Novo Mais Médicos maintains the challenge of retaining doctors – 03/26/2023 – Health

Target of political clashes and left in the background in recent years, Mais Médicos is once again gaining momentum with new public notices scheduled for the coming months and betting on financial incentives to attract professionals.

For specialists and managers interviewed by the Sheetthe measure helps to mitigate the “blackout” of vacancies registered in the program, but it should still require new actions to solve the problem of fixing doctors in the long term in more distant areas or considered more vulnerable.

Announced on the 20th, the new version of the program foresees the opening of 15,000 jobs, 5,000 of which in April, financed by the Ministry of Health, and 10,000 by the end of the year, funded by the municipalities.

Currently, Mais Médicos has 8,366 vacancies filled — less than half of the 18,240 planned in recent years.

The lower rate reflects part of the program’s trajectory over the past decade.

Created in 2013 under protest from medical organizations, the program was initially marked by episodes of xenophobia against Cubans and became a frequent target of political clashes. Gradually, it also recorded improvement in health indicators and came to be defended mainly by mayors.

In recent years, however, it has come and gone: it began to be reduced, then gained survival in the pandemic and, finally, ended up relegated to the background amid the structuring of Médicos por Brasil.

Today, 5,648 doctors work in this other program, which was even announced as a replacement for Mais Médicos in the administration of Jair Bolsonaro in 2019, but only had public notices in 2022. Now, the current government justifies the resumption of the bet on Mais Médicos in the face of the which points to the difficulty of Médicos pelo Brasil in keeping doctors in more vulnerable areas.

A challenge, now, that is back to Mais Médicos.

In the new guise, the program should maintain the priority of adherence to Brazilians, says Saúde. If vacancies are not filled, they should be directed to Brazilians trained abroad and foreigners. However, there will be no cooperation with PAHO (Pan American Health Organization) for the arrival of Cuban doctors.

To encourage adherence, the government is betting on new measures, such as the payment of incentives to physicians who remain in the program for more than three years (the period will be four years, extendable), to those who work in more needy areas and to graduates with assistance of Fies (student financing).

In practice, the measure points to incentives that can reach R$ 118,000 for doctors who stay four years in more vulnerable areas or up to R$ 475,000 in the case of doctors trained in Fies working in these places. Questioned, however, Saúde did not detail which and how many cities would be in the criterion of greater vulnerability.

Lígia Bahia, a professor at UFRJ, says that the fact that Mais Médicos has remained the main initiative for providing doctors in recent years shows that it “is here to stay”.

“This shows the importance of this policy. But the question is: is it here to stay in a precarious way? Will it always be like this, with scholarship holders and exchange students?”, he asks. “With the precariousness of the employment relationship, we run the risk of having a precariousness in the very quality of care.”

For her, the program needs a “second step”. “In it, it would be important to link this process with public universities of excellence to ensure that there is no such precariousness”, she suggests, who points to partnerships in research and training as a way forward.

Fernando Aith, a professor at USP’s School of Public Health, has a similar concern. For him, the resumption is positive and the offer of incentives can help to attract professionals, but it does not solve the long-term or definitive fixation, a factor that is also influenced by the working conditions and structure, he says.

“The salary they are offering and the indemnities may seem high for the average salary in Brazil, but there are doctors who train and work shifts and earn R$30,000 a month. Why then would you go to the Amazon? We have to see how that works.” it will work in the medical market.”

In recent years, the high rate of dropouts in some regions was one of the main difficulties of Mais Médicos.

Data obtained by Sheet via the Access to Information Act, and updated in January, show that the average length of stay in the program is 1 year and 8 months for physicians registered in Brazil and 2 years and 7 months for Brazilians trained abroad.

In some cases, it doesn’t come to that. Between 2013 and 2017, for example, around 20% of Brazilians who joined the program dropped out within a year. Until then, the contract was for three years.

Felipe Proenço, deputy secretary of primary care at the Ministry of Health, says that, in a study to resume the program, the folder identified three main reasons why doctors did not stay. The main one was the search for training, such as residency —the reason that led to the departure of 40% of professionals.

Others were family issues and offers on the job market.

According to him, given this scenario, the new version of Mais Médicos should expand training offers, also including the possibility of master’s degrees, among others. The folder has not yet detailed the measure. On another front, the effort was to expand coverage of maternity and paternity leave.

