MARIO CESAR SCHEFFER
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Medicina Preventiva, Faculdade de Medicina - Docente
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina - Líder
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- 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(2020) RUSSO, Giuliano; CASSENOTE, Alex J. Flores; GUILLOUX, Aline G. Alves; SCHEFFER, Mario CesarBackground 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.
- Evolution of Gender Disparities Among Brazilian Surgical, Anesthesia, and Obstetric Providers(2022) FERREIRA, Julia; BOWDER, Alexis N.; FARIA, Isabella; GRANER, Mariana; BUDA, Alexandra M.; ZIMMERMAN, Kathrin; TRUCHE, Paul; POMPERMAIER, Laura; BOTELHO, Fabio; ALONSO, Nivaldo; SCHEFFER, Mario Cesar; GUILLOUX, Aline Gil AlvesIntroduction: Since 2010, most graduating physicians in Brazil have been female, nevertheless gender disparities among surgical specialties still exist. This study aims to explore whether the increase in female physicians has translated to increased female representation among surgical specialties in Brazil. Methods: Data on gender, years of practice, and specialty was extracted from Demografia Medica do Brasil, from 2015 to 2020. The percentage of women across 18 surgical, anesthesia, and obstetric (SAO) specialties and the relative increases in female representation during the study period were calculated. Results: Of the 18 SAO specialties studied, 16 (88%) were predominantly male (>50%). Only obstetrics/gynecology and breast surgery showed a female predominance, with 58% and 52%, respectively. Urology, neurosurgery, and orthopedic surgery and traumatology were the three specialties with the largest presence of men -and the lowest absolute growth in the female workforce from 2015 to 2020. Conclusions: In Brazil, where significant gender disparities persist, women are still underrepresented in surgical specialties. Female presence is predominant in surgical specialties dedicated to the care of female patients, while it remains poor in those with male patient dominance. Over the last 5 y, the proportion of women working in SAO specialties has grown, but not as much as in nonsurgical specialties. Future studies should focus on investigating the causes of gender disparities in Brazil to understand and tackle the barriers to pursuing surgical specialties.
- Brazilian infectious diseases specialists: who and where are they?(2016) CASSENOTE, Alex Jones Flores; SCHEFFER, Mario Cesar; SEGURADO, Aluisio Augusto CotrimBackground: The infectious diseases specialist is a medical doctor dedicated to the management of infectious diseases in their individual and collective dimensions. Objectives: The aim of this paper was to evaluate the current profile and distribution of infectious diseases specialists in Brazil. Methods: This is a cross-sectional study using secondary data obtained from institutions that register medical specialists in Brazil. Variables of interest included gender, age, type of medical school (public or private) the specialist graduated from, time since finishing residency training in infectious diseases, and the interval between M.D. graduation and residency completion. Maps are used to study the geographical distribution of infectious diseases specialists. Results: A total of 3229 infectious diseases specialist registries were counted, with 94.3% (3045) of individual counts (heads) represented by primary registries. The mean age was 43.3 years (SD 10.5), and a higher proportion of females was observed (57%; 95% CI 55.3-58.8). Most Brazilian infectious diseases specialists (58.5%) practice in the Southeastern region. However, when distribution rates were calculated, several states exhibited high concentration of infectious diseases specialists, when compared to the national rate (16.06). Interestingly, among specialists working in the Northeastern region, those trained locally had completed their residency programs more recently (8.7 yrs; 95% CI 7.9-9.5) than physicians trained elsewhere in the country (13.6 yrs: 95% CI 11.8-15.5). Conclusion: Our study shows that Brazilian infectious diseases specialists are predominantly young and female doctors. Most have concluded a medical residency training program. The absolute majority practice in the Southeastern region. However, some states from the Northern, Northeastern and Southeastern regions exhibit specialist rates above the national average. In these areas, nonetheless, there is a strong concentration of infectious diseases specialists in state capitals and in metropolitan areas. (C) 2016 Published by Elsevier Editora Ltda.
- Financialization in healthcare(2022) BAHIA, Ligia; SCHEFFER, Mario
- The privatization of medical education in Brazil: trends and challenges(2015) SCHEFFER, Mario C.; POZ, Mario R. DalBackground: Like other countries, Brazil is struggling with issues related to public policies designed to influence the distribution, establishment, supply and education of doctors. While the number of undergraduate medical schools and places available on medical schools has risen, the increase in the number of doctors in Brazil in recent decades has not benefitted the population homogeneously. The government has expanded the medical schools at the country's federal universities, while providing incentives for the creation of new undergraduate courses at private establishments. This article examines the trends and challenges of the privatization of medical education in Brazil. Methods: This is a descriptive, cross-sectional study based on secondary data from official government databases on medical schools and courses and institutions offering such courses in Brazil. It takes into account the year when the medical schools received authorization to initiatte the activities, where they are situated, whether they are run by a public or private entity, how many places they offer, how many students they have enrolled, and their performance according to Ministry ofEducation evaluations. Results: Brazil had 241 medical schools in 2014, offering a total of 20,340 places. The private higher education institutions are responsible for most of the enrolment of medical students nationally (54 %), especially in the southeast. However, enrolment in public institutions predominate more in the capitals than in other cities. Overal, the public medical schools performed better than the private schools in the last two National Exam of Students' (ENADE). Conclusion: The privatization of the teaching of medicine at undergraduate level in Brazil represents a great challenge: how to expand the number of places while assuring quality and democratic access to this form of education. Upon seeking to understand the configuration and trends in medical education in Brazil, it is hoped that this analysis may contribute to a broader research agenda in the future.
