How many and which physicians? A comparative study of the evolution of the supply of physicians and specialist training in Brazil and Spain.

BACKGROUND: In the face of the medical workforce shortage, several countries have promoted the opening of medical schools and the expansion of undergraduate and specialization education in medicine. Few studies have compared the characteristics and effects of expanding the supply of general practitioners and specialist physicians between countries. Brazil and Spain, two countries with distinct historical processes and socioeconomic scenarios, yet both with universal public health systems and common aspects in training and medical work, have registered a significant increase in the number of physicians and can be used to understand the challenges of strategic planning for the medical workforce. METHODS: This study provides a descriptive approach using longitudinal data from official databases in Brazil and Spain from 1998 to 2017. Among the comparable indicators, the absolute numbers of physicians, the population size, and the physician's ratio by inhabitants were used. The number of medical schools and undergraduate places in public and private institutions, the supply of residency training posts, and the number of medical specialists and medical residents per 100 000 inhabitants were also used to compare both countries. Seventeen medical specialties with the highest number of specialists and comparability between the two countries were selected for further comparison. RESULTS: Due to the opening of medical schools, the density of physicians per 1 000 inhabitants grew by 28% in Spain and 51% in Brazil between 1998 and 2017. In that period, Spain and Brazil increased the supply of annual undergraduate places by 60% and 137%, respectively. There is a predominance of private institutions providing available undergraduate places, and the supply of medical residency posts is smaller than the contingent of medical graduates/general practitioners each year. CONCLUSION: Both countries have similar specialist densities in cardiology, dermatology, and neurosurgery specialties. However, family medicine and community in Spain has 91.27 specialists per 100 000 inhabitants, while in Brazil, the density is only 2.64. The comparative study indicated the complexity of the countries' decisions on increasing the medical supply of general practitioners and specialist physicians. Research and planning policies on the medical workforce must be aligned with the actual health needs of populations and health systems.

[Analysis of the patient safety culture in a university hospital]. / Análisis de la cultura de seguridad del paciente en un hospital universitario.

OBJECTIVE: 1) To determine the perception of safety of health professionals and non-health professionals in a university hospital; 2) describe the climate of safety with its strengths and weaknesses; 3) evaluate the negatively valued dimensions and establish areas of improvement. METHOD: A cross-sectional and descriptive study carried out at the San Juan University Hospital in Alicante, where the results of the assessment of the safety culture level are collected using Hospital Survey On Patient Safety survey of the Agency for Healthcare Research and Quality adapted to Spanish language. RESULTS: The response rate was 35.36%. The group with the greatest participation was the physician (32.3%) and the service most involved, urgencies (9%). 86.4% had contact with the patient. 50% of workers rated the safety climate between 6 and 8 points. 82.8% did not report any adverse events in the last year. The professionals with the greatest security culture were the pharmacists and with the worst culture, the guards. No strength was identified globally. There were two dimensions that behaved like a weakness: 9 (staffing) and 10 (management support for patient safety). CONCLUSIONS: The patient's perception of safety is good, although it can be improved. No strengths have been identified. The weaknesses identified are staffing, management support for patient safety, handoffs and transitions, and safety perception.