By visitor contributors Carmino Antonio De Souza, Clarissa Vasconcellos De Souza, Giuliano Dimarzio, Adail de Almeida Rollo, Aguinaldo Gonçalves, Rubens Bedrikow, and Lair Zambon
Major Well being Care (PHC) is usually the primary stage of the well being system and is chargeable for the coordination of medical and interdisciplinary care1,2. As the popular entry level to the Brazilian Unified Well being System (SUS), PHC is of basic significance and is current in all areas of the nation. It goals to allow entry to well being care and ensures the coordination and completeness of care. This construction can deal with roughly 80% of the general want associated to illnesses introduced within the Primary Well being Items3.
Regardless of its significance, the valorization of PHC and Household Medication (FM) as a self-discipline and a public coverage has not been prioritized in most Brazilian academic establishments. In keeping with the examine on medical demography carried out by the Regional Medical Council of São Paulo (CREMESP), Brazil had 500,000 physicians in 2020, however with unequal distribution among the many nation’s 5 areas, and a focus of pros within the capital cities in comparison with the countryside4.
Though the Household Well being Technique (EFS) is taken into account a precedence by the Ministry of Well being5, many areas of Brazil face difficulties in recruiting and, particularly, retaining medical professionals for the sphere. In 2020, Brazil had 7,149 FM physicians, solely 2,4% of all specialists within the nation3. Ongoing efforts to rent and retain physicians in rural areas stays difficult, and lots of vacancies stay, leaving residents with out entry to high quality care.
This problem is confronted by many nations. In america (US) of 8,116 major care postgraduate coaching positions (which incorporates pediatrics, inner drugs, and household docs), 42 % have been stuffed by graduates of U.S. medical colleges and the American Affiliation of Medical Schools (AAMC) tasks a scarcity of 21,100 to 55,200 major care physicians (PCP) by 2034. In Europe, the place PCP was historically revered and acknowledged, the dearth of Basic Practitioners (GP) can also be rising2 and is a matter of concern. Workload and a scarcity of perceived status related to the PCP observe could make major care much less enticing5. These kinds of misconceptions, together with decrease salaries, burnout, and tough profession development makes major care a tough specialty to draw and retain docs.
For Feuerwerker6, vacancies in Brazilian establishments are the results of a number of parts: the encouragement of distinctive specialties and establishments, the historic misunderstanding and significance of the apply, and the elevated incentive of specialization in medical training. The shortage of investments in provides and infrastructure in major care, profession growth issues, and low salaries, and the valorization of the formation of FM docs within the work of the EFS additionally contribute to problem in retaining these positions in Brazil.
With the intention to scale back the emptiness charge within the medical residency applications for FM, some Brazilian well being departments launched reforms and extra financing for FM coaching. In 2020, the area of Campinas, the place we work, launched a program known as “Extra Docs for the Metropolis of Campinas” (PMMC), which established a partnership between private and non-private larger training establishments, hospitals, and Urgency/Emergency Items with a novel post-graduation proposal for FM. It created a program to help the coaching of specialists in household drugs, stimulate analysis, and develop care in Primary Well being Items, and has since resulted in a 50% lower in vacancies.
One of many profitable parts of the Campinas program, along with high quality of medical coaching, is that it helps deliver medical classroom coaching nearer to the neighborhood and on a regular basis social actuality. PMMC-trained physicians are conscious of their how their work impacts the area people and its specific well being wants. This system has resulted in care that’s extra aware of neighborhood wants, particularly from the angle of adopting a care mannequin that prioritizes well being promotion, illness prevention, analysis, and remedy in an built-in method8. Nevertheless, for the EFS to proceed to innovate and enhance its response capability to modern well being issues, it should make investments closely in skilled coaching, the rational incorporation of knowledge and communication applied sciences, and the creation of applicable working situations for multidisciplinary groups9.
