Questões de Inglês

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Making family medicine a more attractive specialty: strategies to address the shortage of primary care specialists in Brazil

Primary Health Care (PHC) is often the first level of the health system and is responsible for the coordination of medical and interdisciplinary care. As the preferred entry point to the Brazilian Unified Health System (SUS), PHC is of fundamental importance and is present in all regions of the country. It aims to enable access to health care and ensures the coordination and completeness of care. This structure can treat approximately 80% of the overall need related to diseases presented in the Basic Health Units.

Despite its importance, the valorization of PHC and Family Medicine (FM) as a discipline and a public policy has not been prioritized in most Brazilian educational institutions. According to the study on medical demography carried out by the Regional Medical Council of São Paulo (CREMESP), Brazil had 500,000 physicians in 2020, but with unequal distribution among the nation’s five regions, and a concentration of professionals in the capital cities compared to the countryside.

Although the Family Health Strategy (EFS) is considered a priority by the Ministry of Health, many regions of Brazil face difficulties in recruiting and, especially, retaining medical professionals for the field. In 2020, Brazil had 7,149 FM physicians, only 2,4% of all specialists in the country. Ongoing efforts to hire and retain physicians in rural areas remains challenging, and many vacancies remain, leaving residents without access to quality care.

This issue is faced by many countries. In the United States (US) of 8,116 primary care postgraduate training positions (which includes pediatrics, internal medicine, and family doctors), 42 percent were filled by graduates of U.S. medical schools and the American Association of Medical Colleges (AAMC) projects a shortage of 21,100 to 55,200 primary care physicians (PCP) by 2034. In Europe, where PCP was traditionally respected and recognized, the lack of General Practitioners (GP) is also increasing and is a matter of concern. Workload and a lack of perceived prestige associated with the PCP track can make primary care less attractive. These sorts of misconceptions, along with lower salaries, burnout, and difficult career advancement makes primary care a difficult specialty to attract and retain doctors.

For Feuerwerker, vacancies in Brazilian institutions are the result of several elements: the encouragement of distinctive specialties and institutions, the historical misunderstanding and importance of the practice, and the increased incentive of specialization in medical education. The lack of investments in supplies and infrastructure in primary care, career development concerns, and low salaries, and the valorization of the formation of FM doctors in the work of the EFS also contribute to difficulty in retaining these positions in Brazil.

With the aim to reduce the vacancy rate in the medical residency programs for FM, some Brazilian health departments introduced reforms and additional financing for FM training. In 2020, the region of Campinas, where we work, introduced a program called “More Doctors for the City of Campinas” (PMMC), which established a partnership between public and private higher education institutions, hospitals, and Urgency/Emergency Units with a novel post-graduation proposal for FM. It created a program to support the training of specialists in family medicine, stimulate research, and expand care in Basic Health Units, and has since resulted in a 50% decrease in vacancies.

One of the successful elements of the Campinas program, together with quality of medical training, is that it helps bring medical classroom training closer to the community and everyday social reality. PMMC-trained physicians are aware of how their work impacts the local community and its particular health needs. The program has resulted in care that is more responsive to community needs, especially from the perspective of adopting a care model that prioritizes health promotion, disease prevention, diagnosis, and treatment in an integrated manner. However, for the EFS to continue to innovate and improve its response capacity to contemporary health problems, it must invest heavily in professional training, the rational incorporation of information and communication technologies, and the creation of appropriate working conditions for multidisciplinary teams.

Disponível em: https://speakingofmedicine.plos.org/2023/01/13/. Acesso em: 4 mar. 2024. [Adaptado].

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Making family medicine a more attractive specialty: strategies to address the shortage of primary care specialists in Brazil

Primary Health Care (PHC) is often the first level of the health system and is responsible for the coordination of medical and interdisciplinary care. As the preferred entry point to the Brazilian Unified Health System (SUS), PHC is of fundamental importance and is present in all regions of the country. It aims to enable access to health care and ensures the coordination and completeness of care. This structure can treat approximately 80% of the overall need related to diseases presented in the Basic Health Units.

Despite its importance, the valorization of PHC and Family Medicine (FM) as a discipline and a public policy has not been prioritized in most Brazilian educational institutions. According to the study on medical demography carried out by the Regional Medical Council of São Paulo (CREMESP), Brazil had 500,000 physicians in 2020, but with unequal distribution among the nation’s five regions, and a concentration of professionals in the capital cities compared to the countryside.

Although the Family Health Strategy (EFS) is considered a priority by the Ministry of Health, many regions of Brazil face difficulties in recruiting and, especially, retaining medical professionals for the field. In 2020, Brazil had 7,149 FM physicians, only 2,4% of all specialists in the country. Ongoing efforts to hire and retain physicians in rural areas remains challenging, and many vacancies remain, leaving residents without access to quality care.

