Internal migration of physicians who graduated in Brazil between 1980 and 2014

Background: The internal migration of physicians from one place to another in the same country can unbalance the supply and distribution of these professionals in national health systems. In addition to economic, social and demographic issues, there are individual and professional factors associated with a physician’s decision to migrate. In Brazil, there is an ongoing debate as to whether opening medicine programmes in the interior of the country can induce physicians to stay in these locations. This article examines the migration of physicians in Brazil based on the location of the medical schools from which they graduated. Methods: A cross-sectional design based on secondary data of 275,801 physicians registered in the Regional Councils of Medicine (Conselhos Regionais de Medicina-CRMs) who graduated between 1980 and 2014. The evaluated outcome was migration, which was defined as moving away from the state where they completed the medicine programme to another state where they currently work or live. Results: 57.3% of the physicians in the study migrated. The probability of migration ratio was greater in small grouped municipalities and lower in state capitals. 93.4% of the physicians who trained in schools located in cities with less than 100,000 inhabitants migrated. Fewer women (54.2%) migrated than men (60.0%). More than half of the physicians who graduated between 1980 and 2014 are in federative units different from the unit in which they graduated. Individual factors, such as age, gender, time of graduation and specialty, vary between the physicians who did or did not migrate. Conclusions: The probability of migration ratio was greater in small municipalities of the Southeast region and strong in the states of Tocantins, Acre and Santa Catarina. New studies are recommended to deepen understanding of the factors related to the internal migration and non-migration of physicians to improve human resource for health policies.

Surgical care in the public health agenda.

The current article examines surgical care as a public health issue and a challenge for health systems organization. When surgery fails to take place in timely fashion, treatable clinical conditions can evolve to disability and death. The Lancet Commission on Global Surgery defined indicators for monitoring sustainable universal access to surgical care. Applied to Brazil, the global indicators are satisfactory, but the supply of surgeries in the country is marked by regional and socioeconomic inequalities, as well as between the public and private healthcare sectors.

Surgical care in the public health agenda / Cuidados cirúrgicos na agenda da saúde pública / Asistencia quirúrgica en la agenda de salud pública

The current article examines surgical care as a public health issue and a challenge for health systems organization. When surgery fails to take place in timely fashion, treatable clinical conditions can evolve to disability and death. The Lancet Commission on Global Surgery defined indicators for monitoring sustainable universal access to surgical care. Applied to Brazil, the global indicators are satisfactory, but the supply of surgeries in the country is marked by regional and socioeconomic inequalities, as well as between the public and private healthcare sectors.

O presente artigo aborda os cuidados cirúrgicos como um problema de saúde pública e um desafio para a organização dos sistemas de saúde. Se cirurgias não ocorrerem em tempo adequado, situações clínicas tratáveis podem evoluir para incapacidades e mortes. A Lancet Commission on Global Surgery definiu indicadores para o monitoramento do acesso universal sustentável à assistência cirúrgica. Aplicados ao Brasil, os indicadores globais são satisfatórios, porém a oferta de cirurgias no País é marcada por desigualdades entre regiões, entre estratos socioeconômicos e entre os setores público e privado da saúde.

El presente artículo aborda la asistencia quirúrgica como un problema de salud público y un desafío para la organización de los sistemas de salud. Si no se ejecutan cirugías en el momento adecuado, situaciones clínicas tratables pueden evolucionar en incapacidades y muertes. La Lancet Commission on Global Surgery definió indicadores para la supervisión del acceso universal sostenible a la asistencia quirúrgica. Aplicados a Brasil, los indicadores globales son satisfactorios, aunque la oferta de cirugías en el país está marcada por desigualdades entre regiones, entre estratos socioeconómicos y entre los sectores público y privado de salud.