Evaluating medical education regulation changes in Brazil: workforce impact

Abstract

Background Shortages and inequitable distribution of physicians is an obstacle to move towards Universal Health Coverage, especially in low-income and middle-income countries. In Brazil, expansion of medical school enrollment, curricula changes and recruitment programs were established to increase the number of physicians in underserved areas. This study seeks to analyze the impact of these measures in reduce inequities in access to medical education and physicians’ distribution. Methods This is an observational study that analyzes changes in the number of undergraduate medical places and number of physicians per inhabitants in different areas in Brazil between the years 2010 and 2018. Data regarding the number of undergraduate medical places, number and the practice location of physicians were obtained in public databases. Municipalities with less than 20,000 inhabitants were considered underserved areas. Data regarding access to antenatal visits were analyzed as a proxy for impact in access to healthcare. Results From 2010 to 2018, 19,519 new medical undergraduate places were created which represents an increase of 120.2%. The increase in the number of physicians engaged in the workforce throughout the period was 113,702 physicians, 74,771 of these physicians in the Unified Health System. The greatest increase in the physicians per 1000 inhabitants ratio in the municipalities with the smallest population, the lowest Gross Domestic Product per capita and in those located in the states with the lowest concentration of physicians occurred in the 2013–2015 period. Increase in physician supply improved access to antenatal care. Conclusions There was an expansion in the number of undergraduate medical places and medical workforce in all groups of municipalities assessed in Brazil. Medical undergraduate places expansion in the federal public schools was more efficient to reduce regional inequities in access to medical education than private sector expansion. The recruitment component of More Doctors for Brazil Program demonstrated effectiveness to increase the number of physicians in underserved areas. Our results indicate the importance of public policies to face inequities in access to medical education and physician shortages and the necessity of continuous assessment during the period of implementation, especially in the context of political and economic changes.

Políticas de ampliação do acesso ao ensino superior e mudança no perfil de egressos de medicina no Brasil: um estudo transversal

“…Portanto, os resultados deste estudo apontam que há uma sub-representação de pessoas nascidas em municípios de pequeno porte na escola médica, desvelando uma outra dimensão das desigualdades de acesso ao ensino médico. A expansão de vagas de graduação intensificada nos últimos anos possibilitou redução das iniquidades entre as macrorregiões 7,37 , entretanto, por questões de infraestrutura da rede de serviços a maior parte das vagas de graduação em medicina encontram-se em municípios com mais de 50 mil habitantes 37 . Assim, a expansão de vagas de graduação como estratégia isolada para ampliar o acesso à escola médica dos nascidos em municípios de pequeno porte é insuficiente e deve ser associada a outras medidas.…”

“…No âmbito da saúde, as iniquidades são evidenciadas a partir do menor acesso da população de extratos sociais menos favorecidos aos serviços de saúde 6,7 e na menor relação médico por habitante em municípios mais pobres 7 . Estas diferenças de acesso contribuem para maiores taxas de morbidade e mortalidade da população negra [8][9][10][11] e das parcelas mais pobres da população 12 , tal qual se observou na epidemia de CO-VID-19 8,10,13,14 .…”

“…O número de vagas de graduação em medicina no Brasil cresceu exponencialmente nos últimos anos, impulsionado principalmente pela abertura de instituições privadas 7 . Em 2018, havia 35.755 vagas de graduação, sendo 25.173 (74,4%) vagas em escolas privadas 7 .…”

Situational analysis and reflections on the introduction of advanced practice nurses in Brazilian primary healthcare

“…System (SUS), that is oriented toward primary healthcare (PHC), suffers from a shortage, high turnover, and unequal distribution of physicians [2,3], especially in the rural and remote areas of the Northern and Northeastern macroregions. This threatens the population's access to high-quality, definitive care [4,5]. Approximately 20,000 doctors graduate annually in Brazil, and they are mostly incorporated into private healthcare services in large urban centers [5][6][7].…”

“…This threatens the population's access to high-quality, definitive care [4,5]. Approximately 20,000 doctors graduate annually in Brazil, and they are mostly incorporated into private healthcare services in large urban centers [5][6][7]. Meanwhile, there is a growing number of nurses in the labor market (40,000/year), with greater availability to work in the public healthcare sector, whose services could be more efficiently utilized [6,7].…”