General practitioner in Brazil
Posted on:3/23/2006
| General practice in Brazil is called clínica geral or clínica médica. |
General practice in Brazil is called clínica geral or clínica médica. Any physician is legally allowed to practice without any training after graduation in the medical school, but recent efforts by the government, the Brazilian Medical Association and the specialized Sociedade Brasileira de Clínica Médica are trying to demand also a specialist title for its practice, just like for others such as cardiology, endocrinology, etc. The majority of Brazilian GPs are located in the public health sector and is constituted mostly by young, recently graduated physicians. The reason is that GP is not terribly profitable and about 40% of Brazilian doctors prefer to do specialized practice, instead. To do this, they are required to do medical residence of variable duration and submit to a board of medical examiners in order to get the title of specialist. Each medical society is in charge of organizing the examinations (which usually are carried out once a year) and granting the titles to those physicians who passed the requirements. The title is recognized by the Federal Council of Medicine (the Federal professional regulatory body), the Ministry of Education and the Ministry of Health.
Family medicine, on the other hand, has evolved only recently in Brazil as a separate specialization of general practice. It is a concept which was adapted from several community health models in Europe, such as in Italy, but particularly the one which was created successfully in Cuba, and which was felt to be the most adequate to Brazilian reality. Around 10 years ago, the government recognized that primary health care in Brazil was poorly organized and fraught with many problems, including a lack of attractiveness to young physicians, so a different approach, the Family Health Program (Programa de Saúde da Família or PSF) was tried, initially with some failures, but later with increasing strength and coverage. By spending a great deal of money in order to move the program forward, the Minisrry of Health expanded and reinforced the public health care system, called Unified Health System (Sistema Único de Saúde or SUS) by decentralizing its management to the states and municipalities, by demanding in the Federal Constitution that a miminum percentage of the municipal budget should be spent in free health care to the population, and by setting up a new, multidisciplinary, family health-based system, the PSF. It is essentially based on teams composed by one to four physicians (usually a GP, a gynecologist/obstetrician and a pediatrician), one to two dentists, several nurses and a number of so called Community Health Agents (Agentes Comunitários de Saúde or ACS), who are trained lay persons who visit and have close contact with the families covered in a specific geographical location by the PSF team, in order to carry out preventative, educational and epidemiological work. Specific intensive training programs and recruiting efforts were set up in the country in order to form the PSF teams, which currently involve about 3,000 municipalities, with more than 45,000 teams already in operation; so that it can be considered one of the largest family health programs in the world.
Family physicians per se are still a rare specialty in Brazil, as the profession is generally shunning it (although economical incentive is no longer a valid reason, since physicians who work in the PSF units are generally well paid in comparison to primary health care physicians in the public sector). A few years ago a Brazilian Society of Family and Community Medicine was founded and has lobyied to have its own specialty title and board of examiners, but it has so far remained relatively small.
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