- The state of the surgical workforce in Brazil(2017) SCHEFFER, Mario C.; GUILLOUX, Aline G. A.; MATIJASEVICH, Alicia; MASSENBURG, Benjamin B.; SALUJA, Saurabh; ALONSO, NivaldoBackground. A critical insufficiency of surgeons, anesthesiologists, and obstetricians exists around the world, leaving billions of people without access to safe operative care. The distribution of the surgical workforce in Brazil, however, is poorly described and rarely assessed. Though the surgical workforce is only one element in the surgical system, this study aimed to map and characterize the distribution of the surgical workforce in Brazil in order to stimulate discussion on future surgical policy reforms. Methods. The distribution of the surgical workforce was extracted from the Brazilian Federal Medical Board registry as of July 2014. Included in the surgical workforce were surgeons, anesthesiologists, and obstetricians. Results. There are 95,169 surgeons, anesthesiologists, and obstetricians in the surgical workforce of Brazil, creating a surgical workforce density of 46.55/100,000 population. This varies from 20.21/100,000 population in the North Region up to 60.32/100,000 population in the South Region. A total of 75.2% of the surgical workforce is located in the 100 biggest cities in Brazil, where only 40.4% of the population lives. The average age of a physician in the surgical workforce is 46.6 years. Women make up 30.0% of the surgical workforce, 15.8% of surgeons, 36.6% of anesthesiologists, and 53.8% of obstetricians and gynecologists. Conclusion. Brazil has a substantial surgical workforce, but inequalities in its distribution are concerning. There is an urgent need for increased surgeons, anesthesiologists, and obstetricians in states like Path, Amapa, and Maranhao. Female surgeons and anesthesiologists are particularly lacking in the surgical workforce, and incentives to recruit these physicians are necessary. Government policies and leadership from health organizations are required to ensure that the surgical workforce will be more evenly distributed in the future.
- Who and Where are the University of Sao Paulo Medical School Graduates?(2019) GAMEIRO, Gustavo Rosa; KOYAMA, Leonardo Kenji Sakaue; CRUZ, Ana Luisa Ito Baptista da; CASSENOTE, Alex Jones Flores; GUILLOUX, Aline Gil Alves; SEGURADO, Aluisio Augusto Cotrim; SCHEFFER, Mario CesarOBJECTIVE: To evaluate the impact of a complex-care-based medical school in the context of the Brazilian health care system on students' career choices. METHODS: This was a retrospective cross-sectional study based on medical regulatory organization records. It included records for 7,419 physicians who graduated from FMUSP. Geographic data were analyzed using Kernel maps, and the statistical analysis was performed with SPSS (R) version 24.0. A p-value less than 0.05 was considered significant. RESULTS: Of the 7,419 physicians, 68.6% (95% CI 67.5-69.7) were male, and 20.7% (95% CI 19.8%-21.7%) had no medical specialty, compared to 46.4% nationwide. Internal medicine and surgery-based specialties were more popular, accounting for 39.4% (95% CI 38.3%-40.5%) and 16.8% (95% CI 15.5%-17.6%) of our study group, compared to the Brazilian averages of 25.9% and 13.5%. Our graduates also had a higher probability of staying in Sao Paulo City, especially when born outside the city. CONCLUSION: We believe that FMUSP remains an interesting model for studying the impact of a highly specialized center on the education and career choices of medical students.
- O financiamento de campanhas pelos planos e seguros de saúde nas eleições de 2010(2013) SCHEFFER, Mário; BAHIA, LígiaIn the elections of 2010, the health insurance companies allocated R$ 11,8 million in official donations to campaigns of 153 candidates for elective office, which contributed to the election of 38 federal deputies, 26 state legislators, five senators, five governors and the president. Other 82 candidates received support, but were not elected. It is necessary to improve transparency of the funding and lobby of health plans, so that public and collective interests prevail in policy making, regulation and operation of the Brazilian health system.
- O capital estrangeiro e a privatização do sistema de saúde brasileiro(2015) SCHEFFER, Mario
- Beyond the Mais Medicos (More Doctors) Program(2016) SCHEFFER, Mario