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Sick notes: the state of healthcare was the focus of recent demonstrations

Academics in Brazil have warned that the government’s decision to introduce two years of compulsory service in the public sector for trainee doctors will make medicine an elitist profession.

The changes to the university curriculum leave students facing eight years of training instead of six from 2015, with residencies at public hospitals and clinics added to medical courses.

Specialists criticised the decision, which was announced by the government as part of a recruitment drive to hire 10,000 new doctors for deprived areas.

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The state of public healthcare in Brazil – the Unified Health System (SUS) – was one of the focal points of the mass demonstrations that swept the country last month. The Mais Médicos (“More Doctors”) initiative was unveiled by the government in response.

The move to include mandatory service in public hospitals was said to be inspired by the UK’s NHS.

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“We are bringing a revolutionary experience of medical training that Britain started and other countries have adopted,” said Aloizio Mercadante, the education minister.

But there are fears that the government has soured relations with the middle classes and universities by enforcing the changes from above.

It has already led to protests: last week, hundreds of doctors took to the streets in Rio de Janeiro and São Paulo to demonstrate against the plans, which also include hiring more foreign doctors to fill vacancies in poor areas.

Durval Damiani, professor at the Paediatric Endocrinology Unit at the University of São Paulo Medical School, said the decision would make medicine an elitist career.

“On average, a student spends four years preparing for the entrance exam to enrol on a medical course, after which there [will be] another eight years,” he told Brazilian website R7.

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“After the residency, how old will they be when they graduate? No one has the motivation.”

Exploitation fears

Under Mais Médicos, student doctors would study the current curriculum for six years before spending the seventh and eighth years working with a temporary medical licence.

Medical bodies, including the Federal Council of Medicine, have responded with concerns that trainee doctors would be exploited under the changes.

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“It is a move that favours the exploitation of labour,” four national medical associations say in a joint statement. “We cannot forget that students already complete traineeships in the last stages of their courses and spend three to five years in medical residency courses, usually in units linked to the SUS.”

The National Education Council is said to be considering extending the compulsory public service concept to other careers, including dentistry, psychology, nursing and physiotherapy.

But Milton de Arruda Martins, professor of clinical medicine at USP and former civil servant in the Ministry of Health, said the “best solution” was to boost healthcare resources.

“The experience of many countries has shown that to have doctors in remote or deprived areas, there is a need for [not only] an adequate salary but also adequate working conditions, security, diagnostic resources, opportunities for continuing education and professional stability,” he said.

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