1. Lavras C. Major well being care and the group of regional well being care networks in Brazil. Saúde Soc. [Internet]. 2011Jan.1 [cited 2021Dec.6] 2011;20(4):867-74. Accessible from: http://doi.org/:10.1590/S0104- 12902011000400005.
2. Garatini L, Martini MB, Mannucci PM. Enhancing major care in Europe past COVID-19: from telemedicine to organizational reforms. Inter Emerg Med. 2021; 16:225-58. Accessible from: http://doi.org/:10.1007/s11739-020-02559-x
3. Santos WD, Comes Y, Pereira LL, Costa AM, Merchan-Hamann E, Santos LMP. Analysis of the Extra Docs Program: an expertise report. Saúde Debate. 2019;43(120):256-268; Accessible from: http://doi.org/:10.1590/0103-1104201912019
4. Scheffer M. et al. Demografia Médica no Brasil 2020. FMUSP, CFM. [Internet]. 2020Dec9. 2020. [cited Dec202.9]. ISBN: 978-65-00-12370-8. Accessible from: https://www.fm.usp.br/fmusp/conteudo/DemografiaMedica2020_9DEZ.pdf
5. Schimpff SC. Why major care is in disaster and find out how to repair it. Medical Economics. [Internet]. 2020Feb.7 [cited Apr2022.9]. Accessible from: https://www.medicaleconomics.com/view/why-primary-care-crisisand-how-fix-it
6. Feuerwerker LCM. A especialização de médicos e as residências médicas no Brasil. Saúde Debate. 2001;25(57):39-54. Accessible from: https://pesquisa.bvsalud.org/portal/useful resource/pt/his-8919
7. Tasca R, Massuda A, Carvalho WM, Buchweitz C, Harzheim E. Suggestions to strengthen major well being care in Brazil. Rev Panam Salud Pública. [Interntet]. 2020Jan6 [cited 2021Dec.6]. 2020;44: e4. Accessible from:
8. Câmara dos Deputados. MEC afirma que um terço das vagas de Residência médica estão ociosas. Câmara dos Deputados. [Internet]. 2019Aug.20 [cited 2022Jan.6]. Accessible from: https://www.camara.leg.br/noticias/573483-mec-afirma-que-um-terco-das-vagas-de-residencia-medica-estao-ociosas
9. Gonçalves, MS. The assessment of inner points, exterior atmosphere, and growth of eventualities as a base to outline methods. Santa Maria, RS: Universidade Federal de Santa Maria (UFSM); 2011. Accessible from: https://repositorio.ufsm.br/deal with/1/8218
In regards to the authors:
Carmino Antonio De Souza is a Professor and Head-Chief of the Division of Oncology-Hematology on the College of Campinas – Brazil. He was additionally Municipal and State Secretary of Well being with an unlimited expertise in Public Administration.
Clarissa Vasconcellos De Souza is an MD Specialist in Household Medication on the College of Medication São Leopoldo Mandic with a Masters and Doctorate diploma in Inside Medication from the College of Campinas.
Giuliano Dimarzio is a Professor on the College of Medication São Leopoldo Mandic and Coordinator of the Household Medication Residency Program, with a Masters in Epidemiology and a Doctorate diploma in Medical Schooling from the College of Campinas.
Adail Rollo is a Professor within the Division of Preventive Medication on the College of Campinas, and a Specialist in Public Well being with huge expertise in Well being and Public Administration.
Aguinaldo Gonçalves has a post-Doctorate diploma in Public Well being from the College of São Paulo, with in depth expertise within the subject. He’s presently a Professor on the Pontifical Catholic College of Campinas.
Rubens Bedrikow is a Professor on the Division of Preventive Medication and Coordinator of the Household Medication self-discipline on the College of Campinas with a Masters and Doctorate diploma in Public Well being from the identical college.
Lair Zambon is a Professor and Head-Chief of the Division of Oncology Pulmonology on the College of Campinas. He’s the present Secretary of Well being for town of Campinas.