Brazil has 546 thousand practicing doctors, a proportionally large number, which represents 2.56 doctors for each group of thousand inhabitants. The index is practically the same as that of the United States (2.6) and higher than Japan’s (2.55). Nonetheless, one of the most serious problems faced by users of the Unified Health System (SUS) is the lack of specialists. In regions further away from large cities, the wait for an appointment with a specialist can last several years. The situation takes on dramatic contours that lead public authorities to pay salaries of up to R$135,000 in order to try to attract professionals to the city.

Data from Medical Demographics 2023 confirm this drama: 56.1% of resident doctors were in the Southeast region, a third of them (33.3%) in São Paulo. Meanwhile, the Mid-West (7.5%) and North (3.6%) regions have the lowest resident ratios in Brazil. Together, the states of Roraima and Amapá had, in 2021, just 100 residents. The inequality in the distribution of these vacancies deepens the social abyss in Brazil.

The major obstacles to increasing the number of specialists in Brazil are the insufficient number of medical residency positions available, the poor distribution of these vacancies throughout Brazil and the lack of a MEC** policy for postgraduate studies in the medical field.

The same study showed that the number of graduates starting medical residency has been dropping year after year: between 2018 and 2021 this drop reached 14.8%. The gap between graduates and vacancies in direct access specialties is even greater: in 2018 the deficit was 3,866 and jumped to 11,770 in 2021, an increase of 204%.

Meanwhile, a rule from the Federal Council of Medicine (CFM) prevents thousands of doctors specialized in postgraduate courses offered by federal universities, and even from renowned medical institutions, from publicizing their specializations.

According to Federal Law 3,268, doctors with diplomas and titles registered with the MEC and registered with the Regional Councils of Medicine (CRM) are qualified to practice medicine in any of their specialties. But a CFM resolution created a private model with powers to define the fate of medical specialties.

Unlike all other professions, including the health sector, postgraduate courses accredited by the MEC do not grant the doctor the title of specialist. To present their specialty, the professional needs to attend residency or take one of the postgraduate courses accredited by private medical societies linked to the Brazilian Medical Association (AMB). In other words, it is not the highest education body in Brazil that says which courses can confer the title of specialist on doctors, but it is a private entity who does so.

Strong action by the MEC is needed to democratize access to medical specialization and take the power to define who can or cannot be a specialist out of the hands of private entities. The highest body must create a commission to establish strict standards and criteria for specialist training courses that are offered in Brazil.

Until this is done, we will see this social gap increase even further: on the one hand, we will have millions of Brazilians without access to care in specialties such as psychiatry, geriatrics, neurology, among others, while, on the other hand, private entities further elitize the specialized medicine and restrict it to a privileged group that can pay dearly for insurance plans and private consultations.