HEALTH-BRAZIL: Physicians and Market Forces

By Mario Osava Reprint | | Print |

Mario Osava

RIO DE JANEIRO, Jan 13 1998 (IPS) - Brazil has one of the highest ratios of medical doctors to population in the world – 1.25 physicians for every 1,000 inhabitants – and therein lies the problem.

The surfeit of physicians means salaries are constantly dropping and, while medicine remains the most popular and competitive course of study in universities the precariousness of health services continues to be a major concern for Brazilians.

According to the Federal Medical Council, there are now more than 200,000 doctors in Brazil and the ratio to the population is better that the World health recommendations of one doctor for every 1,00 people.

The main problem, however, is the deplorable distribution of doctors in Brazil, where 61.3 percent are concentrated in the main cities of weach state while there is a shortage of medical specialists in the country’s interior, says the Federal Council, which regulates medical practice nationwide.

This imbalance is also a reflection of the unequal development of the country’s regions. Rio de Janeiro is the most favored city, with 4.8 doctors for every 1,000 inhabitants – a much higher proportion than found in many developed countries.

This concentration dates back to the days before 1960 when Rio de Janeiro was the nation’s capital and its hospital network was the most extensive in the country. Notwithstanding the high numbers, there are complaints about poor service, avoidable deaths and rejection in hospitals are commonplace.

Dissatisfaction is also widespread among medical professionals, who have held several strikes over the past few years protesting their low salaries in state institutions and in private hospitals.

According to a study conducted by the Oswaldo Cruz Foundation, a research and vaccine production institute, the average income of doctors in Brazil is only 1,325 dollars per month. Barely six percent make more than 4,000 dollars while 37.3 percent earn less than 1,000 dollars per month.

More than half of doctors hold three or more jobs to survive, working excessive hours and spending time going from job to job. 8.97 percent have five or more jobs and only 16.6 percent dedicate themselves exclusively to one.

In spite of the deterioration of medical practice, national university entrance exams show that medical studies attract the largest number of university-bound students year after year.

At the University of Campinas, located 100 kilometers from Sao Paulo, 33,327 candidates competed for 2.245 places in 46 courses of study this past month. In the field of medicine, 9,277 candidates competed for 110 spots, making the acceptance ratio one for every 84.34 students that applied.

The situation is no better at other institutions. At the State University of Rio de Janeiro, 60.2 students compete for every spot in medical studies.

Twenty-year old Alessandra Faria de Macedo, in her second attempt to enter medical school, once again failed to get the necessary score, which was good enough to study dentistry at a private university that will cost her father 900 dollars per month.

She decided to go with this second option “because its part of the health field,” but she does not rule out attempting to enter medical school again in the future. “I like to work in hospitals and care for sick people,” she explained.

Without visible improvements in salary and working conditions, it is not the market but vocation which explains the desire of young Brazilians to enter medical school year after year. The humane character of the profession is factor here, no doubt.

Last year, Juliana Garbayo dos Santos passed the exam and was able to enter a university near Rio de Janeiro. She chose medicine, after considering psychology and social work, because of her desire to “help the people.”

Yet moving doctors to the interior of the country, where they are most needed, continues to be an apparently insurmountable challenge. Small cities fail to attract them even with offers of high salaries.

One of these cities, a municipality with some 70,000 inhabitants in the interior of Minas Gerais, has been attempting to hire doctors for its hospital offering salaries of 7,000 dollars to no avail. “Attracting specialists is most difficult,” lamented the local health secretary, Juraci Moreira.

According to Ricardo Menezes de Macedo, president of the Union of Medical Doctors in Minas Gerais, doctors concentrate in the big capitols because diagnostic services, new technologies, and the people able to pay for them are also concentrated there.

Moreover, it is this same market that “dismisses the doctor who works in the interior,” said Menezes to Jornal do Brasil, a newspaper in Rio de Janeiro. (FIN/IPS/mo/mj/he/mg/98)