Psychiatry career in Brazil: Regional disparities, differences and similarities in an international context

Abstract

This review explores the literature related to career choice of psychiatry in Brazil through selection of scientific articles published in the period from 1999 to 2013 in the MEDLINE and SciELO databases. There are currently 145 medical schools in Brazil, the highest concentration being in the more developed areas. In 2005, there were 6,003 psychiatrists working in Brazil, a rate of 3.3 psychiatrists per 100,000 inhabitants, with unequal distribution across the geographical regions of the country: a rate of 4.5 psychiatrists/100,000 inhabitants in the southern region, and less than one psychiatrist per 100,000 inhabitants in the northern region. The south and south-east regions comprise 56% of the national population and 76% of the residency posts in psychiatry. In 2013, 27% of the residency posts in psychiatry were not filled, particularly in the north and north-east areas, where the shortage of professionals is more pronounced. The number of specialized doctors is far below what is needed to cover the burden attributed to neuropsychiatric disorders in the country. The main hypotheses to explain this imbalance in Brazil are the relatively low exposure to the speciality during undergraduate course work, the stigma attached to mental disorders, and the poor organization of mental healthcare services.

EPA guidance on how to improve the image of psychiatry and of the psychiatrist

“…In a themed issue of the International Review of Psychiatry [83], Lydall et al included a number of studies from around the world looking at medical students’ interest in recruitment to psychiatry [7,13,42,45,47,48,58,62,73,92]. The general themes were that a small proportion of students went into medicine because they wanted to do psychiatry and a small proportion changed their mind.…”

Mental healthcare in Brazil: modest advances and major challenges

“…Mirroring the uneven distribution of wealth in the country, the number of psychiatrists is much higher in the southern states of Brazil (4.55 psychiatrists per 100 000 inhabitants) than in the northern states (less than 1 psychiatrist per 100 000 inhabitants). The number of residency posts is not proportional to the population distribution, and 27% of these posts were not filled in the most recent selection, particularly in the poorest geographical areas of the country, where specialised professionals are more needed (Fernandes 2013). …”

Mental health and psychiatric care in Bolivia: what do we know?

“…These include: an insufficient amount of services, lack of qualified professionals, poor mental health training for primary care staff, and extended stays in psychiatric hospitals, among others. A comparison with a neighbouring country in South America such as Brazil, which ranks sixth in GDP in the world, shows that Brazil also has a small number of psychiatrists (3.2 psychiatrists per 100,000 population) [9,13,30]. It should be noted that the number of psychiatrists in both Bolivia (1.6 psychiatrists per 100,000) and Brazil is below what the WHO recommends, which is 5–9 psychiatrists per 100,000 inhabitants [30].…”

“…A comparison with a neighbouring country in South America such as Brazil, which ranks sixth in GDP in the world, shows that Brazil also has a small number of psychiatrists (3.2 psychiatrists per 100,000 population) [9,13,30]. It should be noted that the number of psychiatrists in both Bolivia (1.6 psychiatrists per 100,000) and Brazil is below what the WHO recommends, which is 5–9 psychiatrists per 100,000 inhabitants [30]. In order to cope with the needs for mental health care, Brazil has implemented Psychosocial Community Centers (CAPS), which are distributed through the entire country (current mental health policy establishes that there should be a CAPS for each 200,000 inhabitants in the country).…”