This issue is faced by many countries. In the United States (US) of 8,116 primary care postgraduate training positions (which includes pediatrics, internal medicine, and family doctors), 42 percent were filled by graduates of U.S. medical schools and the American Association of Medical Colleges (AAMC) projects a shortage of 21,100 to 55,200 primary care physicians (PCP) by 2034. In Europe, where PCP was traditionally respected and recognized, the lack of General Practitioners (GP) is also increasing and is a matter of concern. Workload and a lack of perceived prestige associated with the PCP track can make primary care less attractive. These sorts of misconceptions, along with lower salaries, burnout, and difficult career advancement makes primary care a difficult specialty to attract and retain doctors.

For Feuerwerker, vacancies in Brazilian institutions are the result of several elements: the encouragement of distinctive specialties and institutions, the historical misunderstanding and importance of the practice, and the increased incentive of specialization in medical education. The lack of investments in supplies and infrastructure in primary care, career development concerns, and low salaries, and the valorization of the formation of FM doctors in the work of the EFS also contribute to difficulty in retaining these positions in Brazil.

With the aim to reduce the vacancy rate in the medical residency programs for FM, some Brazilian health departments introduced reforms and additional financing for FM training. In 2020, the region of Campinas, where we work, introduced a program called “More Doctors for the City of Campinas” (PMMC), which established a partnership between public and private higher education institutions, hospitals, and Urgency/Emergency Units with a novel post-graduation proposal for FM. It created a program to support the training of specialists in family medicine, stimulate research, and expand care in Basic Health Units, and has since resulted in a 50% decrease in vacancies.

One of the successful elements of the Campinas program, together with quality of medical training, is that it helps bring medical classroom training closer to the community and everyday social reality. PMMC-trained physicians are aware of how their work impacts the local community and its particular health needs. The program has resulted in care that is more responsive to community needs, especially from the perspective of adopting a care model that prioritizes health promotion, disease prevention, diagnosis, and treatment in an integrated manner. However, for the EFS to continue to innovate and improve its response capacity to contemporary health problems, it must invest heavily in professional training, the rational incorporation of information and communication technologies, and the creation of appropriate working conditions for multidisciplinary teams.

Disponível em: https://speakingofmedicine.plos.org/2023/01/13/. Acesso em: 4 mar. 2024. [Adaptado].

Leia o texto a seguir para responder à questão.

Making family medicine a more attractive specialty: strategies to address the shortage of primary care specialists in Brazil

Primary Health Care (PHC) is often the first level of the health system and is responsible for the coordination of medical and interdisciplinary care. As the preferred entry point to the Brazilian Unified Health System (SUS), PHC is of fundamental importance and is present in all regions of the country. It aims to enable access to health care and ensures the coordination and completeness of care. This structure can treat approximately 80% of the overall need related to diseases presented in the Basic Health Units.

Despite its importance, the valorization of PHC and Family Medicine (FM) as a discipline and a public policy has not been prioritized in most Brazilian educational institutions. According to the study on medical demography carried out by the Regional Medical Council of São Paulo (CREMESP), Brazil had 500,000 physicians in 2020, but with unequal distribution among the nation’s five regions, and a concentration of professionals in the capital cities compared to the countryside.

Although the Family Health Strategy (EFS) is considered a priority by the Ministry of Health, many regions of Brazil face difficulties in recruiting and, especially, retaining medical professionals for the field. In 2020, Brazil had 7,149 FM physicians, only 2,4% of all specialists in the country. Ongoing efforts to hire and retain physicians in rural areas remains challenging, and many vacancies remain, leaving residents without access to quality care.

This issue is faced by many countries. In the United States (US) of 8,116 primary care postgraduate training positions (which includes pediatrics, internal medicine, and family doctors), 42 percent were filled by graduates of U.S. medical schools and the American Association of Medical Colleges (AAMC) projects a shortage of 21,100 to 55,200 primary care physicians (PCP) by 2034. In Europe, where PCP was traditionally respected and recognized, the lack of General Practitioners (GP) is also increasing and is a matter of concern. Workload and a lack of perceived prestige associated with the PCP track can make primary care less attractive. These sorts of misconceptions, along with lower salaries, burnout, and difficult career advancement makes primary care a difficult specialty to attract and retain doctors.

For Feuerwerker, vacancies in Brazilian institutions are the result of several elements: the encouragement of distinctive specialties and institutions, the historical misunderstanding and importance of the practice, and the increased incentive of specialization in medical education. The lack of investments in supplies and infrastructure in primary care, career development concerns, and low salaries, and the valorization of the formation of FM doctors in the work of the EFS also contribute to difficulty in retaining these positions in Brazil.

