Brazil’s Doctor Controversy Continues

By Maria Lopez Conde, Senior Contributing Reporter

SÃO PAULO, BRAZIL – The Brazil-trained doctors participating in the “Programa Mais Médicos” (More Doctors Program) began working in 454 municipalities where health professionals are needed last Monday, September 2nd amid reports of no shows, as the controversy over the government initiative continues to mount.

Controversy Over More Doctors Continues, Rio de Janeiro, Brazil News

Foreign doctors had to undergo training before practicing in Brazil last week, photo by Elza Fiuza/ABr.

Announced by President Dilma Rousseff following the mass countrywide protests that demanded better public services in June and July, the program was designed as temporary measure to battle Brazil’s chronic lack of doctors. According to the Health Ministry, there are only 1.8 health professionals for every 1,000 people in Brazil, while in neighboring Argentina and Uruguay, there are 3.2 and 3.7 for every 1,000 citizens, respectively.

The program also requires future Brazilian doctors to serve two years in public hospitals before graduating, which adds two years to the current six-year medicine curriculum. Rousseff’s initiative will create up to 11,500 new spots for medicine-related careers at Brazilian universities until 2017, among others.

“Programa Mais Médicos” has already began recruiting doctors from abroad in an effort to cope with Brazil’s lack of doctors, especially in the poorer northeast and rural areas where there are not enough national doctors. Bringing in foreign doctors – especially about 4,000 from Cuba, hired through an agreement with the Pan American Health Organization – has proven contentious and has elicited strong reactions from the medical community and doctors’ associations.

“It’s not a program, it’s a political and electoral proposal that emerged to improve the President’s image,” João Batista Gomes Soares, president of the Regional Medicine Council of Minas Gerais, told O Estado de Minas about “More Doctors.”

Controversy over "More Doctors" Continues, Rio de Janeiro, Brazil News

Health Minister Alexandre Padilha has said the Cuban doctors will be mostly dispatched to the underserved Brazilian northeast, photo by Elza Fiuza/ABr.

Soares has been one of the program’s most outspoken critics, and he believes the initiative will employ doctors who are not qualified to practice medicine in Brazil and who cannot communicate with a Portuguese-speaking population. Brazil’s Medical Association has already filed a lawsuit against the program in the Supreme Federal Court (STF), claiming “More Doctors” is unconstitutional.

“As if a doctor were the only agent that can solve problems in healthcare,” Soares said. “Minas [Gerais] has 200 cities without doctors. But in those cities, there is also no judge, prosecutor or priest.”

Another point of contention has been the fact that the Cuban doctors flown in to serve in Brazil’s communities will have their R$10,000 stipend paid directly to the Cuban government. On August 27th, tensions reached a boiling point when Brazilian doctors booed and verbally assaulted Cuban health professionals as they arrived in Recife’s airport.

“How does the [government] find money to fund 4,000 doctors?… Actually, they take that money from the municipality’s PAC funding. Why does the money destined to healthcare end up in Cuba?,” Soares asked.

All across the country, the official start of the program has been marred by the controversy, as well as several reports of absences. In the Rio de Janeiro state municipality of Duque de Caxias, which was set to receive one of the state’s largest doctor contingents, only five out of the thirteen scheduled to work there showed up on their first day. Among the five, two were foreigners, one Colombian and one Portuguese. According to Veja magazine, the eleven others were from the states of Rio or São Paulo.

“A provisional measure is a law, and law must be enforced,” affirmed Alexandre Padilha, Minister of Health, after participating at an event at the University of Brasília last week. The Health Minister has denounced what he deemed as the “xenophobic attitude” of Brazilian doctors and has defended the “humanitarian” merit of President Rousseff’s program.

About 3,600 Cuban-trained doctors are supposed to arrive by the end of the year. Over 1,000 Brazilian doctors are also set to take part in the program.

8 Responses to "Brazil’s Doctor Controversy Continues"

  1. Jorge  September 4, 2013 at 1:19 PM

    I’m definately not the one to defend the govern, however this time I’m forced to. The Brazilian doctors are complaining so much but they won’t go where the foreign doctors are going! Of course the responsability for a good health system in our country can’t be put entirely on the doctor’s sholders, nevertheless they have to recognise that they play quite an important part in this story. Unfortunately, in this country, the atitude towards the population is always elitist: the govern only attends the rich people’s needs, and the doctors do the same. They don’t want to work in an abandoned city God-only-knows-where, they want to work in the capitals, the big cities, the turistic places because that’s where they are paid more. And it’s they’re right to do think like that. But they can’t complain if somebody else is willing to go where they’re not.

  2. Sven van 't Veer  September 5, 2013 at 12:32 PM

    Brazilian doctors are complaining, yet none of them wants to practice in small towns in the Interior of Minas Gerais, São Paulo or Rio Grande do Sul, let alone Amazonas, Sergipe or Ceará. They also don’t agree to a plan whereby newly graduated doctors are obliged to practice in those places for two years, as soon as they graduate. They all want to work in the big Cities like Rio de Janeiro, São Paulo and Belo Horizonte, and even there it sometimes takes up to two months to make an appointment with a doctor.

    They try to hide behind the “Revalida” exam which doctors that graduated in other countries must pass, which is so complex that people that studied at renowned universities like Johns Hopkins, Sorbonne or Harvard can’t pass it (on average 20% pass), while none of the Brazilian medical schools can be found in the first 200 places of the world medical schools ranking.

  3. Gary D. Gordon  September 5, 2013 at 10:32 PM

    Lack of doctors in the interior of Brazil is nothing new. The choice of many medical school graduates is governed by how much they can earn, rather than where doctors are needed.

    I think the program to require future Brazilian doctors to serve two years in public hospitals before graduating is reasonable, especially if their medical education was subsidized by the government. Working with a senior doctor in an understaffed hospital, a young medical graduate often gets more opportunities to learn his profession.

    My father, Dr. Donald C. Gordon (www.apib.org/gordond.htm), was an American who graduated from Harvard Medical School in 1922. In 1929 he moved to Brazil, learned Portuguese, and got his diploma revalidated. In 1936 he moved to Rio Verde (west of Brasilia) in the state of Goias, founded a hospital (Hospital Presbiteriano Dr. Gordon), and worked there for 25 years.

    Dr. Benjamin, a Brazilian medical director of the hospital, after my father retired, summed up my father’s guiding light this way;

    “We have here the Gordian spirit:

    • A love and care for all people, rich and poor alike
    • A concern for efficiency and economy
    • A desire to keep abreast of advances in medicine
    • And a mutual respect for all hospital personnel”

    If medical doctors, and all hospital personnel, took this to heart, they could serve the needy in the interior of Brazil as my father did.

  4. Pasquale Ferrari  September 8, 2013 at 1:14 PM

    As a person who would like to live in Brazil I have been dismayed at the lack of specialists in the NE who I can see for my health problems. Just saying without going into my specific needs.

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