Preferências para o trabalho na atenção primária por estudantes de medicina em Minas Gerais, Brasil: evidências de um experimento de preferência declarada

Girardi, Sabado Nicolau; Carvalho, Cristiana Leite; Maas, Lucas Wan Der; Araujo, Jackson Freire; Massote, Alice Werneck; Stralen, Ana Cristina de Sousa van; Souza, Osmar Ambrósio de

doi:10.1590/0102-311x00075316

Cited by 23 publications

(8 citation statements)

References 14 publications

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“…En la mayoría de los países, la concentración de profesionales en áreas urbanas y en los servicios de atención terciaria de salud resultan en una fragilidad en la atención primaria a la salud (APS) y puede estar relacionada con la mala distribución de la fuerza de trabajo y la migración de los recursos humanos en salud (8, 10) que afectan, sobre todo, a las regiones más pobres y remotas (9, 11).…”

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Distribución de la fuerza de trabajo en enfermería en la Región de las Américas

Cassiani

Hoyos

Barreto

et al. 2018

Rev Panam Salud Publica

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RESUMEN Objetivo. Describir la distribución de la fuerza de trabajo de enfermería en países de la Región de las Américas y relacionar el número de recursos humanos en enfermería con las tasas de mortalidad materna. Métodos. Análisis descriptivo y exploratorio de 27 países de la Región. Las variables del estudio fueron la proporción de profesionales por país y subregión, la categoría profesional y la razón de enfermero-médico. Se utilizó la proporción de mortalidad materna, que es un indicador general de salud de la población, para analizar la relación con el cuantitativo de los enfermeros. Se analizaron la distribución de frecuencias y la densidad del recurso humano de enfermería por país y subregión. Resultados. La distribución de enfermería es heterogénea. Existen países con más de 80 enfermeros por 10 000 habitantes y otros con menos de cinco profesionales por 10 000 habitantes. En 34,1% de los países, la relación enfermero-médico es menor a uno. Se observan diferencias en la distribución de personal de enfermería por región, subregión y al interior de país. Conclusiones. En varios países, el número de enfermeros por habitantes es menor a lo esperado. La mayoría de los países muestran un retraso importante en la relación del número de enfermeros licenciados respecto al personal técnico y auxiliar. Es necesario implementar iniciativas para aumentar el número de enfermeros licenciados en toda la Región.

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Distribución de la fuerza de trabajo en enfermería en la Región de las Américas

Cassiani

Hoyos

Barreto

et al. 2018

Rev Panam Salud Publica

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“…The finding that the public/private nature of medical schools does not influence the intention to practice in PHC is somewhat counterintuitive and appears to contradict the expectations of Brazilian [27,28] and international scholars [13]. A possible explanation for this may be found in the overrepresentation of students from affluent backgrounds in public medical schools, and in the demanding admission tests, granting places only to the highest performing students, typically schooled privately [43].…”

Section: Discussionmentioning

confidence: 88%

“…Places are limited in private institutions too, but competition is less intense, as lower thresholds are set for Enem and Vestibular exams scores [26]. Critics have voiced concerns on the ability of these new, private medical schools to produce the PHC doctors that the Brazilian health system needs [27,28].…”

Section: Introductionmentioning

confidence: 99%

The role of private education in the selection of primary care careers in low and middle-income countries. Findings from a representative survey of medical residents in Brazil

et al. 2020

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Background: Primary health care (PHC) doctors' numbers are dwindling in high-as well as low-income countries, which is feared to hamper the achievement of Universal Health Coverage goals. As a large proportion of doctors are privately educated and private medical schools are becoming increasingly common in middle-income settings, there is a debate on whether private education represents a suitable mean to increase the supply of PHC physicians. We analyse the intentions to practice of medical residents in Brazil to understand whether these differ for public and private schools. Methods: Drawing from the literature on the selection of medical specialties, we constructed a model for the determinants of medical students' intentions to practice in PHC, and used secondary data from a nationally representative sample of 4601 medical residents in Brazil to populate it. Multivariate analysis and multilevel cluster models were employed to explore the association between perspective physicians' choice of practice and types of schools attended, socio-economic characteristics, and their values and opinions on the profession.Results: Only 3.7% of residents in our sample declared an intention to practice in PHC, with no significant association with the public or private nature of the medical schools attended. Instead, having attended a state secondary school (p = 0.028), having trained outside Brazil's wealthy South East (p < 0.001), not coming from an affluent family (p = 0.037), and not having a high valuation of career development opportunities (p < 0.001) were predictors of willingness to practice in PHC. A low consideration for quality of life, for opportunities for treating patients, and for the liberal aspects of the profession were also associated with future physicians' intentions to work in primary care (all p < 0.001). Conclusions:In Brazil, training in public or private medical schools does not influence the intention to practice in PHC. But students from affluent backgrounds, with private secondary education, and graduating in the rich South East were found to be overrepresented in both types of training institutions, and this is what appears to negatively impact the selection of PHC careers. With a view to increasing the supply of PHC practitioners in middle-income countries, policies should focus on opening medical schools in rural areas and improving access for students from disadvantaged backgrounds.

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“…The employment scenarios that proved to be the most plausible in terms of public intervention were those that combined intermediate wages, good working conditions and obtaining an additional 10 to 20 points in medical residency examinations. 13 Higher income, satisfaction with training decisions and board certification were also variables associated with a higher retention rate. 14…”

Section: Discussionmentioning

confidence: 97%

Can medical residency keep young specialists in the place where they graduate? Cross-sectional and exploratory study of the first seven years after implementation of medical residency programs in the State of Tocantins, Brazil

et al. 2022

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BACKGROUND: New medical schools and new medical residencies in Brazil, mainly in its interior, were opened under the justification of collaborating towards distribution of these healthcare professionals and specialist doctors across the national territory. However, this proposal did not guarantee that medical practitioners would become established in the place where they graduated and specialized. OBJECTIVE: To calculate, through interviews, how many specialists who graduated in the state of Tocantins stayed there after finishing their medical residency; and to analyze the factors that made them stay or leave the place. DESIGN AND SETTING: Cross-sectional exploratory study conducted at a Brazilian federal public higher education institution. METHODS: All graduates from medical residencies in Tocantins, who graduated between 2013 and 2019, were contacted by telephone and, after obtaining consent, an interview was conducted. The interviews took place between June 2020 and January 2021. RESULTS: The permanence of medical residency graduates in the state increased from 50% in an earlier study to 55.8% in the current study, thus showing a situation of stability. In addition, we detected some reasons for staying or not. In a multivariate analysis, only working in the state capital was related to staying in the state of Tocantins, showing a 5.6 times greater chance. CONCLUSIONS: The percentage of those who remained was just over 50%, even some years after implementation of the first programs. Most specialists remained working for the state health department, with a smaller proportion in municipal health departments, and were concentrated in the state capital.

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Preferências para o trabalho na atenção primária por estudantes de medicina em Minas Gerais, Brasil: evidências de um experimento de preferência declarada

Cited by 23 publications

References 14 publications

Distribución de la fuerza de trabajo en enfermería en la Región de las Américas

Distribución de la fuerza de trabajo en enfermería en la Región de las Américas

The role of private education in the selection of primary care careers in low and middle-income countries. Findings from a representative survey of medical residents in Brazil

Can medical residency keep young specialists in the place where they graduate? Cross-sectional and exploratory study of the first seven years after implementation of medical residency programs in the State of Tocantins, Brazil

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