With the aim to reduce the vacancy rate in the medical residency programs for FM, some Brazilian health departments introduced reforms and additional financing for FM training. In 2020, the region of Campinas, where we work, introduced a program called “More Doctors for the City of Campinas” (PMMC), which established a partnership between public and private higher education institutions, hospitals, and Urgency/Emergency Units with a novel post-graduation proposal for FM. It created a program to support the training of specialists in family medicine, stimulate research, and expand care in Basic Health Units, and has since resulted in a 50% decrease in vacancies.

One of the successful elements of the Campinas program, together with quality of medical training, is that it helps bring medical classroom training closer to the community and everyday social reality. PMMC-trained physicians are aware of how their work impacts the local community and its particular health needs. The program has resulted in care that is more responsive to community needs, especially from the perspective of adopting a care model that prioritizes health promotion, disease prevention, diagnosis, and treatment in an integrated manner. However, for the EFS to continue to innovate and improve its response capacity to contemporary health problems, it must invest heavily in professional training, the rational incorporation of information and communication technologies, and the creation of appropriate working conditions for multidisciplinary teams.

Disponível em: https://speakingofmedicine.plos.org/2023/01/13/. Acesso em: 4 mar. 2024. [Adaptado].

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Plastic Waste In The Oceans

    In the last few years there has been more and more evidence that plastic pollution in our oceans is becoming a massive problem. Large pieces of plastic which end up in the sea can entangle marine animals or can also suffocate them.

    Tiny pieces of plastic — broken down by the action of water and the sun — cause harm by entering the marine food chain. If the animals eat plastic it will make them feel artificially full so that they do not eat and they starve to death. Furthermore, when fish have eaten plastic it becomes part of their body; if we then eat that fish our food contains plastic — we are eating our own plastic waste.

Infographic

(www.reducereuserecycle.co.uk. Adaptado.)

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    They power tiny phones and two-tonne electric cars. They form the guts of a growing number of grid-storage systems1 that smooth the flow of electricity from wind and solar power stations. Without them, the electrification needed to avoid the worst effects of global warming would be unimaginable.

    But lithium-ion (Li-ion) batteries have downsides. Lithium is scarce, for one. And the best Li-ion batteries, those with layered-oxide cathodes, also require cobalt and nickel. These metals are scarce, too — and cobalt is also problematic because a lot of it is mined in the Democratic Republic of Congo, where working conditions leave much to be desired. A second sort of Li-ion battery, a so-called polyanionic design that uses lithium iron phosphate (LFP), does not need nickel or cobalt. However, such batteries cannot store as much energy per kilogram as layered-oxide ones.

    A group of companies, though, think they have an alternative: making batteries with sodium instead. Unlike lithium, sodium is abundant: it makes up most of the salt in the oceans. And chemists have found that layered-oxide cathodes which use sodium rather than lithium can get by without cobalt or nickel to increase their quality. The idea of making sodium-ion (Na-ion) batteries at scale is therefore gaining traction. Engineers are adjusting designs. Factories, particularly in China, are springing up. For the first time since the Li-ion revolution began, lithium’s place on the electrochemical pedestal is being challenged.

(www.economist.com, 25.10.2023. Adaptado.)

¹grid-storage system: sistema de armazenamento de energia elétrica.

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    They power tiny phones and two-tonne electric cars. They form the guts of a growing number of grid-storage systems1 that smooth the flow of electricity from wind and solar power stations. Without them, the electrification needed to avoid the worst effects of global warming would be unimaginable.

    But lithium-ion (Li-ion) batteries have downsides. Lithium is scarce, for one. And the best Li-ion batteries, those with layered-oxide cathodes, also require cobalt and nickel. These metals are scarce, too — and cobalt is also problematic because a lot of it is mined in the Democratic Republic of Congo, where working conditions leave much to be desired. A second sort of Li-ion battery, a so-called polyanionic design that uses lithium iron phosphate (LFP), does not need nickel or cobalt. However, such batteries cannot store as much energy per kilogram as layered-oxide ones.

    A group of companies, though, think they have an alternative: making batteries with sodium instead. Unlike lithium, sodium is abundant: it makes up most of the salt in the oceans. And chemists have found that layered-oxide cathodes which use sodium rather than lithium can get by without cobalt or nickel to increase their quality. The idea of making sodium-ion (Na-ion) batteries at scale is therefore gaining traction. Engineers are adjusting designs. Factories, particularly in China, are springing up. For the first time since the Li-ion revolution began, lithium’s place on the electrochemical pedestal is being challenged.

(www.economist.com, 25.10.2023. Adaptado.)

¹grid-storage system: sistema de armazenamento de energia elétrica.