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Brazil has more doctors than ever, but still not enough

. Dec 14, 2020
doctors brazil Brazil never had as many doctors as it does today. Photo: Photocarioca/Shutterstock

Amid one of the largest health crises in the country’s history, Brazil has never had so many doctors. In the space of a decade, the number of trained doctors has doubled, going from 230,110 in 2010 to 502,574 in 2020. But it is still not enough to treat the entire population during pandemic times.

In some states, there are doctors to spare; in others, they are harder to come by. As with many aspects of Brazilian society, the distribution of medical professionals is unequal and runs on lines of class and wealth.

In the richer Southeast, several cities have a highly <a href="https://brazilian.report/power/2020/07/01/exclusive-health-spending-in-brazil-states-as-small-as-usd-20-cents-a-day/#:~:text=bool(false)-,Exclusive%3A%20Health%20spending%20in%20Brazil%20states%20as%20small,USD%2020%20cents%20a%20day&amp;text=An%20exclusive%20study%20by%20The,capita%20between%202017%20and%202019.">advantageous rate of doctors per capita</a>, while the rate in the poor North and Northeast is drastically lower.</p> <p>On a national level, Brazil has an average of 2.4 doctors for every 1,000 inhabitants. In the North region, however, this drops to 1.3 per 1,000 people, and 1.69 in the Northeast. All 16 states in the two regions fall below the national average — in Pará, for instance, there are only 1.07 doctors for every 1,000 inhabitants.</p> <p>The data comes from the Medical Demography in Brazil 2020 study, a partnership between the Federal Board of Medicine and the <a href="https://www5.usp.br/">University of São Paulo</a> (USP), released this Tuesday. The research indicates that the vast majority of Brazil&#8217;s doctors remain concentrated in the country&#8217;s South and Southeast regions, where the per capita average is often much higher than the rate of OECD countries.</p> <p>In the southern city of Florianópolis, for instance, there are 10.68 doctors for every 1,000 people. This rate rises to 13.71 in Vitória, the capital of Espírito Santo state.</p> <h2>Boom in medical schools</h2> <p>USP professor Mário Scheffer, the author of the study, highlights that Brazil has gained ground on the international rankings, surpassing Mexico, Japan, South Korea, and Colombia in terms of doctors per 1,000 inhabitants. However, he admits that Brazil is far from reaching the average levels of OECD countries.</p> <p>Mr. Scheffer says that the increase in doctors in Brazil is a result of the expansion of medical training, with a significant increase in university courses in recent years. &#8220;From 2011 to today, over 20,000 new university places were opened for medicine courses,&#8221; he said.</p> <p>The study also underlines the poor nationwide distribution of medical workers. &#8220;Around 76 percent of the Brazilian population lives outside of state capitals, and only 45 percent of doctors work in these areas,&#8221; Mr. Scheffer points out.</p> <p>One of the major factors in Brazil&#8217;s &#8220;doctor shortage&#8221; concerns the quantity of these professionals that work in the <a href="https://brazilian.report/power/2018/07/11/brazil-public-healthcare-system/">public health service</a>. Only 22 percent work exclusively in the <a href="https://brazilian.report/business/2019/03/17/brazil-healthcare-system-pension-system/">public sector</a>, while 28 percent are private-only, and the remaining 50 percent are both public and private.</p> <p>&#8220;How can a country with half a million doctors have a shortage of professionals? As well as regional inequality, there is [inequality] within the health system itself. If we consider that the private health sector treats just 25 percent of the population, these doctors are disproportionately concentrated in these private health structures,&#8221; noted Mr. Scheffer.</p> <h2>A need for public policy</h2> <p>The president of Brazil&#8217;s Federal Board of Medicine, Mauro Ribeiro, said that in order to change this outlook and ensure an improved distribution of doctors around the country, the government must create public policies that attract medical professionals to previously overlooked areas. Meanwhile, he also argues that the increase of spots in medicine courses does not necessarily mean care is being improved.</p> <p>“The policy of increasing medicine courses, claiming it would increase the population&#8217;s access to health, was a fallacy. Today we have 343 medical schools, but no infrastructure that can deal with this. In 40 years, when we have 1.5 million doctors, 60 to 65 percent of them will not have completed medical residencies. There are cities which offer medicine courses, but don&#8217;t even have hospitals,&#8221; warned Mr. Ribeiro.</p> <p>In order to ensure quality health care, Mr. Ribeiro stresses that multidisciplinary teams of professionals are required in Brazil&#8217;s municipalities, not just doctors. &#8220;It is no use leaving the best doctor in the country alone in a city. [He/she] needs nurses, nursing technicians, medicine.&#8221;</p> <h2>Most doctors are men, for now</h2> <p>The study also analyzed the demographic profile of Brazil&#8217;s doctors. Men still make up the majority of professionals, but this imbalance appears to be shifting. Five years ago, 42.5 percent of the country&#8217;s doctors were women; now, they make up 46.6 percent of the total. Furthermore, when looking at doctors under 30 years of age, 58.5 percent are women, suggesting that the gender balance in medical professions will be flipped in the coming decades.

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Renato Alves

Renato Alves is a Brazilian journalist who has worked for Correio Braziliense and Crusoé.

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