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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].

BBC celebrates 400th anniversary of the publication of Shakespeare’s ‘First Folio’ with ambitious pan-BBC season

    November marks 400 years since
arguably the greatest work of English literature
was created, the ‘First Folio’, published seven
years after the death of William Shakespeare
[5] and without which much of his work would
have been lost for future generations to enjoy
today.
    The BBC is celebrating this
extraordinary anniversary with an ambitious
[10] season of content across TV, Radio, BBC iPlayer
& BBC Sounds exploring why, 400 years on,
Shakespeare's relevance and influence is as
strong as ever. A wealth of programming
featuring major actors and leading experts,
[15] including new documentaries, performance, 

music, drama, comedy, news coverage and the
best of the BBC archive, as well as special items
on flagship BBC shows, will celebrate the man,
his world and his timeless writing.
[20]    Suzy Klein, Head of BBC Arts and
Classical TV, says: “Shakespeare lived in a
dangerous age of plague, violence, vicious
rivalries and political assassinations and his
very survival is something of a miracle. His work
[25] was almost lost to history, and without the First
Folio being published in 1623, eighteen of his
greatest plays would have been lost forever.
We would have none of those immortal
characters such as Cleopatra and Marc
[30] Anthony, Macbeth or Malvolio, Prospero and
Ariel. Shakespeare changed the way we talk,
the words we use, our films, books,
catchphrases and memes, the very way we
think – and yet we know very little about him.
[35] This major new season pieces together the
clues from his life and work to reveal the
driving forces behind the glover's son from
Stratford upon Avon who became the greatest
writer that ever lived.”
[40]    Charlotte Moore, BBC Chief Content
Officer, says: “The BBC has a rich history of
showcasing Shakespeare and bringing his works
alive to successive generations. The 400th
anniversary of the publication of the First Folio
[45] is an important opportunity to build on this
legacy with an ambitious array of programming
across the BBC celebrating the genius of our
greatest writer. With documentaries,
performance, music, drama, comedy and
[50] educational content as well as the very best of
the BBC’s extraordinary archive, this season
demonstrates our commitment to offering
audiences programming they wouldn’t find
anywhere else.”
[55]    The centrepiece of the season is a
gripping three-part documentary series for BBC
Two and iPlayer, Shakespeare: Rise of a
Genius, featuring an A-list cast of actors,
including Dame Judi Dench, Dame Helen
[60] Mirren, Brian Cox, Adrian Lester, Lolita
Chakrabarti, Martin Freeman and Jessie
Buckley, alongside academics and writers James
Shapiro, Jeanette Winterson, Lucy Jago , Jeremy
O’Harris and Ewan Fernie - who provide fresh
[65] insights into the incredible story of our greatest
writer, the place and time he inhabited and the
work he produced. The series is made by 72
Films (a Fremantle company), the award-

winning producers of Rise of the Nazis,
[70] Elizabeth’s Secret Agents.
    Contributing to the series, Dame Judi
Dench, says: “His understanding of everything,
of love, of anger, of jealousy, of rage, 

melancholy – who did it better, who has ever
[75] done it better? I wish I’d met him, oh I wish I’d
met him.”
    Accompanying the series, BBC Four
will feature a star-studded selection of archive
performances with specially filmed
[80] introductions from David Tennant on
Hamlet, Sir Richard Eyre on King
Lear, Dame Janet Suzman on Wars of the
Roses, Gregory Doran on the Shakespeare Gala
from the RSC, Russell T Davies on A
[85] Midsummer Night’s Dream, Dame Helen
Mirren on As You Like It, Hugh Quarshie on
Othello and Steven Berkoff on Hamlet at
Elsinore.
    BBC Four will be showing a number of
[90] acclaimed performances of Shakespeare's
greatest plays including Hamlet from the Bristol
Old Vic featuring rising star Billy Howle in the
title role; Henry V from Shakespeare’s Globe
with Jamie Parker in the lead role; the
[95] RSC’s Henry VI Part 1 with Sir Antony Sher in
the role of Falstaff; and the RSC’s Much Ado
About Nothing.
    On BBC Radio 4 – Dame Judi Dench,
one of Britain’s foremost Shakespearean actors
[100] will be John Wilson’s guest on This Cultural
Life. A special edition of Front Row: 1623
Review Show will see the panel and guests go
back in time to review the music, poems and
plays from the year that the First Folio was
[105] published. In addition, First Folio, a new semi

fictionalised comic drama tells the story of the
creation of the first book of Shakespeare’s
plays.
    Radio 3 will dedicate a day exclusively
[110] to music inspired by Shakespeare, while Drama
on 3: The Hamlet Season will feature three
contemporary dramas based on Hamlet, the
Shakespearean play that has been put on the
most times around the world.
[115]    In addition, BBC Teach will publish a
collated collection of resources for primary and
secondary schools to mark the anniversary,
including a new nine-part video animation of
Romeo and Juliet for primary schools.

Adapted from: https://www.bbc.com/mediacentre/2023/shakespeare-first-folio-400-anniversary