Brazil has a low percentage rate of physicians per inhabitant, and to try to solve this issue, a program was created to bring foreign doctors to work in the country. This article will explain the aims of “Mais Médicos” project, established in 2013.
A polemic topic has been brought up in newspapers and other news media: the project “Mais Médicos”, or more doctors, a federal plan for taking Brazilian and foreign doctors to the most needy regions of the country in order to fulfill the demand for medical assistance. It is a measure adopted by the Brazilian government in an attempt to improve the national health system.
Brazil has over 359600 physicians, which represents 1.8 physicians per inhabitant, less than what Argentina (3.2), Uruguay (3,7), Portugal (3.9), and Spain (4) have. The Brazilian government considers that 3.2 physicians per inhabitant is an ideal number of doctors, based on the efficiency of United Kingdom's public health system.
There is an unequal distribution of doctors throughout the regions, and 22 states have less doctors than the national average; only Espírito Santo, the Federal District, Rio Grande do Sul, São Paulo, and Rio de Janeiro have more than 1.8 doctors per citizen.
The project aims to create 10000 job positions, most of them in Unidades Básicas de Saúde, which are the basic units of health, for physicians in regions that lack or don't have enough medical care, such as the inland municipalities in the suburbs and in the North and Northeast regions. The government provides financial aid in terms of housing and nourishment, which are granted by the municipalities.
This is only one of the measures taken by the project, which also plans to invest over BRL 15 billion in hospitals and health units infrastructure until 2014, both in the works and in equipment. Also, there will be a change in the Medical education in the country. From 2015 on, students who get into college will have to perform Medicine for two years, besides and after the 6-year regular Medicine course, in basic units and on the SUS emergency. Called the “2nd cycle of Medicine”, it will be a training-in-service which will allow students to work directly with the population.
The positions for doctors were first made available for Brazilians, but since there was no fulfillment of applications, there was the possibility for Brazilian doctors who graduated abroad to apply, and then foreigners. When applying, doctors needed to indicate the municipalities where they would like to work. By the end of the application process, over 15000 doctors were registered in the system and approximately 3500 cities had shown interest to participate in the project.
The Brazilian government would then accept or reject the candidates, and the ones accepted would be submitted to a three-week training course which involved subjects like basic attendance to patients, the SUS functioning system, and Portuguese classes.
Only professionals who had knowledge in Portuguese, who came from countries with over 1.8 physicians per inhabitant, and who studied in accredited universities could apply to the program. The doctors accepted will have a temporary register, only valid for the municipalities to where they were appointed.
Doctors will work 40 hours a week, for three years, having the possibility to renew the period and work for a total of 6 years. They will earn BRL 10000 monthly, plus a financial aid whose value depends on the region where they are working. They will be paid the INSS too, but the 13th salary, FGTS and extra hours are not included in the agreement, since there is no CLT and no employer-employee bonds.
Physicians from Cuba will have a different treatment compared to doctors of other nationalities. Unlike other countries' doctors, who could apply individually for the project, Cubans were “sold” as a package from Opas or Organização Pan-Americana de Saúde, the Pan American Health Organization, straight to the Brazilian Ministry of Health.
For these employees, the BRL 10000 equivalent to the salary won't be deposited in their account, but sent to the Cuban government, which will then pass between 40% and 50% of the amount to the doctors. Cuba has already sent abroad over 130000 health professionals to 108 countries, including Brazil. This is one of the country's largest sources of funds, yielding USD 5 billion per year.
Due to the difference of salary between Cubans and other nationalities' physicians, the chief of Coordenadoria Nacional de Combate às Fraudes nas Relações de Trabalho, which is the national coordination of combat to labor frauds, said that the Public Ministry of Labor, MPT, would have to interfere in the project, claiming that the employee recruitment made by the Cuban government was irregular. The regime has also received criticisms from some Brazilian doctors, who said that the work system is comparable to slavery.
Pros and Cons
The medical community considers the “importation” of doctors to be a risky measure, since no strict criteria were established to choose them, and they won't need to revalidate their degrees once in Brazil. They also claim that the arrival of foreign professionals doesn't necessarily mean that the attendance to the health of the population will be improved since the main issue is the lack of infrastructure, and that even if it solves anything, it will be temporary.
The Federação Nacional de Médicos, national physicians federation, also stated its concern arguing that the foreign doctors might not be used to the most common and serious diseases in Brazil, which could represent an obstacle to identify and treat the illnesses.
In its turn, the Brazilian government defends that this is a stopgap measure taken in an emergency to fulfill the demands in health public system. According to it, bringing doctors from abroad is a way of regulating the health system, at least for a while, since it takes many years for new physicians to graduate.
Also, the government explained that foreign doctors hired by the program “Mais Médicos” are authorized only to work in the regions where they were designated to, and that they don't need a degree revalidation because they are not working in all national territory, but only in a specific region.