The role of private education in the selection of primary care careers in low and middle-income countries. Findings from a representative survey of medical residents in Brazil

Imagem de Miniatura
Arquivos
art_RUSSO_The_role_of_private_education_in_the_selection_2020.PDF (890.06 KB)
Citações na Scopus
3
Tipo de produção
article
Data de publicação
2020
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
BMC
Autores
RUSSO, Giuliano
Citação
HUMAN RESOURCES FOR HEALTH, v.18, n.1, article ID 11, 10p, 2020
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background Primary health care (PHC) doctors' numbers are dwindling in high- as well as low-income countries, which is feared to hamper the achievement of Universal Health Coverage goals. As a large proportion of doctors are privately educated and private medical schools are becoming increasingly common in middle-income settings, there is a debate on whether private education represents a suitable mean to increase the supply of PHC physicians. We analyse the intentions to practice of medical residents in Brazil to understand whether these differ for public and private schools. Methods Drawing from the literature on the selection of medical specialties, we constructed a model for the determinants of medical students' intentions to practice in PHC, and used secondary data from a nationally representative sample of 4601 medical residents in Brazil to populate it. Multivariate analysis and multilevel cluster models were employed to explore the association between perspective physicians' choice of practice and types of schools attended, socio-economic characteristics, and their values and opinions on the profession. Results Only 3.7% of residents in our sample declared an intention to practice in PHC, with no significant association with the public or private nature of the medical schools attended. Instead, having attended a state secondary school (p = 0.028), having trained outside Brazil's wealthy South East (p < 0.001), not coming from an affluent family (p = 0.037), and not having a high valuation of career development opportunities (p < 0.001) were predictors of willingness to practice in PHC. A low consideration for quality of life, for opportunities for treating patients, and for the liberal aspects of the profession were also associated with future physicians' intentions to work in primary care (all p < 0.001). Conclusions In Brazil, training in public or private medical schools does not influence the intention to practice in PHC. But students from affluent backgrounds, with private secondary education, and graduating in the rich South East were found to be overrepresented in both types of training institutions, and this is what appears to negatively impact the selection of PHC careers. With a view to increasing the supply of PHC practitioners in middle-income countries, policies should focus on opening medical schools in rural areas and improving access for students from disadvantaged backgrounds.
Palavras-chave
Primary care and UHC, Medical education in LMICs, Private medical schools, Physicians in Brazil, Choice of medical specialties, Family medicine in LMICs
URI
https://observatorio.fm.usp.br/handle/OPI/36050
Referências
  1. Almeida N, 2011, LANCET, V377, P1898, DOI 10.1016/S0140-6736(11)60326-7
  2. Guilloux AGA, 2019, BMC MED EDUC, V19, DOI 10.1186/s12909-019-1562-6
  3. Bai XL, 2019, J CLIN NURS, V28, P2101, DOI 10.1111/jocn.14791
  4. Puertas EB, 2013, REV PANAM SALUD PUBL, V34, P351
  5. BLAND CJ, 1995, ACAD MED, V70, P620, DOI 10.1097/00001888-199507000-00013
  6. Bodenheimer T, 2007, ANN INTERN MED, V146, P301, DOI 10.7326/0003-4819-146-4-200702200-00011
