Competition with private network removes SUS resident doctor – 04/23/2023 – Health

Remaining working exclusively in the SUS (Sistema Único de Saúde) after the medical residency period is not the goal of most health professionals. Salary competitiveness with the private market and the working conditions found in the public sector are the main factors that keep resident physicians away from the SUS.

The data are contained in Medical Demography 2023, a study conducted by the Department of Preventive Medicine of the Faculty of Medicine of the University of São Paulo (FMUSP).

“Less than a quarter of physicians [do país] work exclusively at SUS, regardless of whether they are specialists or not, or whether they have completed medical residency. If you think that about 8% to 10% are resident physicians, we have a very small percentage”, says Mário Scheffer, professor at FMUSP, coordinator of the study.

According to the survey, 24.6% of the interviewed resident physicians, after a period of one year of residency, claim to work mostly or full time in the SUS. Five years later, this preference drops to 12.1%.

The study heard 1,614 medical residents aged up to 35 years. The interviews were conducted by telephone, with the application of a questionnaire with 32 questions.

According to Scheffer, medical residency is mostly financed by the Ministries of Health or Education or by state governments. About 17% of the residency is financed by institutions or hospitals with their own resources.

“Specialized training takes place entirely in the SUS, funding is public grants paid by the government. But, after graduating, these doctors enter a job market that will not primarily serve SUS users”, declares Scheffer.

Fernando Brito, 26, finished his residency in anesthesiology at Faculdade de Medicina do ABC, in the metropolitan region of São Paulo. It was completed in February this year. A month later, he joined as a preceptor —he makes the link between theoretical and practical teaching— at the Hospital das Clínicas and specializes in pediatric anesthesia, also at the HC.

“I chose to stay one more year improving myself. Preceptorship is an administrative process in which I can help the anesthesiology residents themselves to have a better experience with problem solving, organization of shifts and classes. So, I preferred it, even trained and able to work in the private market, use this opportunity to improve myself further.”

The doctor understands that, especially in disciplines where there are procedures, such as surgery, or in some of the clinics, the recent graduate often chooses to join the private network in search of higher remuneration and more consistent with the expectation that this person has.

“Salary matters, but that’s not all. If I found the same qualities in SUS that I find in private, for me, there would be no problem staying in SUS. The salary is fair, but obviously it could improve, to match the private,” says Brito.

“But there are also working conditions. Often, the materials, inputs, found in the private network are of better quality. The administration and management teams are more qualified.”

For Adriano Massuda, public health physician and professor at FGV, one of the main points that hinder an attractive career for doctors within the public network is the difference between specialties.

“You have to look at specialty by specialty. Some are very pro-market, while others are pro-public system, such as family medicine, preventive and social medicine, infectology, areas that have a greater field of work in the public system”, says the physician, who was deputy executive secretary at the Ministry of Health (2011 and 2012).

Massuda also points out that the private sector has already shown interest in these predominant areas of the public service. “For example, in family and community medicine, those who sought, in general, were those who were already more suited to work in the SUS. In recent years, the private sector has seen the importance of the work of the family doctor and started to hire professionals of that specialty.”

Medical Demography also points to a major imbalance in the distribution of medical residents across the country. The highest concentration is in the Southeast region, with 56%. Then comes the South (16%), Northeast (17%) and Midwest (8%). The biggest gap is in the North, which has only 4% of residents. The states of Roraima and Amapá, for example, have less than a hundred residents combined.

“The Ministries of Health and Education have to work in a more articulated way to expand the number of residency programs in regions where there is a great need and lack of training”, says Massuda.

“To do a residency program, you have to have a service. This also comes into play as an investment policy in infrastructure, which is not just physical. It has to be part of a development project for the national health system in which hand training qualified workforce is crucial to face the health problems of primary care in specialized care”, says the doctor.

For Renata Vilhena, associate professor in the area of ​​public management at Fundação Dom Cabral and president of República.org, some aspects need to be changed so that careers become more attractive and attract professionals who are more aligned with the public service , reducing evasion.

“Sometimes, so much time is invested in training a professional and he soon leaves. Then it is necessary to take a new contest, there is turnover, and this causes a great loss for the provision of the public service”, says the professor.

“You have to have the courage to look at the whole and create a vision of the future, where you want to go for career improvement, where it is possible now, where it is possible in a few years. What cannot be left that way.”