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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
The Campinas program
Thelps to attract physicians.
is established on rural areas.
invests on distinctive specialties.
is a public-private collaboration.
trains multidisciplinary teams.
🔐 Gabarito (clique para revelar)
🧭 Leitura orientada
A questão solicita identificar a alternativa correta sobre o programa de Campinas, com base nas informações apresentadas no texto. É necessário observar a natureza institucional do programa e como ele foi estruturado.
O texto descreve o programa “More Doctors for the City of Campinas” (PMMC) como uma iniciativa que envolve diferentes tipos de instituições trabalhando de forma integrada.
🔍 Análise alternativa por alternativa (com pegadinhas)
(A) ❌ Errada
Pegadinha: efeito confundido com definição.
Embora o programa tenha contribuído para
reduzir vagas ociosas,
o texto não o define
primordialmente como uma estratégia
de atração genérica de médicos,
mas sim como um modelo institucional específico.
(B) ❌ Errada
Pegadinha: localização incorreta.
O programa é descrito como
atuante na
região de Campinas,
não sendo caracterizado
como um projeto
exclusivamente rural.
(C) ❌ Errada
Pegadinha: inversão de foco.
O texto afirma que o programa
busca fortalecer a
Medicina de Família,
e não investir em
especialidades distintivas,
que são apontadas como parte do problema.
(D) ✅ Correta — GABARITO
Pegadinha: nenhuma — informação explícita.
O texto afirma que o programa
estabeleceu uma
parceria entre instituições públicas e privadas,
incluindo
universidades, hospitais
e unidades de urgência/emergência,
caracterizando claramente uma
colaboração público-privada.
(E) ❌ Errada
Pegadinha: extrapolação do texto.
Embora o texto mencione
equipes multidisciplinares
como necessidade futura,
ele não afirma que o programa
tenha como foco principal
o treinamento dessas equipes.
🧠 Resumo B3GE™ Master
✔ O PMMC envolve instituições públicas e privadas.
✔ Parceria entre universidades, hospitais e serviços de saúde.
✔ Foco na formação em Medicina de Família.
✔ Alternativa correta descreve a estrutura do programa.
🔎 Gabarito confirmado: (D)