Medicine courses proliferate waiting for the STF – 04/29/2023 – Health

Higher education institutions are awaiting a decision by Minister Gilmar Mendes, of the STF (Federal Supreme Court), on the future of medical courses in the country. Two opposing actions were presented to the court, and the sentence will define which criteria must be followed in the opening of new graduations.

The lawsuits were filed in June 2022, while the five-year moratorium imposed by the Michel Temer (MDB) government was still in effect as a way to curb the creation of classes. The result, however, was different. Through injunctions, educational institutions opened 75 medical courses during the blockade – five public (three state and two federal) and 70 private, totaling more than 6,000 vacancies.

The official freeze ended earlier this month, and the MEC (Ministry of Education) published a new ordinance. The document indicates the need for “adequate, sufficient and quality public equipment” or the establishment of partnerships with hospitals to make the practical part of the course viable. It also provides for new public calls within three months.

But the faculties understand that the norm will not have practical effect until the matter is evaluated in court.

The first action before the STF was presented by Anup (National Association of Private Universities). The entity asks that the demand for a public call for the opening of new private courses in medicine be declared constitutional.

Days later, the Crub (Council of Rectors of Brazilian Universities), which brings together 130 public, private and community educational institutions, also appealed to the Supreme Court, but to request the suspension of the need for summons. For the organization, authorizations for new medical courses must follow the same procedure as for other graduations.

Despite the antagonistic requests, there is a common point in the positioning of the class entities. They all cite the commodification of medical courses – which since 2010 have almost doubled, going from 208 to 389 – and claim to be concerned about the training of future doctors. Currently, the country graduates approximately 40,300 professionals per year, according to the CFM (Conselho Federal de Medicina).

What does the law say?

The mandatory public call is stipulated in Law 12,871/2013, which established the More Doctors program. According to the norm, it is up to the MEC to indicate which municipalities can receive new courses in medicine and choose among the interested educational institutions.

At the time, the federal government justified that the process would be a way to improve the distribution of professionals in the country, but there are doubts that this was achieved.

According to the CFM, the country has 564,385 physicians, which corresponds to a national rate of 2.65 professionals per thousand inhabitants. In the state of São Paulo, this proportion is higher, at 3.70 and in Rio de Janeiro it reaches 4.07. In Maranhão, the rate is 1.27 and, in Amazonas, 1.44.

Crub also questions the legality of the requirement. According to the entity’s lawyer, Dyogo Patriota, the rule violates university autonomy and free competition and benefits the education giants. “What the MEC did, in fact, was to commercialize the courses, and the large groups knew how to take advantage”, he says.

“The first notice [do Mais Médicos] it was aimed at the richest region with the most doctors in Brazil, with a predominance of cities in the Southeast and South and with many cities in the metropolitan region of large capitals or economic hubs, which is contrary to the objectives of equitable distribution of doctors across the country. The second, although it finally focused on the North, Northeast and Midwest regions, was largely won by the large educational business groups”, claims Crub in the petition presented to the STF.

On the other hand, the president of Anup, Elizabeth Guedes, says that the call is a way of guaranteeing the quality of new medicine courses, since it stipulates criteria beyond those established in Sinaes (National System for the Evaluation of Higher Education).

The law provides, for example, adequate infrastructure, including libraries, laboratories and clinics; access to health services, clinics or hospitals with basic specialties; and teaching and technical staff with capacity to develop research.

The public call also considers, in the assessment of the entities, economic aspects that favor publicly traded companies, such as the giants represented by Anup, to the detriment of equity, as defended by the medium and small institutions of the Crub.

For Guedes, there is a rush to open medical classes because they are more profitable — monthly fees exceed R$ 9,000 — and have lower dropout and default rates.

“The injunctions generated a secondary market,” he criticizes. She states that the requirements for an injunction or public notice are unequal and sees the public call as natural to benefit companies with more financial resources.

What is the opinion of doctors and students?

The AMB (Brazilian Medical Association) and the CFM understand that it is not necessary to open any more medical courses in the country. For the entities, Brazil has enough doctors and it is illusory to believe that the opening of vacancies, by itself, will improve the distribution of professionals.

“Our problem today does not concern the number, but the qualification and distribution”, says César Fernandes, president of the AMB. He points out that it is essential for medical students to have contact with patients both in basic health units and in medium and high complexity hospitals, but this has not been observed.

The bodies defend as ideal parameters the provision of five public hospital beds for each student in the host city of the course; monitoring of each Family Health team by a maximum of three undergraduate students and the existence of a teaching hospital.

However, 70% of the municipalities with medical courses do not have a teaching hospital; 51% do not have enough beds in the SUS and 28% do not have a satisfactory number of Family Health teams, according to the CFM.

The lack of structure for the courses in operation and the non-requirement of these criteria explicitly in the current regulations are also of concern to medical students.

“We are not against the opening of schools. We are against the indiscriminate opening, in places without beds, without hospitals so that students can attend to patients”, says Rafael Lobo, president of Aemed-BR (Association of Medical Students of Brazil).

What is the position of the Federal Government?

The Secretary for Management of Work and Education in Health, Isabela Pinto, says that both the Ministry of Health and the MEC have maintained dialogue with medical entities and that the intention is to join forces to assess the issue carefully. Recently, minister Camilo Santana and vice president Geraldo Alckmin had meetings with the presidents of CFM and AMB.

According to the secretary, the government is concerned both with better distribution of physicians and with quality training for students, and intends to adjust the workforce to the demographic profile and strengthen regulatory policies.

Questioned whether the new calls will bring the three criteria defended by doctors and students, Isabela Pinto says that the minimum conditions for the practical part of the graduation are still under study. “We are checking the numbers based on the studies, the evidence, in order to then make all these criteria for opening courses explicit.”

The MEC also argues that the resumption of calls aims to reduce the shortage of doctors in some regions. “This reordering of the supply of graduation vacancies in Medicine, through inducing measures implemented by the State, is a policy that intends to change the Brazilian reality in the medium and long term”, he points out.

The ministry also points out that, although the objective of the moratorium was to promote greater control over medical training, the measure ended up generating judicialization of processes, and Ordinance No. 650 reestablishes the guidelines.

“The criteria for public calls are being prepared within the scope of the Interministerial Commission for Health Education Management and will be published within 120 days from the publication of Ordinance No. 650, that is, in early August. The first call notices will select municipalities and, later, institutions of higher education”.