The provision of financial incentives, on the other hand, occurred as a strategy compared to other offers on the job market, which can be attractive especially for doctors trained with Fies, says the assistant secretary. The folder calculates that there are 15 thousand in this group in the last three years.

“This leads us to understand that there is a great possibility of attracting more physicians registered in Brazil”, says Proenço.

For Lígia Giovanella, coordinator of Abrasco’s primary care research network, the offer of new incentives shows concern in guaranteeing the presence of professionals. “It is true that fixation in remote areas is a challenge all over the world. Sometimes, you cannot fix it, but you manage to maintain care.”

The resumption of the program, however, generated criticism on social networks by some physicians, who questioned the precarious bond and the value of the scholarship compared to that of Médicos pelo Brasil (R$ 15,750, against R$ 12,386 in Mais Médicos), which provided for a contract CLT after two years.

Proenço, however, says that the sum of aid and incentives for those who go to a vulnerable location makes the new program more attractive to those who remain in the post.

The clashes continue. In recent days, medical organizations have again questioned the opening of vacancies for doctors without revalidation of the diploma and promised to appeal to Congress for changes in the provisional measure that brings the program’s rules.

The possibility of entry of Brazilian physicians trained abroad, however, was celebrated by some health managers.

For Franmartony Firmo, president of Cosems-AM, which brings together municipal health secretaries from Amazonas, the resumption of the program can help reduce the deficit of professionals.

“Doctors with CRM were not able to be placed in all regions of the state, but Brazilians trained abroad, yes. That is why I believe that now we will have doctors as we had in the first Mais Médicos.”

The council’s estimate points to a lack of 400 physicians in the state. In Maués, where he is secretary, he says he is waiting for the replacement of three doctors. For now, professionals rotate between health units to ensure care.

“Many doctors even sign up, but don’t show up, or give up in a few months due to the conditions of an inner city.”

According to him, part of the last vacancies were for Cuban doctors who passed the Revalida. “They passed and left. I even joked that they passed and became Brazilians, and they laughed. Nobody wanted to stay in the municipality”, he reports.

WHAT CHANGES IN MORE DOCTORS

Notices

How was: although it was still the main provisioning program, Mais Médicos was being left in the background amid the replacement of Médicos by Brazil

How it looks: program has public notices again. The idea is to launch a public notice with 5,000 vacancies by April, and another 10,000 vacancies by the end of this year. Scholarship value will be R$ 12,400, with provision for financial incentives

Time of participation in the program

How was: three years, extendable for an equal period

How it looks: four years, extendable for an equal period

Offer of financial incentives

How was: program provided travel assistance, among others

How it looks: maintains aid and starts to bring other financial incentives

• Permanence incentive (by staying at least three years): model in which professionals can receive an additional 10% to 20% of the total sum of scholarships for the entire period they were in the program, depending on the vulnerability of the municipality. According to the rules, the physician will receive the full incentive at the end of 48 months or may anticipate 30% of that amount at the end of 36 months. Thus, a doctor who stayed 48 months, for example, and is in a city that provides an additional 10% of scholarships would receive an extra R$ 59,400
• Incentive to become a Fies doctor (when staying at least 12 months): model in which professionals can receive an additional 40% to 80% of the total sum of scholarships for the entire period they were in the program, depending on the vulnerability of the municipality . Amount will be paid in four installments: 10% per year during the first three years, and the remaining 70% after completing 48 months
• Incentive for Fies resident physicians in family and community medicine: vacancies will be offered to resident physicians in family and community medicine who benefited from Fies, helping to pay the total amount of the debt

educational offer

How was: Specialization

How it looks: specialization, master’s or improvement

Maternity leave

How was: doctor stopped receiving the scholarship during the period of the leave, starting to receive assistance from the INSS

How it looks: will receive the scholarship to complete the amount of the INSS aid during the period of up to six months

Paternity leave

How was: no layoffs planned during this period

How it looks: will receive the scholarship for a period of up to 20 days

Other benefits

Additional 10% score in residency program selection for physicians who complete the family and community medicine residency

Counterpart with municipalities

How was: selection and vacancies were funded by the Ministry of Health

How it looks: municipalities will be responsible for paying scholarships to doctors hired for the remaining 10,000 vacancies, while the selection process is up to the Ministry of Health

_{Source: Ministry of Health}