the measure as a market reserve that benefited those who already had this degree, in addition to contradicting the course evaluation tools applied by the ministry.

The private network accumulates 158,017 enrollments in medicine in 223 courses. Today, around 200 lawsuits deal with course openings. Despite the blockade created by Temer, the increase in vacancies for courses already authorized was not stopped and there are cases of institutions that managed to unblock MEC procedures in court, in addition to the release of processes that were already in progress.

“Every public policy or law that is customarily discussed in court is flawed”, says lawyer José Roberto Covac, a consultant for private higher education groups.

Throughout the Bolsonaro government, the MEC maintained a close relationship with sectors of the private market and threatened to edit new rules. But it was only in 2022 that the topic took shape in the folder, a working group was created and, finally, the ordinance was published, on December 31 — revoked days later.

In general, this ordinance determined the interlocution of new courses with the SUS (Sistema Único de Saúde) and maintained new openings through public calls, a strategy that divides companies in the sector. This model tends to favor large, more capitalized groups.

The group most in favor of the rules created in the Bolsonaro government is Anup (National Association of Private Universities), an entity chaired by Beth Guedes, sister of former Minister of Economy Paulo Guedes.

At Anup, she represents a faculty that is part of Afya, a giant in the medical courses sector that was idealized by the former minister before he took office in the Bolsonaro government.

Beth Guedes and Anup were contacted by the report, but there was no response.

It was the association that took to the STF (Federal Supreme Court) an action that seeks to maintain the More Doctors calling model. Another court action, proposed by the Council of University Rectors, goes the opposite way and questions this prediction.

The judicialization on the subject, in which institutions managed to proceed with their processes in court, is also identified as a problem in the Anup action.

From Mais Médicos, in 2013, until the lock in 2018, 13 thousand vacancies were created. In the following four years, the period of the Bolsonaro government with the measure inherited from Temer, the number of vacancies increased by 8,522 (mostly in private institutions) —most of them created after the judicialization of the subject.

The market sees medicine as the biggest profit bet. It is estimated that a course with 100 places is worth around R$ 200 million.

This occurs both because of the high monthly fees for the courses (the average is R$ 8,462.61) —in contrast to a market that expands in distance education, with low average tickets—, and because of the widespread success in occupying vacancies.

Medicine has the best vacancy occupancy rate in the country, with a rate of 96.6% in 2021, according to official data. Evasion is the lowest, 4% in the years 2017 and 2018, against 19% in engineering, 18% in law and 16% in nursing.

Henrique Sartori, former secretary for higher education regulation in the Temer government, says the government was right to revoke the ordinance. “Every government has the prerogative of that. Now, it will have the opportunity to better understand what was talked about and which path it will want to guide”, he says, who is in favor of the coexistence of models, with the government’s promotion of certain regions and openness of the regular MEC system.

This is the position of Abmes (Brazilian Association of Higher Education Supporters). “We defend that the MEC be free to authorize new courses, both by calling and by protocol”, says Celso Niskier, president of the entity.

“Now, after the pandemic, there is already a shortage of doctors in large centers, and why not allow quality projects to enter?”, he asks.

While the discussion is not concluded, the regional difference in the number of physicians in the country remains. The average of professionals per thousand inhabitants in Brazil is 2.4, close to some rich countries. But the rate does not take into account regional inequalities.

There are 502,475 doctors working in Brazil, according to a study by CFM (Conselho Federal de Medicina) with USP (University of São Paulo). But the presence of professionals per thousand inhabitants ranges from 3.7 in Rio de Janeiro to 0.8 in Maranhão, according to a 2020 study by the National Council of Education.

The numbers still hide the concentration of professionals in the capitals, emphasizes the entity.