Uneven Distribution: Brazil’s Increasing Doctor Count Raises Concerns

The Medical Demography in Brazil 2023 study , carried out by the Faculty of Medicine of USP (FMUSP) in partnership with the Brazilian Medical Association (AMB), highlights the disproportion between the population and number of doctors. Mário Scheffer, professor at the Department of Preventive Medicine at the USP Faculty of Medicine and coordinator of the study, explains that the number of doctors has increased in recent years and that the biggest problem is distribution. 

The study 

The study has been conducted since 2010 and, after the release of the Demographic Census of the Brazilian Institute of Geography and Statistics (IBGE) 2022, it was possible to update the count, distribution and profile of doctors in Brazil. According to the professor, the number of professionals has increased in all regions of the country. “This is a direct consequence of the great opening and expansion of medical courses and places in medical schools, which happened mainly in the last decade. The forecast, according to the study, is that there will be 1 million doctors in just over ten years”, he comments.

For Scheffer, the challenge that accompanies the training of new doctors is the promotion of quality teaching and the distribution of professionals in regions with the greatest demand for care. 

Disproportion of doctors  

The study carried out by FMUSP classifies doctors as generalists – professionals who, at the end of their degree, are inserted into the job market and have not completed a specialization or completed a medical residency program – and specialists – doctors who have pursued a specialization and completed a residency program . 

According to Scheffer, there are 200,000 general practitioners in Brazil, and the number continues to increase. However, there is concern about the training of these doctors: “Often, these professionals study low-quality courses and start to serve precisely where the population needs it most, in primary care, in emergency rooms, on hospital shifts”.

In the case of medical specialists, the study confirmed that there is a large concentration of professionals mainly in capitals and in private services. “There is, therefore, a lack of specialists, especially to serve the public network. This is one of the reasons for the queues at consultations, exams and surgeries in the SUS”, explains Scheffer. Currently, there are more than 350 thousand specialist doctors distributed across more than 55 specialties, which are poorly divided across the country. 

Furthermore, another concern highlighted by the professor is whether there will be enough specialist doctors for the coming years, as demand will be higher. “ The population over 60 years old is only growing in Brazil , and with this there will be an increase in chronic diseases, which are among the main causes of illness and death in Brazil”, he explains. 

Specialization 

Recently, some policies were implemented to try to improve the issue of doctors, such as the National Queue Reduction Program, aimed at surgeries, exams and consultations. However, this program depends on the greater availability of specialists to fully function. 

The study identified that there is a large gap between graduation and specialized training. “Medical residency, which is the main method of training specialists, has not followed the opening of medical schools and undergraduate courses”, points out Scheffer. One of the ways to resolve the issues presented, therefore, is to rescue Brazil’s ability to train more specialists. 

Some specific areas have a greater lag, such as anesthesiologists. Many surgeries are postponed, which increases the waiting list, because there are not enough professionals. Data highlighted by the study showed that the number of anesthetists in Maranhão is five times lower than in Rio de Janeiro. This scenario is also repeated in the rate of surgeons – in Pará, for example, the supply of these professionals is six times lower than in the Federal District. 

The first step to improving the scenario highlighted by the study is to evaluate the quality of medical training at undergraduate level. There was an expansion of new medical courses, which was not accompanied by an adequate assessment model. It is also necessary to think about the specialized training of these professionals, through the promotion of residency vacancies, mainly in strategic specialties for the health system.