Residência médica e os sistemas de saúde: o caso do Distrito Federal

Abstract

In 1963, residency programs started at Federal District, in Brasília, with creation of the first Residency Commission in 1964 (CINRE), a precursor to COREME, regulated by National Comission of Medical Residency (CNRM) in 1987. SES-DF is responsible for the management of 5 Teaching-Hospitals, 34 thousand health workers, a hospital complex, as well as for the investment of 120 million reais every 2 years in Medical Residency. Despite this, Medical Residency Programs (MRP) have been questioned by MEC. In the search to analyze the PRMs inserted in the local SUS, a quantitativequantitative study was conducted through a structured interview with 47 MRs from 3 teaching hospitals. Statistically significant data were: exclusive dedication of women to the Programs (p=0.03), greater investment of male physicians in the work for SUS (p=0.025) and greater pretension of work hours for professionals of clinical specialties than the surgical ones, after the end of the specialization (p=0.02). Most of medical residentes want to stay in the central-west region, reinforcing MR as a fixation factor for physicians; 45.8% of the professionals intend to complete weekly 40 hours of work, with 20 hour working in a public hospital and 20 hours in a private relationship; the main expectation of work place is the public hospital (85.4%); 25% intend to work in Primary Health Care. According to residents, there is a shortage of resources, professionals, infrastructure, examinations, medications, beds, minimum working conditions, management, administration, standardization of protocols, complex treatments, payment, stimulation of scientific production. The most negative points of the Medical Residency at Unified Health System were: infrastructure, the value of the scholarship, preceptory, the public health workers, the compulsory interships determined by MEC, the shortage of time for studies and congresses, the exhaustive workload, insufficient incentive to research and scientific work. The positive aspects were associated with the large volume of patients with complex cases and the heterogeneity of clinical conditions, which in turn also leads to overcrowding, reinforcing the curative, biomedical and hospital-centered care model prevalent at Federal District. SUS s inability to cope with triple burden of diseases, increased demand for care by RIDE, low coverage and resolutiveness of local Primary Care, as well as poor administrative capacity of the system make the practice scenario hostile to education and disadvantage the development of technical and relational attributes by medical residents. The low investment of the public health sector, surpassed by the private system s spending in this area, does not guarantee universality of access, integrality and equity of care. If there is no increase in financing and efficiency of public spending, with costeffectiveness evaluation of services, control and monitoring of health indices, patients entry into SUS will continue to occur in the final stages of chronic diseases, without guaranteeing that SUS principles are ensured and contributing to the loss of the quality of Medical Residency Programs.