According to the study Medical Demography in Brazil 2023, created through a partnership between the Brazilian Medical Association and the USP School of Medicine, in 2022 Brazil registered 389 medical schools, offering 41,805 undergraduate places. It should also be noted that more than 50% of these vacancies opened in 2013, evidencing accelerated growth in the last ten years.
In addition, the study highlights that one of the most striking features of this expansion was the opening of vacancies in the private sector: from 2003 to 2022, new medical degree vacancies in public institutions increased by 64%, while in the private sector there was an increase of 358%. In the Southeast, for example, the region with the highest concentration of medical degree vacancies in the country, only 16.6% are from public schools.
Despite this, a 2021 study by CFM (Federal Council of Medicine) indicates that only 20% of the schools are located in municipalities that meet the ideal criteria, which, according to Ordinances No. 2/2013 and 13/2013 of the Ministry of Education, correspond to: the existence of a hospital with a minimum of 100 beds available for the course; a teaching hospital; five or more public beds per student; and a maximum number of three students per health team.
Also, when the schools created between 2011 and 2021 are evaluated, this percentage drops to 10%. This is because these prerequisites have been relaxed, making it possible to increase the opening of new courses. The CFM indicated, for example, in 2021, the existence of 116 teaching hospitals distributed irregularly across Brazil. More than half of the colleges are in municipalities that do not have these hospitals.
The distribution of doctors across Brazil
A reflection of the increase in the number of vacancies is the increase in the number of doctors in Brazil. The study Medical Demography in Brazil 2023 indicated that more than 250,000 new doctors entered the Brazilian labor market between 2010 and 2023. In 2000, Brazil registered 239,110 doctors. That number more than doubled by 2023, accounting for a total of 562,229 doctors in January. This corresponds to a national index of 2.6 doctors per 1,000 inhabitants.
However, this national index corresponds to an average, which differs in each region. In the North there is a record of 1.45 doctors per 1,000 inhabitants, while in the Northeast this index is 1.93. In the Southeast, Midwest, and South regions, the rates are 3.39, 3.10, and 2.95 doctors per 1,000 inhabitants, respectively.
From the point of view of the Brazilian states, those with the highest densities are the Federal District (5.53), Rio de Janeiro (3.77) and São Paulo (3.50), while the lowest are in Pará (1.18), Maranhão (1.22) and Amazonas (1.36). It is also worth noting the concentration of doctors in Brazilian capitals, with a correspondence of 6.13 professionals per 1,000 inhabitants.
Context of medical specialization in Brazil
In relation to scenery of the specializations, according to the study carried out in partnership between the Brazilian Medical Association and the USP School of Medicine, the number of medical records with degrees in a specialty increased 84% in the last ten years. In 2022, Brazil reported that 62.5% of practicing doctors were specialists. According to the study, this data represents the expansion of medical residency in Brazil.
In addition, the study indicates that the gap between the number of graduates and medical residency vacancies increased, as this gap went from 3,866 vacancies to 11,770 from 2018 to 2021. Given the growth in the number of medical courses in Brazil, this gap is expected to increase even more if the rate of expansion of medical residency vacancies does not keep up with this movement.
However, the issue of uneven distribution across Brazil should be highlighted. Around 46% of medical residency institutions are in the Southeast region. Still, 33.3% of residents are concentrated in São Paulo. This percentage is followed by Minas Gerais with 11.1%, Rio de Janeiro with 10% and Rio Grande do Sul with 7.1%.
It should be noted that the specialties with the highest number of doctors, representing 55.6% of the total number of registered specialists, are: Clinical Medicine (56,979), Pediatrics (48,654), General Surgery (41,547), Gynecology and Obstetrics (37,327), Anesthesiology (29,358) and Orthopedics and Traumatology (20,972), Occupational Medicine (20,804) and Cardiology (20,324). Another relevant fact is that, out of the total of the 55 specialties that exist in Brazil, only 13 represent 70% of the records of medical specialists.
In addition, with regard to the Surgical Workforce, which includes obstetricians, anesthesiologists, and surgeons, the study highlights that Brazil has an index of 66 specialists per 100,000 inhabitants, which represents a ratio greater than triple the ideal recommended by the Lancet Commission On Global Surgery. However, the uneven distribution across Brazil is also reflected in this density. For example, while the Federal District has 151.5 specialists per 100,000 inhabitants, in Maranhão this index drops to 26.7.
Curriculum reform, high level of updating and artificial intelligence
Brazilian medical education faces some of the most common challenges mentioned above - such as the lack of structure in conjunction with the expansion of undergraduate programs, the gap in residency vacancies, and the uneven distribution of doctors and specialists across Brazil - but it also encompasses other discussions, such as curriculum reform, the high level of updating, and the emergence of new technologies such as ChatGPT.
In the context of the advancement of medical education, the discussion about changes in the teaching model and in the training of health professionals grew. Thus, the institution of the More Doctors program in 2013 also planned to update the curricula of medical courses, as guided by National Curricular Guidelines for the Undergraduate Medical Course. The program predicted that institutions would join the reform between 2014 and 2018, but the changes imply an increase in costs with more teachers and environments, a difficult process that has not yet been implemented by all universities.
In addition, regarding the high level of updating of the medical professional, a paper Doctor Peter Densen estimated some relevant data. According to the doctor, knowledge doubled every 50 years in 1950. In 1980, this occurred every 7 years. In 2010, every 3 and a half years. Finally, he estimated that in 2020 this would occur every 0.2 years - that is, in 73 days. In this sense, it is understood that knowledge is expanding faster than the capacity for assimilation and application, whether in education, patient care, or research.
Finally, the repercussions surrounding generative artificial intelligence technologies, such as ChatGPT and Med-Palm2 — Google's language model developed for doctors -, cannot be ignored. It is questioned how these tools may influence medical education and this challenge of constantly updating medical knowledge. There is still no definitive answer, but one survey A 2021 survey conducted at 18 Canadian universities indicated that 78.7% of the interviewees understand that artificial intelligence will impact their careers. Still, all of them believe it is necessary to include disciplines in the curriculum that address the most basic principles of these technologies.
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