The number of medical students in Brazil grew, but the total number of doctors trained in residency to obtain specialist titles did not increase in the same proportion. While the graduation rate reached 1.05 students for every thousand inhabitants, that of medical residents was just 0.21 per thousand, a rate that should reduce the impact of the policy of expanding vacancies for the area, especially in care to the public health system.
The alert comes from the Medical Demography Radar in Brazil, prepared by researchers from USP (University of São Paulo) in partnership with the AMB (Brazilian Medical Association) and updated this month with new data from the National Education Census. According to the authors, in 2022, Brazil had 321,581 specialist doctors, which corresponds to only 62.5% of professionals working in the country, with all the others, 192,634 doctors (37.5%), generalists.
Last year, almost 1 million people (952,865) tried to enroll in national degrees and the country registered a record 245,501 students on the course, an increase of 25.2% compared to the 167,788 students in 2018.
The report points out that, from 2015 to 2023, the supply of medical residency in Brazil more than doubled. Looking at the last five years, however, almost nothing has been done to keep up with the increase in the number of medical graduates.
Between 2018 and 2022, the total number of residents increased by just 8.7%, from 41,274 to 44,857 in the same period. Another problem is that the supply remains concentrated: São Paulo, Minas Gerais, Rio de Janeiro and Rio Grande do Sul together have more than 60% of medical residency vacancies.
Mário Scheffer, professor at the Department of Preventive Medicine at the USP Faculty of Medicine and coordinator of the survey, says that the queues at the SUS (Unified Health System) are directly related to the lack of specialists. “Specialties are essential for the SUS to expand resolute primary care and overcome the problem of access to surgeries, exams and consultations in specialized care, both outpatient and hospital”, he reinforces.
Residency is, according to Scheffer, the main way to obtain a specialist title alongside courses offered by medical societies. Vacancies for residents and career plans in the public system, however, remain unequally distributed across regions, concentrated mainly in capitals and metropolitan areas, with specialists, in the end, mainly absorbed by the private system.
The mapping was based on records from the OECD (Organization for Economic Cooperation and Development), the latest census by the Brazilian Institute of Geography and Statistics (IBGE), the Federal Council of Medicine (CFM) and, this month, the National Institute of Educational Studies and Research Anísio Teixeira (Inep).
In the coming years, the study indicates a country with a supply of younger and female doctors and record density of trained professionals by 2035, when the country should jump from the current 2.7 doctors per thousand inhabitants to rates above 4.4 doctors for every thousand.
Despite a good national average, close to that of countries such as South Korea (2.5/thousand) and the USA (2.6/thousand), medical density in Brazil still varies greatly across the territory, making it possible to find 6 doctors for each thousand inhabitants in the Federal District and only 1 for every thousand in Maranhão.
Doctor Fernanda Nicolela Susanna, a first-year ophthalmology resident at the Hospital das Clínicas de São Paulo (HC/USP), saw more than half of her colleagues continue their careers without specialization. “I think some people didn’t feel ready, but I also have a lot of friends who wanted to pass, who were studying hard and didn’t get the place. Every year it’s more competitive,” she ponders.
To guarantee the residency she was looking for, the doctor began studying in her sixth year of graduation, with a group and study plan, as well as extra classes at a course. “I was very happy with the results, but it was a difficult year, which required a lot of dedication,” she says.
According to the mapping, women are already the majority among recent medical graduates and, in 2024, for the first time, they should also be the majority in the profession. “Women will make up more than 50% of doctors, with the prospect of reaching 56% or 57% in the next decade”, points out Scheffer.
The professor reinforces that the feminization of the career is an important milestone in medical demography and that this, as in other areas, is accompanied by challenges to contain gender inequalities.
“They are a minority in 36 of the 55 specialties. They are a majority in just 19. So, if we are talking about a future with a greater presence of women in the profession, and if we are defending the need to expand the supply of specialist training, we must discuss these specialties in which women are underrepresented”, he assesses.
The professor, who also participated in income studies based on surveys of doctors and data from the Federal Revenue Service, also states that there is significant inequality in remuneration between doctors. The survey showed that the average income declared by male doctors in 2020 was R$36,421 compared to R$23,205 for female doctors (i.e., 63.7% of men’s income in the same profession). “Men declare higher income in all age groups, while women have less flexible variations. Until the age of 30, women declare, on average, 82.7% of men’s income, a difference that widens for intermediate age groups, decreasing again at older ages”, says Scheffer.
The professor emphasizes that the marked difference in favor of men may be due to other income from property sources declared in the IR, but that inequality according to gender is verified in other studies and sources. “In the Continuous National Household Sample Survey (Pnad), from IBGE, and in the National Survey with Doctors, from the Medical Demography study, the income of female doctors is also proportionally lower”, recalls Scheffer.