Making family medicine a more attractive specialty:
strategies to address the shortage of primary care specialists in Brazil
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.
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 em: https://speakingofmedicine.plos.org/2023/01/13/. Acesso em: 4 mar. 2024. [Adaptado].
The Campinas program
