The More Doctors Program and the rearrangement of medical residency education focused on Family and Community Medicine

Abstract

The More Doctors Program (PMM) was created in 2013 to address problems such as the insufficient number and unequal distribution of doctors, and their inadequate education profile to fulfill the population needs. Among other axes, it proposes changes in medical education, including the rearrangement and expansion of residency, suggesting one seat for every medical course graduate. This study reflects upon the elements that were essential to propose and implement changes in medical residency through PMM. The following advances were identified: better distribution of residency seats across Brazil; diversification of universalization strategies; regulations for residency seats focused on Family and Community Medicine; and preceptorship qualification. The conclusion section presents the challenges faced by the required institutional effort to maintain PMM’s actions in order to regulate residency and expand actions to other professions.

Medical school expansion policies: educational access and physician distribution

“…This initiative aims to expand medical residency programmes to medium and small cities, in conjunction with improving capacity to retain health care workers in these municipalities . Between 2006 and 2016, 2238 placements in family medicine residency programmes were created and most were made available after the PMMB (79.9%) . The pace of expansion has been inadequate and, as in other countries, there is an insufficient number of medical students intending to become family physicians.…”

“…The pace of expansion has been inadequate and, as in other countries, there is an insufficient number of medical students intending to become family physicians. Consequently, most of the places in family medicine are not filled . This situation requires further analysis and elaboration of new strategies, because the expansion of residencies in family medicine is an essential element of medical education in Brazil …”

“…28,29 Between 2006 and 2016, 2238 placements in family medicine residency programmes were created and most were made available after the PMMB (79.9%). 34 The pace of expansion has been inadequate and, as in other countries, there is an insufficient number of medical students intending to become family physicians. Consequently, most of the places in family medicine are not filled.…”

“…17,34,35 This situation requires further analysis and elaboration of new strategies, because the expansion of residencies in family medicine is an essential element of medical education in Brazil. 27,34 In 2016, about 66 million Brazilians lived in cities with <50 000 inhabitants, demonstrating that reducing physician shortages in rural and deprived areas required additional measures. A few institutions in underserved areas prioritised the admission of students from small municipalities in the region, aiming to increase retention of physicians.…”

Programa Médicos pelo Brasil: inovação ou continuidade?

“…Portanto, é este cenário fértil de bons resultados do PMM no provimento, 26,27 da aprovação do programa entre a população, gestores e médicos [28][29][30][31] e o crescente interesse pela residência de MFC 32,33 e do cenário da APS como campo de trabalho que dá força para legitimar o novo programa no contexto de disputas do novo governo. E, em um cenário de retração de tantas políticas públicas para os mais pobres, 9 ver surgir um programa que se propõe a fortalecer a APS e a combater iniquidades no provimento de médicos evidencia os acertos do programa anterior e a tentativa de superá-lo.…”