Tiago Villanueva: Why does Brazil want to recruit doctors from Spain and Portugal?

Tiago_VillanuevaI recently met up with a Portuguese friend who works as a researcher and doctor in New York. She has an immense passion for Brazil and told me she would love to work there if she gets the opportunity to. Portuguese media have recently been flooded with reports that Brazil is considering recruiting doctors from Portugal and Spain as it is not training enough doctors to meet its needs.

According to a report by the Brazilian Ministry of Health, in the last ten years there were 146 867 posts available for doctors in Brazil, but only 93 156 doctors graduated during that period.

The report adds that Brazil has about 1.8 doctors per 1000 inhabitants. The ministry’s goal is to reach a figure of about 2,7 doctors per 1000 inhabitants, which corresponds to the number of doctors in the UK. According to the report, the UK is the country, “after Brazil, with the largest public health system with universal coverage.” And to do that, Brazil needs to recruit about 168 424 doctors.

At first glance, it may sound like a win-win situation. With the country facing tremendous financial constraints, the working conditions of Portuguese doctors have been getting progressively worse and many Portuguese doctors are now either leaving, or considering leaving the country in pursuit of greener pastures. Portugal’s health spending per capita in 2012 (14 474 euros) has been at an all time low in the past five years. Unemployment of doctors in Portugal is still residual, but may become a serious problem in the future, as I’ve explained in a previous blog. But in Spain, it seems even worse, with 2649 doctors registered in employment centres and receiving unemployment benefits in April 2013. Many newly qualified specialists in Spain are choosing to leave the country to avoid having to contend with short term contracts. Some are choosing to access a training position in a new specialty, which at least ensures a stable placement and salary for a few years.

When my friend talked about working in Brazil she was referring in particular to the large metropolitan areas of São Paulo and Rio de Janeiro, where health facilities, academic centres, resources, money, critical mass of professionals, and knowledge tend to cluster. But that does not seem to be the intention of the Brazilian Ministry of Health, which is aiming to recruit foreign doctors to work in the outskirts of large cities or in municipalities in remote rural areas of inner Brazil. It seems like Brazil is not considering recruiting doctors from neighbouring South American nations with fewer doctors per 1000 inhabitants like Bolivia and Paraguay.

There may be some advantages for Portuguese and Spanish doctors working in Brazil. They have cultural and linguistic affinities (particularly in the case of Portugal), and their training is well regarded in Brazil. However, they may be subject to examinations in order to validate their qualifications, which is important to appease Brazilian public opinion and medical associations, who are concerned about patient safety if the competence of foreign doctors is not scrutinised. Passing the exams would allow Portuguese and Spanish doctors to work in any geographical area in Brazil. There have been recent discussions about granting Portuguese doctors automatic recognition of their qualifications, but that would only enable them to work in certain regions of Brazil and for a limited number of years. The Portuguese Medical Association thinks that waiving professional competence checks for Portuguese doctors could be interpreted as disregarding Portuguese medicine.

An agreement was recently signed to mutually recognise Engineering and Architecture degrees between Portugal and Brazil, but medicine was not included. The Council of Deans of Portuguese Universities has called for similar treatment of medical degrees, arguing that it may be an easier task to harmonise the curriculums of medical degrees in both countries as medicine has a common curricular structure to all specialties.

I am really curious to see whether Brazil will develop enough pulling power to be able to attract Portuguese doctors, as the lack of resources and working conditions in many remote areas of inner Brazil makes it difficult to attract even Brazilian doctors to work there. According to the aforementioned report, only 1.79% of doctors working in Brazil qualified overseas, compared to 37% of doctors in the UK.

A recent article by Sophie Arie in the BMJ states that migration of healthcare professionals is now predominantly “south-north” rather than “east-west.” Indeed, Northern Europe remains very attractive in terms of opportunities to pursue specialist training and career development opportunities, and it is still the preferred destination for Portuguese and Spanish doctors wanting to work elsewhere. But non European destinations are also starting to become potential migration magnets for Portuguese and Spanish doctors.

It is important to note that Portugal continues to struggle with a considerable shortage of doctors, particularly in primary care and emergency departments, where a lot of the manpower consists of doctors from, ironically, Brazil (as well as other South American nations and Lusophone African countries).

Tiago Villanueva is a locum GP based in Portugal, and a former BMJ Clegg Scholar and editor, Student BMJ.