A lawyer specializing in Educational Law and Management analyzes issues related to the clash over the creation of new vacancies.
The Ministry of Education (MEC) announced on Thursday (27/06) that it will soon make a new rectification to call for proposals no. 1/2023, for the authorization of new medical courses. The deadline for submitting proposals, which was scheduled to close on July 5, is likely to be extended by another 90 days due to the tragedy in Rio Grande do Sul.
The rectification also aims to clarify frequently asked questions, an initiative which, according to the MEC, seeks to prevent this extension from impacting on the date of publication of the results.
Long-standing problem
Resumed in 2023, after a five-year ban on the creation of vacancies, authorization for new medical courses has presented a series of obstacles due to its relationship with public policies.
"The biggest issue is the linking of the course authorization process to the prior existence of a public call. The process doesn't differ much. But for Medicine, institutions don't have the same freedom as for other courses," explains Ana Claudia Ferreira Julio, a specialist in Educational Law and Management at Barcellos Tucunduva Advogados.
At the beginning of June, the Federal Supreme Court (STF) ruled that a "public call" is necessary for Medicine, and that new courses must comply with the More Doctors Law (see "Chronology").
Sub judice courses
Another point dealt with by the STF was "in progress" applications, and it was decided that applications that had already passed the initial stage of analysis of the documentation by the MEC could follow the regular authorization process.
The next steps include: an on-site evaluation by the National Institute for Studies and Research (INEP); an opinion from the National Health Council (CNS); an analysis by the Secretariat for Work Management and Health Education (SGTES); and a decision and publication of the authorization decree by the Ministry of Education.
This definition was important because, during this period of "freezing" of new courses, several educational institutions obtained authorization, via court decision, for their applications to be received and analyzed by the MEC. Some even opened new classes on the basis of these decisions, and the delay in approval by the MEC created a climate of fear for both students and institutions.
"I understand the students' concerns, but I see it as unlikely that they will lose the credits they have already studied. The STF itself, in its judgment, said that courses authorized on the basis of court decisions should be maintained," says Ana Cláudia.
With regard to educational institutions, BTLAW's expert sees the same logic: "I don't see a scenario of a 'stampede of students' due to the STF's decisions, which were express in safeguarding the rights of institutions that had courses authorized by court decision or even for those that, also by court decision, had their authorization requests received by the MEC, and went beyond the documentary analysis phase."
More Doctors and the change in criteria
In 2013, the More Doctors Law was enacted with the aim of reducing regional inequalities in healthcare by reducing the shortage of doctors in the priority regions of the SUS.
For the lawyer, there are positive aspects to the legislation: "there has been a significant impact on the national scenario, with an increase in primary care coverage, a reduction in avoidable deaths and hospitalizations, and a milestone of 18,500 medical professionals working under the Program".
However, there are also negative aspects: "a student's graduation in a certain city does not guarantee that he or she will remain there, working professionally. And the priority criterion of location is not recommended by the WHO itself, which recommends a study using other criteria, such as demographic density, per capita income, among other aspects"
Finally, the expert also highlights economic side effects: "It's a criterion that interferes with free competition. This can result in a shortage of places, an increase in tuition fees and, eventually, a drop in quality."
Chronology
In 2013, the More Doctors Law (Law 12.871/2013) was created, which stipulated that new medical courses should be opened through public calls. These calls for tenders determine the opening of vacancies only in specific health regions, aiming to serve municipalities with a low number of doctors - to give you an idea, the OECD establishes 3.73 doctors per thousand inhabitants, Brazil has 2.7 doctors per thousand inhabitants (data from 2023) and Mais Médicos intends to work in municipalities with less than 2.5 doctors per thousand inhabitants.
In 2018: a moratorium was decreed, prohibiting the opening of new medical degrees, which led to lawsuits to guarantee the continuity of the creation of vacancies. To make this possible, court decisions resorted to the general system for accrediting new degrees at the MEC, provided for in law 10.861/04.
In 2023: the opening of new medical courses was back on track, with a public notice published in October and the rules of the More Doctors Law being required. However, around 360 applications were in progress - eight institutions, for example, began offering undergraduate courses by means of an injunction, but still without the final approval of the Ministry of Education (MEC).
In June/2024: STF rules that the "public call" is necessary and that new courses must comply with the law. And that applications "in progress" could only obtain authorization if they had already gone through the initial stages. Around 160 colleges fell into these cases.