The account, however, is more difficult to close when it comes to specialties. Just to give an example, 424 clinical oncologists are responsible for the treatment of all miners in the fight against cancer in Minas Gerais. If they were divided by cities, at least half of the 853 municipalities in Minas would not be offered assistance.
The data make up the Medical Demography of Brazil 2023, released by the Brazilian Medical Association (AMB), the result of a partnership with researchers from the Department of Preventive Medicine of the Faculty of Medicine of the University of São Paulo (FMUSP). The low availability of specialized labor proven by the survey, in practice, has made care, including emergency ones, unfeasible, and even led to deaths across the state.
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These difficulties, arising from a much more complex scenario than what can be seen at the doors of Emergency Care Units (UPAs), health centers and hospitals, are the central theme of the series “From the ‘blackout’ of doctors to chaos in health” , which O TEMPO starts publishing this Tuesday (20).
“We live in a situation of chaos in public health across the country, and it is a scenario that goes beyond the resolving capacity of municipalities. We know that there are pediatricians in training, but when we need assistance in the SUS, there is not the necessary amount. When a person seeks care in primary care, which are the health centers, and there are signs that they may have cancer, they need to be referred for examinations and specialized consultations. But, as there is a lack of specialists, even with the request of the local doctor, there is a huge delay and a consequent worsening of the disease”, reports the president of the Health Council of the Hospital Infantil João Paulo II, Denise Martins Ferreira. She attends meetings of several Municipal Health Councils and speaks with the experience of years of acting in health, as a psychologist.
A chaos that jeopardized, for example, the independence of Hortência Maria de Freitas, 72, in December last year, and which almost took the life of a 1-month-old baby who was waiting for specialized care in March of this year. In both cases, reported in O TEMPO, vacancies appeared in time to prevent the worst. Hortência did not lose both legs for lack of vascular surgery, and the baby did not die without a vacancy in a specialized hospital with professionals prepared to treat bronchiolitis. The two situations mentioned are part of a question: the need for manpower and specialized vacancies to treat certain diseases. “Contrary to what people think, it’s not just transferring the patient. There has to be a vacancy, in a place with the necessary equipment and doctors available”, explains the assistant professor of physiotherapy at Una who worked for ten years in public health, as coordinator of Family Health Support Centers, Thalisson Henrique Martins Silva.
In Divinópolis, in the Midwest region of Minas Gerais, the lack of doctors has already led to the closure of pediatric care at the local public hospital and overcrowds the UPA, where 48 patients are waiting to be transferred. Some of them, in a situation considered serious, have been in place for about 20 days. “It’s not just a pen stroke. There is a regulation, under the competence of the State, for the transfer to take place. There is a hierarchy; depending on the severity of the patient, he is referred to a hospital. But it is necessary to have a bed available in the network and specialists to receive the patient”, says the municipal secretary of Health of the city, Alan Rodrigo da Silva, who is also first secretary of the Council of Municipal Health Secretariats of Minas Gerais (Cosems).
A selection process has been open for two years in the city in search of doctors from different areas. “A doctor can charge R$500 for private consultations. If he takes care of ten children, he receives R$5,000 a day, or R$25,000 a week. Which municipality can afford that?”, says the secretary.
In São João del-Rei, in Campo das Vertentes, the scenario is no different. “It is very difficult to retain the workforce. Sometimes the doctor agrees with us in a week and the next week he receives a proposal from another municipality. As the demands do not stop, we need to balance the number of doctors available and seek transfers to neighboring cities. But it’s difficult everywhere”, says the city’s Health Secretary, Renê Marcos.
Belo Horizonte suffers from a deficit of 10% of doctors
Currently, 35% of emergency admissions that occur in the capital are people who do not live in Belo Horizonte. In the Emergency Care Units (UPAs) of the city, this percentage is 30%. Many of those treated patients came from cities that suffer from a lack of doctors. “The emergency service has this characteristic of welcoming in the emergency room. In a second moment, the person can be referred to the emergency municipalities”, explains the undersecretary of Health Care of BH, Taciana Malheiros.
At the same time that it deals with the remaining demand from the surroundings, BH faces the difficulty of maintaining a complete medical staff. Currently, the deficit of professionals is 10% in the city. “We have been trying to strengthen our residency programs to attract professionals and keep them in the network, which is a national challenge”, says Taciana.
Fhemig staff faces a deficit of 15% of professionals
Recently, the Minas Gerais Hospital Foundation (Fhemig) had to cancel less serious and non-urgent procedures due to the lack of anesthesiologists. Maternidade Odete Valadares and Hospital Alberto Cavalcante, both in the group, had elective surgical procedures reduced by half due to the difficulty of closing the scale of professionals. At João XXIII, emergency cases were maintained, but there was a small impact on scheduled surgeries, that is, those already performed on out-of-risk patients. A situation that, according to the assistance director of Fhemig, Lucineia Carvalhais, has just been provisionally resolved.
“Over the last seven months, we have been looking for temporary solutions to provide the rosters. We launched public notices for the accreditation of individuals and companies to hire a single doctor, because then we were able to pay better and supply the lack of shifts and professionals”, he explains. Now, the chain is going to make a public tender, with 1,800 vacancies for several areas, including the medical one, to recompose the staff.
According to Lucineia, the lack is not just of anesthesiologists. Currently, the staff of physicians in the network has a deficit of 10% to 15%. “This is an average, but it varies a lot between specialties. Neurosurgeon, for example, has the tightest scale. In pediatric surgery, the shortage reaches 20%. It is a reality that always forces us to be creating creative alternatives to maintain the service. And it is a national reality, it does not depend on a hospital, ”she says.
For her, the main justification for the lack of specialists is remuneration. “We cannot give salary increases because they are civil servants, and the increases need to be approved and are limited by the Fiscal Responsibility Law”, she explains.
The picture experienced by the Fhemig network summarizes a broader scenario. “The Unified Health System (SUS) table for paying specialists is very outdated. We are talking about R$ 20 per consultation. It’s not worth it for a professional who can charge BRL 300 for consultations in offices”, explains health management specialist Odarlone Orente. According to the Demografia Médica do Brasil 2023 survey, only 24.6% of resident physicians state that they intend to work full-time in the SUS.
Access to health shows differences
According to the survey carried out by the Brazilian Medical Association (AMB), in the capitals there is one doctor for 163 people, while in municipalities with up to 10,000 inhabitants the care of 2,257 patients is provided by only one professional.
“This is a reality that is usually a consequence of the precarious working conditions that are offered. No professional will choose a place that doesn’t pay on time, that doesn’t meet the needs to do a good job, that you can be a victim of violence”, reports Artur Oliveira Mendes, president of the Union of Doctors of Minas Gerais (Sinmed-MG) . He criticizes the lack of an attractive career plan, with competitive wages and infrastructure in health units.
Ranking
Even with the shortage of professionals, Minas is the state with the third largest number of doctors in the country, behind only São Paulo and Rio de Janeiro.
Source: The Time
