RAMB NOVEMBRO

lias

710

ssoc

ras

2016; 62(8):709-710

136 medical schools were created. Today, there are 242

schools, and most do not have minimum conditions to

train a good doctor. The government authorized schools

in municipalities that do not have even a primary care

hospital, and with faculty members whose professorial

titles are not sufficient for the position. Many of these

schools do not have a teaching hospital. They sign agree-

ments with public or private hospitals, which are not pre-

pared to allow training, and students are often left with

assisting physicians unprepared for the task. What is the

point of having thousands of doctors, if training is so

precarious? In the absence of qualified teachers, appropri-

ate mentoring or well equipped hospitals, it will be impos-

sible to train good professionals. “The reckless authorization

of medical degrees penalizes students who, innocently, pay

up to BRL 9,000 a month in private institutions for the

questionable benefit of poor tuition,” says Lopes.

The government’s proposal is to increase by 65% the

number of vacancies in medicine until 2017. The prob-

lem is that the new courses planned as part of the Mais

Médicos Program will accept professors who do not have

MSc or PhD degrees, simply because there is a shortage

of such professionals. It will be a matter of blind students

being guided by blind, unqualified, lecturers, according

to Lopes. Fifty-nine percent (59.2%) of the medical grad-

uates in São Paulo failed the 2013 edition of the Region-

al Board of Medicine of São Paulo (Cremesp, in the Por-

tuguese acronym) examination, revealing the poor

training given by medical schools without proper structure

for medical training. The Temer government should im-

mediately prohibit the opening of new medical schools,

and close all the schools that do not have qualified teach-

ers and their own teaching hospitals.

ais

édicos

rogram

Despite being a good idea, in principle, to bring health

care to remote and poor locations, the Mais Médicos

Program (literally meaning “more doctors”) was designed

in haste and took advantage of a troubled political mo-

ment, with a clear intention of transferring resources to

countries under the rule of a dictatorship. This is shown

by the huge amount of Cuban physicians enrolled in the

program to the detriment of other nationalities, including

Brazilian doctors. The idea that those remote and needy

communities had inadequate health care not only due to

a lack of medical professionals, but especially due to a

lack of minimal structure to provide decent service with

laboratory testing, imaging exams, hospital facilities, and

multidisciplinary teams, has never been raised. The

old-fashioned and poetic view of the socialist barefoot

doctor, armed with a prescription slip, stamp, and stetho-

scope, prevailed as if that was enough to solve the complex

health problems of the poor in Brazil

Physicians, even

those excellently trained, cannot performmiracles. Health

care is offered with the support of equipment, tests, hos-

pital infrastructure, multidisciplinary team etc.

antas

asas

the

“

holy

houses

of mercy

”

The precarious situation of Santas Casas (public hospitals

whose name literally means “holy houses”) is a major

concern in Brazil. These are secular institutions across

the country, responsible for much of the medical care

provided by SUS. They receive much less than they spend,

are always in debt and often badly managed.

These institutions use a SUS fee schedule that has

been lagged for over 10 years. Of every BRL 100 spent, the

hospital receives only BRL 60. This is most definitely a

public shame. Compensation for health should at least

keep pace with inflation. Rogatti, in a recent speech at the

Federation of Industries of the State of São Paulo (FIESP,

in the Portuguese acronym), mentioned some difficulties

faced by Santas Casas, including the lack of money in the

health budget, payments that are invoiced only after the

completion of procedures, and the need to redefine the

ceiling of funds to be transferred to some institutions.

Writing off tax debts makes no difference, he explained,

because most of the debt is with banks. In this meeting

on the situation of Santas Casas held at FIESP, the thought

that the health management model is scrapped and needs

to be modified as urgently as possible was consensus. “We

have no doubt that the budget is not right and we have

to change the current bad management,” he said.

Since the expenses above are greater than the funds

given by the government, these hospitals end up resorting

to bank loans with unpayable interest. This leads to the

collapse of these secular charities, which are responsible

for much of the public medical assistance in the country.

onclusion

Therefore, and in light of the problems above, we expect

the new government to use good judgment and strive hard

to solve health problems in Brazil, abandoning the dema-

gogic and populist solutions of the previous government.

eferences

Articles published in the

Folha de S.Paulo

newspaper, and

a lecture on Santas Casas held at the Federação das In-

dústrias do Estado de São Paulo (FIESP).