Impact of educational policies on access to health care in Brazil: A cross‐sectional study

Abstract

Introduction Various initiatives to improve access to health care have been implemented internationally. In Brazil, this has included policies intended to expand access to higher education for underrepresented socio‐economic groups. These measures have reduced inequalities in access to medical education, but it is not known whether they influence career choices. We examine the effect of these educational policies on physician practice patterns in primary care and/or in medically underserved areas. Methods This is a cross‐sectional study that analysed the association between affirmative educational policies and the career choices of physicians who graduated between 2010 and 2015. Multivariate binary regression analysis was used to evaluate the impact of affirmative educational policies on physician career choices, including primary care practice, practice in cities with ≤20 000 inhabitants, and practice in less developed municipalities 4 years after graduation. Results We identified the practice patterns of 65 304 (82.8%) physicians 4 years after their graduation. Most physicians included in our analysis were female (54.5%), aged ≤27 years (72.4%), born in developed cities and studied in private medical schools. Physicians admitted to medical school based on racial or social access policies were more likely to practice in municipalities with fewer than 20 000 inhabitants (odds ratio [OR]: 1.64; 1.36–1.98) and in primary care (OR: 1.55; 1.35–1.53). Physicians who benefited from scholarships for under‐represented socio‐economic groups were more likely to practice in small cities (OR: 1.24; 1.07–1.43) and primary care (OR: 1.23; 1.11–1.37). The provision of financial aid also improved the likelihood of practice in primary care and underserved areas. Graduation from medical schools located in smaller cities was associated with practice in municipalities ≤20 000 inhabitants and primary care. Conclusions Our results demonstrated that educational policies implemented in the Brazilian context are effective in reducing inequities in physician distribution and led to an increase in the number of physicians practicing in primary care.

Towards a deeper medicine: Widening participation and race–class social relations

“…Figueiredo et al observe that wealthier students practice in cosmopolitan city centres and in secondary care specialties after graduation. 1 Kumwenda et al similarly note this pattern in specialty choice in the UK. 11 Interestingly, even though effective primary care COMMENTARIES has been shown to prevent illness and reduce mortality across populations, there is a poorer public perception towards general practitioners in the UK, compared to the more 'elite' interventionist specialties.…”

“…We must recognise that medical education and practices have co‐evolved with wider political projects and acts of racist and classist stigmatisation. Figueiredo et al observe that wealthier students practice in cosmopolitan city centres and in secondary care specialties after graduation 1 . Kumwenda et al similarly note this pattern in specialty choice in the UK 11 .…”

“…Sampling a significant 65 304 medical doctors in Brazil, Figueiredo et al identify that increasing access to medical education for people from marginalised groups leads to a higher number of doctors who choose to practice in underserved areas facing physician shortages. 1 Raising a number of important observations, this study provides multiple openings to deepen medical education's dynamic understandings of widening participation policies and their impact on the lived experiences of trainee doctors and patients from marginalised groups.…”

“…Race and class are social relations that are enacted, embodied and (re)produced between groups and clearly correlate with patterns of morbidity and mortality 3 . Despite some purposeful policy changes in Brazil, admitting students from underserved areas is still uncommon and not included in the Quotas Law 1 . I draw a parallel with the UK's own Equality, Diversity and Inclusion laws, which do not include social class, 4 making it less effective in reaching those who are most likely to experience economic difficulties, such as racialised and disabled people.…”

A retomada do Programa Mais Médicos em 2023

“…Para os profissionais que foram beneficiários do FIES, essa indenização alcança 80% da quantia recebida pelo médico participante no período de 48 meses, se atuar em área de vulnerabilidade indicada pelo MS, ou 40% do total das bolsas se atuar em outras áreas de difícil fixação. Essa medida busca ampliar a fixação dos profissionais nas áreas mais vulneráveis, considerando que médicos beneficiários do FIES têm até 30% mais chances de atuar em municípios menores e de Índice de Desenvolvimento Humano baixo (Figueiredo et al, 2023).…”