Fatores associados à intenção de permanecer trabalhando na atenção primária à saúde entre os médicos brasileiros do Programa Mais Médicos na Paraíba

Abstract

Introduction: As in many other countries, in Brazil there are regional and social inequalities in the distribution of physicians, a fact that compromises the expansion of the Family Health Strategy (ESF). The More Doctor Program (PMM) aims to fill this gap and has been successful in this process, but it is uncertain whether, excluding the characteristics of the PMM, physicians will still remain in the PHC. This study identifies characteristics related to PMM and the work of physicians, which increase their intention to remain working in PHC after the end of the program. Methodology: This is an observational, cross-sectional, quantitative, descriptive and analytical study, based on a database formed of an online questionnaire applied to physicians belonging to the PMM, in Paraíba, between December 2015 and September 2016. It was performed descriptive analysis, by means and standard deviations, absolute frequencies and proportions. For the identification of the variables associated with the intention to remain working in the PHC after the program, the prevalence ratio (PR) was calculated through the Poisson model, constructing a multivariate model. Results: The results are presented in 2 articles. The first one indicates, from the evaluation of the physicians, health units with physical structure, medicines and supplies that can still be improved; complete health teams with fragile employment links, developing dynamic work processes with planning and group activities; and fragility in the technical-pedagogical axis of the matrix support teams. Despite the difficulties, 83.5% of physicians (Brazilian and foreign) are expected to remain working in PHC after PMM. The second article points out that specifically among Brazilians, 78.4% of physicians intend to remain working in the PHC after the PMM. It is observed a direct relation between this intention and the increase of the age of the doctors and of their time of formation; have graduated in another country and have had good experience with PMM supervision; be satisfied with municipal management; and have an interest in being a preceptor and / or doing the Family and Community Medicine Residency. Final Considerations: The study offers important elements from the perspective of physicians for several of the PMM elements. These data indicate the importance for health managers of qualifying the network in order to retain the presence of good health professionals and to guarantee a quality PHC for the population. The data also allow us to evaluate the PMM as a public policy, contributing to the qualification of health care policies for PHC and SUS as a whole.