  7. Brooks RG, 2002, ACAD MED, V77, P790, DOI 10.1097/00001888-200208000-00008
  8. Burgess S, 2013, STAT MED, V32, P4726, DOI 10.1002/sim.5871
  9. Cavalcante Neto Pedro Gomes, 2009, Rev. bras. educ. med., V33, P198, DOI 10.1590/S0100-55022009000200006
  10. Core R, 2018, LANG ENV STAT COMP
  11. Creed PA, 2010, SOC SCI MED, V71, P1084, DOI 10.1016/j.socscimed.2010.06.027
  12. de Oliveira FP, 2015, INTERFACE-BOTUCATU, V19, P623, DOI 10.1590/1807-57622014.1142
  13. DSILVA J, 2015, [No title captured], V350, DOI 10.1136/BMJ.H106
  14. Dutra Fabiana Caetano Martins Silva e, 2016, Fisioter. Pesqui., V23, P98, DOI 10.1590/1809-2950/14900923012016
  15. Escolas Medicas do Brasil, 2019, VAL MENS CURS MED PR
  16. Ferrinho P, 2015, HUM RESOUR HEALTH, V13, DOI 10.1186/s12960-015-0004-8
  17. Ferrinho P, 2011, HUM RESOUR HEALTH, V9, DOI 10.1186/1478-4491-9-9
  18. Fronteira I, 2014, HUM RESOUR HEALTH, V12, DOI 10.1186/1478-4491-12-63
  19. Gadelha C. A. G., 2013, Health, V5, P1607, DOI 10.4236/health.2013.510217
  20. Gill H, 2012, CAN FAM PHYSICIAN, V58, pE649
  21. Girardi SN, 2017, CAD SAUDE PUBLICA, V33, DOI 10.1590/0102-311X00075316
  22. Hamaker EL, 2011, HDB ADV MULTILEVEL A
  23. Harris JE, 2013, BMJ OPEN, V3, DOI 10.1136/bmjopen-2012-002051
  24. Harvey A, 2005, CAN MED ASSOC J, V172, P737, DOI 10.1503/cmaj.1040146
  25. Jolly P, 2013, ACAD MED, V88, P468, DOI 10.1097/ACM.0b013e318285199d
  26. Kim YY, 2016, HUM RESOUR HEALTH, V14, DOI 10.1186/s12960-016-0141-8
  27. Kiolbassa K, 2011, BMC FAM PRACT, V12, DOI 10.1186/1471-2296-12-25
  28. Lambert T, 2011, BRIT J GEN PRACT, V61, DOI 10.3399/bjgp11X583173
  29. Li J, 2018, J HEALTH ECON, V62, P45, DOI 10.1016/j.jhealeco.2018.09.005
  30. de Souza LCL, 2015, PLOS ONE, V10, DOI 10.1371/journal.pone.0133585
  31. Macinko J, 2015, NEW ENGL J MED, V372, P2177, DOI 10.1056/NEJMp1501140
  32. Mahal A, 2006, MED EDUC, V40, P1009, DOI 10.1111/j.1365-2929.2006.02560.x
  33. MANSKI CF, 1990, J AM STAT ASSOC, V85, P934, DOI 10.2307/2289590
  34. Marten R, 2014, LANCET, V384, P2164, DOI 10.1016/S0140-6736(14)60075-1
  35. Matsumoto M, 2010, HEALTH POLICY, V96, P239, DOI 10.1016/j.healthpol.2010.02.008
  36. Mcpake B, 2015, 99535 WORLD BANK, P1
  37. Miotto BA, 2018, BMC HEALTH SERV RES, V18, DOI 10.1186/s12913-018-3076-z
  38. Mullan F, 2010, ANN INTERN MED, V152, P804, DOI 10.7326/0003-4819-152-12-201006150-00009
  39. Mwandigha LM, 2018, BMJ OPEN, V8, DOI 10.1136/bmjopen-2017-020291
  40. Nair M, 2010, MED EDUC, V44, P856, DOI 10.1111/j.1365-2923.2010.03747.x
  41. Ormerod JT, 2011, STAT MED, V30, P1326, DOI [10.1002/sim.4181, DOI 10.1002/SIM.4181]
  42. Park S, 2005, NURS RES, V54, P406, DOI 10.1097/00006199-200511000-00007
  43. Scheffer MC, 2015, HUM RESOUR HEALTH, V13, DOI 10.1186/s12960-015-0095-2
  44. Scheffer MC, 2016, REV ASSOC MED BRAS, V62, P853, DOI 10.1590/1806-9282.62.09.853
  45. Smith F, 2015, J ROY SOC MED, V108, P396, DOI 10.1177/0141076815599674
  46. Steven K, 2016, BMC MED EDUC, V16, DOI 10.1186/s12909-016-0536-1
  47. Taber BJ, 2011, J VOCAT BEHAV, V78, P202, DOI 10.1016/j.jvb.2010.09.006
  48. Watkins DA, 2018, LANCET, V392, P1434, DOI 10.1016/S0140-6736(18)32389-4
  49. Weissman C, 2012, ISR J HEALTH POLICY, V1, DOI 10.1186/2045-4015-1-13
  50. Yang YH, 2019, BMJ OPEN, V9, DOI 10.1136/bmjopen-2018-022097

Coleções
Artigos e Materiais de Revistas Científicas - FM/MPR
Artigos e Materiais de Revistas Científicas - LIM/24
Artigos e Materiais de Revistas Científicas - LIM/39
Artigos e Materiais de Revistas Científicas - ODS/03
Artigos e Materiais de Revistas Científicas - ODS/04
Artigos e Materiais de Revistas Científicas - ODS/10