the federal government resumed the Mais Médicos program for Brazil, this Monday (20), and will pay a fixation incentive that can reach R$ 120 thousand for the doctor who stays for four years in vulnerable areas. This incentive will be extended if the doctor has been benefited by Financing for Higher Education Students (Fies).
The program’s actions aim to increase the average length of stay of professionals in the service centers through training strategies for specialists and payment of incentives. In a ceremony at the Planalto Palace, the Minister of Health, Nísia Trindade, said that the participants request dismissal for three main reasons: seeking training offers, family demands and other professional opportunities.
“That’s why we want to move forward with the proposal to retain doctors trained in Brazil in the program over the years. This new stage proposes an extension to four years, the time necessary for the doctor to submit to the specialist title test”, said the minister.
To this end, President Luiz Inácio Lula da Silva signed this Monday the provisional measure establishing the National Strategy for the Training of Specialists in Health and the decree establishing the Interministerial Commission for the management of Work and Education in Health. The training program also includes other areas of health, aimed at assisting multidisciplinary teams for comprehensive health care for the population. It is expected that the first notices will enable 963 medical residency grants and 837 multiprofessional residency grants.
According to Nísia Trindade, doctors who are already in the program will have continuity of activities and those who join will have an incentive to prove the title of medical specialties. “The return of Mais Médicos comes at a fundamental moment. Contracts for 2,500 physicians have been terminated or terminated in June this year. Therefore, it is necessary to extend the permanence of these professionals, who have had the highest average permanence in the [Programa] Family Health. Some are now in Yanomami territory helping us to overcome the health emergency”, highlighted the minister.
The new More Doctors already foresees the opening of 15 thousand vacancies in the program. The initiative aims to expand the population’s access to medical care in primary care, the gateway to the Unified Health System (SUS), especially in regions of extreme poverty and lack of care. For President Lula, it is a policy that serves the population, doctors and also the mayors of small towns across the country.
“The only thing that a mayor wants to hire is a lack of a doctor in a city. Sometimes he pays a higher salary than he could pay and still can’t find a doctor who is willing to go to a small town in the interior, which doesn’t have a mall, which doesn’t have a movie theater, which has nothing. People sometimes don’t want to go and that’s understandable,” said Lula. “But it’s also understandable the effort that went into creating this program. At the time, we suffered many accusations, many people in the medical profession did not accept Mais Médicos, especially many people did not accept Cuban doctors who came from abroad”, recalled the president.
new vacancies
The government’s objective is that by the end of the year around 28,000 professionals will be established throughout the country, mainly in areas of extreme poverty. A spokesperson for the Ministry of Health explained that the Mais Médicos program, created in 2013, under the administration of Dilma Rousseff, has never been discontinued and currently has 18,000 vacancies. Of these, 13,000 are completed by physicians hired in previous public notices and 5,000 will be offered through a new public notice, which will be launched this March.
According to the government, in the last six years, Mais Médicos was mischaracterized and suffered from a lack of incentives, with 2022 being the year with the greatest lack of professional assistance in the municipalities. “The year 2022 ended with more than 4,000 Family Health teams without doctors, the worst scenario in ten years, affecting mainly vulnerable areas and people”, said the Minister of Health.
Of the total number of new vacancies for 2023, 10,000 will be offered in a format that provides for a counterpart from municipalities. According to the Ministry of Health, with this form of hiring, city halls will have lower costs, greater agility in replacing professionals and conditions to extend the permanence of professionals in localities. The investment by the federal government will be R$ 712 million this year.
According to Nísia, the government maintained an intense dialogue with medical representative entities, and the concern is with the issue of unregistered doctors in Brazil. Therefore, according to her, the focus of Mais Médicos is to reinforce incentives for Brazilian physicians trained in the country to settle in the program.
When it was created in 2013, the program was marked by the hiring of Cuban doctors. At the time, the federal government made an agreement with the Pan American Health Organization (PAHO) to bring these professionals to fill vacancies not filled by Brazilians or other foreigners with diplomas validated in Brazil.
As the law already provides, Brazilian professionals and exchange students, Brazilians trained abroad or foreigners, who will continue to work with the Ministry of Health Register, can participate in the Mais Médicos para Brasil public notices. Brazilian physicians trained in Brazil will have preference in the selection of notices.
“We want all doctors who sign up to be properly trained Brazilian doctors [no Brasil]. If you don’t have the conditions, we want Brazilian doctors trained abroad or foreign doctors who work here. If not, we will call for foreign doctors [formados no exterior] occupy this task, because what matters is not just knowing the nationality of the doctor, it is knowing the nationality of the patient, who is a Brazilian who needs health”, argued President Lula in his speech.
The duration of participation in the program is now four years, extendable for an equal period, when the doctor can do specialization and master’s degree. The grant is R$ 12,800, plus housing assistance. Brazilians and foreigners trained abroad who participate in the program will have a 50% discount on the diploma revalidation test, the Revalida, carried out by the Ministry of Education. In the last edition of Revalida, the registration fee was R$ 410.
Training and incentives
A survey carried out by the Ministry of Health points out that 41% of program participants give up working in more remote locations to go in search of training and qualification. As an incentive, then, they will receive an additional 10% to 20% of the total sum of scholarships for the entire period of stay in the program, depending on the vulnerability of the municipality.
The amount, which could reach R$ 120,000, will be paid at the end of the 48 months. The professional will also have the option of anticipating 30% of this payment at the end of 36 months of work in the program.
More Doctors for Brazil will also give incentives to professionals trained with the support of the federal government, benefiting from Financing for Higher Education Students (Fies). “The bonus will allow these doctors to pay off their debts if they stay the entire time of our program”, explained Nísia.
In this case, the additional amount will be 40% to 80% of the total sum of scholarships for the entire period of stay in the program, depending on the vulnerability of the municipality, and will be paid in four installments: 10% per year during the first three years, and the remaining 70% after completing 48 months of work.
Another challenge, according to the government, is expanding the training of family and community physicians, who are those targeted for care in basic health units (UBS). For this, vacancies will be offered for resident physicians who were benefited by Fies to fulfill the residency program in areas with a shortage of professionals.
To support the continuity of the program for women physicians, a supplement will be made to the aid from the National Institute of Social Service (INSS), so that she receives the same amount as the scholarship during the period of six months of maternity leave. For program participants who become parents, a 20-day leave will be guaranteed with maintenance of the scholarship value.
Fewer hospitalizations
According to the Ministry of Health, the new More Doctors is a public policy that involves strategies designed in the short, medium and long term, since the first consultation, carried out in basic health units, is responsible for monitoring the health situation of the population, prevention and reduction of injuries.
“Today there is consolidated evidence that the program managed to provide professionals to the most vulnerable areas, increased access to Family Health, reduced hospital admissions and infant mortality. That’s why he’s back”, argued the Minister of Health, Nísia Trindade.
Data from the Mais Médicos Program Observatory Network, made available by the folder, indicate that, between 2013 and 2015, the number of consultations in municipalities with doctors from the program increased by 33%, while the number of hospitalizations was 4% lower. In municipalities where Mais Médicos coverage reached more than 36% of the population, the reduction in the number of hospitalizations in the same period was even greater, reaching 8.9%.
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