Without an agreement with Cuba, Mais Médicos tries to attract Brazilian professionals

The government of Luiz Inácio Lula da Silva (PT) is making adjustments to launch a new version of the Ministry of Health’s Mais Médicos program in the first half of the year. At first, there will be no agreement with the Cuban dictatorship for hiring foreign professionals. One of the justifications for this is that the federal government considers that Brazil has increased the number of doctors in recent years.

The expectation is that the government will prioritize the hiring of Brazilian doctors, rather than Cubans, as occurred in 2013, when then-president Dilma Rousseff (PT) launched the first version of the program. During the PT government, Mais Médicos reached 18,200 professionals, of which 11,000 were Cubans brought to Brazil through a cooperation agreement between the Brazilian government and Cuba, intermediated by the Pan American Health Organization (PAHO). .

The former partnership was widely criticized, both for the lack of revalidation of these doctors’ diplomas to work in Brazil, and for the withholding of 75% of each professional’s salary, which remained with the Cuban dictatorship. The export of medical and health services is still one of the main sources of foreign currency for the Caribbean island.

Currently, Mais Médicos has about 40% of foreign professionals out of just over 8,000 who work in the program. The new version, however, provides that foreign physicians can compete only for the vacancies remaining in the public notice. In addition, the expectation is that the proposal will require the Revalida exam for graduates outside Brazil.

The movement is a government strategy to try to soften the criticism of medical entities contrary to the prioritization of foreigners without proof of Revalida. The exam is a unified process for revalidating diplomas of foreign physicians compatible with the training requirements of Brazilian universities. The tests are administered by Inep, an agency linked to the Ministry of Education, twice a year.

“We cannot arrive and offer to our society unqualified doctors, who you don’t even know the origin. The Federal Council of Medicine does not relinquish this prerogative”, said José Hiran Gallo, president of the Federal Council of Medicine (CFM).

Government will offer specialization to Brazilian doctors

To try to attract Brazilian doctors to the program, the new version of Mais Médicos intends to offer specialization courses for health professionals. The details, however, have not yet been presented by the Ministry of Health.

“What we are going to do is study ways to encourage more physicians trained in Brazil, it is a priority. The idea is to reintroduce Mais Médicos with incentives, qualifications and training. The deadline is to have a design of the program and the new edition being made” , explained the Minister of Health, Nísia Trindade, in an interview with Life wheelfrom the TV Cultura.

For Raul Canal, president of the Brazilian Society of Medical Law and Bioethics (Anadem), the government needs to offer attractive compensation for Brazilian professionals to participate in the program.

“For this to happen, it is necessary to structure incentive programs, so that these professionals work in all corners of the national territory, especially in those farthest from the big centers”, he argues.

The proposal to encourage the provision and retention of professionals will be agreed with states and municipalities.

In addition, the federal government is evaluating the possibility of new contract extensions – currently scholarships are disputed via public notices and have a three-year term, which can be extended for another three. In this regard, the Ministry of Health informed the People’s Gazette who is studying ways to make staying in the program “longer and more attractive”, however, he did not indicate the strategy that will be employed or what will happen to the doctors whose contracts are expiring at the beginning of this year.

Justice determines that Cubans without Revalida be readmitted

Representing almost 80% of the professionals hired in the first version of Mais Médicos, Cubans left Brazil at the end of 2018, shortly after the election of then-President Jair Bolsonaro (PL).

At the time, the Bolsonaro government, critical of the program and the Castro dictatorship, conditioned the maintenance of contracts to the completion of diploma revalidation exams and the full transfer of salaries to health professionals.

“We conditioned the continuity of the Mais Médicos program to the application of a capacity test, full salary to Cuban professionals, today most destined for the dictatorship, and the freedom to bring their families. Unfortunately, Cuba did not accept it”, justified the Bolsonaro government.

With the casualties, Mais Médicos was replaced by the Doctors for Brazil program, which until October last year had more than three thousand professionals hired. A People’s Gazette asked the Ministry of Health if the new government intends to close the program created in the Bolsonaro administration, but received no response.

Despite the departure of Cuban doctors from Brazil, a decision by the Federal Regional Court of the 1st Region (TRF 1), in January, determined that the government rehire about 1,700 professionals whose contracts were terminated during the Bolsonaro administration. The request for rehiring was presented by the National Association of Medical Professionals Trained in Foreign Institutions and Exchange Students.

According to Judge Carlos Augusto Pires Brandão, the release of Cuban doctors, even without the Revalida exam, is as important for professionals as it is for Brazilian public health, especially in regions with more difficult access.

“There is another fact that recommends this urgent judicial measure. The More Doctors for Brazil Program makes it possible to implement public health actions to combat the health crisis that has taken hold in the region of the Yanomami indigenous people. There is a state of public health emergency declared, decreed through the Ministry of Health”, he justified.

Despite this, the Minister of Health recently stated that the portfolio is still studying how to comply with the determination of Justice. “Regarding the court’s decision, the ministry’s own legal area is analyzing it to see how we are going to deal with Cuban doctors”, justified Nísia Trindade.

Study shows the concentration of physicians in large centers in Brazil

One of the Ministry of Health’s justifications for not promoting agreements with other countries for hiring foreigners is that Brazil has increased the number of doctors in recent years. In 2012, Brazil had 1.9 physicians per thousand inhabitants and, currently, this average is 2.5, according to the study “Medical Demography in Brazil 2023” by the University of São Paulo (USP) and the Brazilian Medical Association (AMB). ).

According to the survey, Brazil reached the milestone of 562,229 physicians enrolled in the 27 Regional Councils of Medicine (CRMs). Despite this, most professionals are concentrated in the large centers of the country.

The North region has the lowest concentration of professionals per thousand inhabitants (1.45), while the Southeast has the highest concentration among the regions, with a rate of 3.39. The Federal District has, on average, 5.53 doctors for every thousand inhabitants. In Pará, the average is only 1.18.

“This means that volume does not solve Brazil’s health problem. There is nothing new when we point out that in smaller municipalities and further away from large centers there is an evident lack of access to health services”, explains Raul Canal.

In the assessment of the president of Anadem, the lack of professionals in the interior of the country is not due to lack of interest, but to the lack of structure in these regions.

“The poor distribution of professionals is not the result of a supposed lack of interest on the part of doctors, who even migrate to these regions. The big problem is that they end up giving up working in these cities, where they notice the absence of a minimum infrastructure. serve with dignity”, argues Canal.