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Making family medicine a more attractive specialty: strategies to address the shortage of primary care specialists in Brazil
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Primary Health Care (PHC) is often the first level of the health system and is responsible for the coordination of medical and interdisciplinary care. As the preferred entry point to the Brazilian Unified Health System (SUS), PHC is of fundamental importance and is present in all regions of the country. It aims to enable access to health care and ensures the coordination and completeness of care. This structure can treat approximately 80% of the overall need related to diseases presented in the Basic Health Units.
Despite its importance, the valorization of PHC and Family Medicine (FM) as a discipline and a public policy has not been prioritized in most Brazilian educational institutions. According to the study on medical demography carried out by the Regional Medical Council of São Paulo (CREMESP), Brazil had 500,000 physicians in 2020, but with unequal distribution among the nation’s five regions, and a concentration of professionals in the capital cities compared to the countryside.
Although the Family Health Strategy (EFS) is considered a priority by the Ministry of Health, many regions of Brazil face difficulties in recruiting and, especially, retaining medical professionals for the field. In 2020, Brazil had 7,149 FM physicians, only 2,4% of all specialists in the country. Ongoing efforts to hire and retain physicians in rural areas remains challenging, and many vacancies remain, leaving residents without access to quality care.
This issue is faced by many countries. In the United States (US) of 8,116 primary care postgraduate training positions (which includes pediatrics, internal medicine, and family doctors), 42 percent were filled by graduates of U.S. medical schools and the American Association of Medical Colleges (AAMC) projects a shortage of 21,100 to 55,200 primary care physicians (PCP) by 2034. In Europe, where PCP was traditionally respected and recognized, the lack of General Practitioners (GP) is also increasing and is a matter of concern. Workload and a lack of perceived prestige associated with the PCP track can make primary care less attractive. These sorts of misconceptions, along with lower salaries, burnout, and difficult career advancement makes primary care a difficult specialty to attract and retain doctors.
For Feuerwerker, vacancies in Brazilian institutions are the result of several elements: the encouragement of distinctive specialties and institutions, the historical misunderstanding and importance of the practice, and the increased incentive of specialization in medical education. The lack of investments in supplies and infrastructure in primary care, career development concerns, and low salaries, and the valorization of the formation of FM doctors in the work of the EFS also contribute to difficulty in retaining these positions in Brazil.
With the aim to reduce the vacancy rate in the medical residency programs for FM, some Brazilian health departments introduced reforms and additional financing for FM training. In 2020, the region of Campinas, where we work, introduced a program called “More Doctors for the City of Campinas” (PMMC), which established a partnership between public and private higher education institutions, hospitals, and Urgency/Emergency Units with a novel post-graduation proposal for FM. It created a program to support the training of specialists in family medicine, stimulate research, and expand care in Basic Health Units, and has since resulted in a 50% decrease in vacancies.
One of the successful elements of the Campinas program, together with quality of medical training, is that it helps bring medical classroom training closer to the community and everyday social reality. PMMC-trained physicians are aware of how their work impacts the local community and its particular health needs. The program has resulted in care that is more responsive to community needs, especially from the perspective of adopting a care model that prioritizes health promotion, disease prevention, diagnosis, and treatment in an integrated manner. However, for the EFS to continue to innovate and improve its response capacity to contemporary health problems, it must invest heavily in professional training, the rational incorporation of information and communication technologies, and the creation of appropriate working conditions for multidisciplinary teams.
Disponível no link: https://speakingofmedicine.plos.org/2023/01/13/. Acesso em: 4 mar. 2024.
QUESTÃO
According to the text, Primary Health Care (PHC)
has been in first order of importance by the Government.
has an equal distribution in the country’s regions.
is very important and also the entry way to SUS.
had a number of half a million doctors in 2020.
is disciplined by Medical Councils in Brazil..
🔐 Gabarito (clique para revelar)
🧭 Leitura orientada
A questão pede a alternativa correta de acordo com o texto sobre a Primary Health Care (PHC). A resposta deve ser extraída diretamente das informações apresentadas no segundo parágrafo.
O texto afirma que a PHC é o primeiro nível do sistema de saúde e funciona como porta de entrada preferencial para o Sistema Único de Saúde (SUS), além de ser considerada fundamental.
🔍 Análise alternativa por alternativa (com pegadinhas)
(A) ❌ Errada
Pegadinha: interpretação exagerada.
Embora a PHC seja considerada prioridade,
o texto afirma que sua
valorização não tem sido priorizada
pelas instituições educacionais,
o que contradiz a alternativa.
(B) ❌ Errada
Pegadinha: leitura contrária ao texto.
O texto destaca que há
desigualdade na distribuição
de profissionais entre as regiões do país,
e não uma distribuição igual.
(C) ✅ Correta — GABARITO
Pegadinha: nenhuma — informação literal.
O texto afirma explicitamente que a PHC
é de
fundamental importância
e atua como
porta de entrada preferencial
para o SUS,
correspondendo exatamente
ao que a alternativa apresenta.
(D) ❌ Errada
Pegadinha: dado fora de contexto.
O número de
500.000 médicos
refere-se ao total de médicos no Brasil,
e não exclusivamente à PHC.
(E) ❌ Errada
Pegadinha: informação inexistente.
O texto não afirma que a PHC
é disciplinada pelos
Conselhos Médicos,
mas sim integrada ao SUS
como política pública.
🧠 Resumo B3GE™ Master
✔ PHC é o primeiro nível do sistema de saúde.
✔ Atua como porta de entrada do SUS.
✔ É considerada de fundamental importância.
✔ Atenção para não confundir dados gerais com específicos.
🔎 Gabarito confirmado: (C)