¿Cómo evolucionó la distribución de médicas y médicos especialistas en Argentina?: un análisis demográfico de la profesión médica al 2020 / How did the distribution of doctors and medical specialists evolve in Argentina?: a demographic analysis of the medical profession to 2020

Las políticas sobre trabajadores/as de salud deben garantizar su distribución adecuada. En Argentina dicha distribución es desigual, sobre todo en especialistas en atención primaria de la salud (APS). El objetivo de este trabajo fue describir la distribución de médicos/as, especialistas lineales y en APS en Argentina, durante el año 2020, teniendo en cuenta la situación económica y sanitaria de cada jurisdicción. Se trata de un trabajo descriptivo y analítico, que utilizó fuentes de datos primarias y secundarias. Se correlacionó la tasa de mortalidad infantil y el producto bruto per cápita de cada jurisdicción ordenándolas de mejores a peores indicadores. La tasa de médicos fue 3,88 médicos/as cada 1000 habitantes, 72% concentrándose en 4 jurisdicciones (Ciudad Autónoma de Buenos Aires, Provincia de Buenos Aires, Córdoba y Santa Fe). El 53% son especialistas y el 27,6% lo son en APS. CABA tuvo una tasa de 16,5 médicos/as por mil; Santiago del Estero y Formosa alcanzaron valores de 1,8 y 1,9 médicas/os por mil habitantes respectivamente. Con respecto a 2014, se observó disminución de especialistas en APS (-14,8%), registrándose las mayores pérdidas en Santiago del Estero, Formosa y Catamarca (-84,5%; -70,1% y -87,3%). La situación nacional sobre la distribución de médicos/as en Argentina desde 1954 a la actualidad fue empeorando en detrimento de las provincias con mayores necesidades. La baja adherencia al sistema de residencias a especialidades de APS pronostica un empeoramiento de la situación de no haber cambios estructurales. Será necesario un fortalecimiento del rol rector del estado en el abordaje de esta problemática (AU)

Policies on health workers must guarantee their adequate distribution. In Argentina, this distribution is unequal, particularly among primary care specialists (PHC).The objective of this article is to describe the distribution of physicians, PHC and non-PHC specialists in Argentina in 2020, considering the economic and health situation of each jurisdiction.We conducted a descriptive cross-sectional study with an analytical stage using primary and secondary data sources. The jurisdictions were classified according to the correlation between infant mortality rate and gross product per capita.The rate of physicians in Argentina in 2020 was 3.88 physicians per 1,000 inhabitants. 72% are concentrated in 4 jurisdictions (City of Buenos Aires, Province of Buenos Aires, Córdoba and Santa Fe). 53% are specialists and 27.6% are PHC specialists. The City of Buenos Aires has a rate of 16.5 physicians per thousand; and Santiago del Estero and Formosa reach values of 1.8 and 1.9 physicians per thousand inhabitants, respectively.There was a decrease in PHC specialists (-14.8%), with major losses recorded in Santiago del Estero, Formosa and Catamarca (-84.5%; -70.1% and -87.3%, respectively).The distribution of physicians in Argentina from 1954 to the present has worsened to the detriment of the provinces with the greatest needs. The lack of adheren-ce to the specialty of PHC predicts a worsening of the situation if there are no structural changes. It is necessary to strengthen the leading role of the state in addressing this problem (AU)

Conflictos del cirujano: ¿La vocación quirúrgica está en crisis? / Conflicts of surgeons: is surgical vocation in crisis?

RESUMEN Introducción: En los últimos años vemos un aumento de bibliografía que se refiere a problemas perso nales y psicológicos del cirujano, a la deserción en residencias de cirugía y a la falta de especialización de individuos jóvenes. Este aumento se observa sobre todo en revistas de jerarquía como Lancet o JAMA. ¿Pero cuál es la situación en la Argentina? ¿Consideramos que nos están pagando adecua damente por nuestra práctica? ¿Pensamos en abandonar nuestra especialidad? ¿Cuántos conflictos tenemos con pacientes por mes? Estimamos necesaria la realización de un trabajo regional que lo plasme. Objetivo: conocer la situación socioeconómica actual de los cirujanos. Material y métodos: estudio de corte transversal. Resultados: de 73 cirujanos encuestados de la provincia de Santa Fe, se recibió respuesta en un 57,5 %. El 87,8 % fueron hombres y 56,1% estaba dentro del grupo de edad adulto intermedio/mayor al momento del estudio. El 97,6 % de los cirujanos concordó en que sus ingresos no se corresponden con el tiempo invertido en la práctica. Consideraron abandonar su práctica diaria en el último año en un 26,2 %; la causa económica es el principal problema para el 72,7%. Discusión: la incomodidad del cirujano frente a su salario (97,6 %), la discrepancia de porcentajes en tre cirujanos y cirujanas (87,8% vs. 12,2%), la falta de cirujanos jóvenes (43,9%) y la alarmante cifra de cirujanos graduados por año (35 por año) son cuatro puntos clave que consideramos deberían abordar de manera urgente los entes políticos y, sobre todo, las Asociaciones de Cirugía.

ABSTRACT Background: In recent years we have witnessed more publications about personal and psychological issues affecting surgeons, residents quitting surgery residencies, and lack of specialization of young in dividuals. This growth can be observed especially in high-impact journals such as The Lancet or JAMA. But what is the situation in Argentina? Do we think that we are receiving adequate payment for our practice? Do we consider quitting our specialty? How many conflicts do we have with patients each month? We think that a regional work is necessary to reflect this situation. Objective: The aim of this study is to determine the current socioeconomic situation of surgeons. Material and methods: We conducted a cross-sectional study. Results: A total of 73 surgeons from the province of Santa Fe were contacted and 42 answers were received (response rate 57.5%): 87.8% were men and 56.1% corresponded to middle/older adulthood. Almost all surgeons (97.6%) agreed that their income did not reflect the time spent in practice. Up to 26.2% of survey respondents considered quitting their daily practice in the last year due to eco nomic reasons, which is the main problem for 72.7% of them. Discussion: Surgeons' discomfort with their salaries (97.6%), the discrepancy in percentages between male and female surgeons (87.8% vs. 12.2%), the lack of young surgeons (43.9%) and the alarming number of surgeons graduated per year (35 per year) are 4 key issues which we believe should be urgently addressed by political bodies and, especially, by surgery associations.

Interest in and practices related to gynecologic oncology among members of the Brazilian Federation of Associations of Gynecology and Obstetrics / Interesse e práticas relacionadas à oncologia ginecológica entre os membros da Federação Brasileira de Associações de Ginecologia e Obstetrícia

Abstract Objective The present study aims to obtain basic demographic information, the level of interest and of training in gynecology oncology among Brazilian obstetricians and gynecologists (OB-GYNs) to create a professional profile. Methods An online questionnaire was sent to 16,008 gynecologists affiliated to the Brazilian Federation of Associations of Gynecology and Obstetrics (FEBRASGO, in the Portuguese acronym). We considered gynecologists dedicated to gynecologic oncology (OB-GYNs ONCO) those who self-reported that > 50% of their daily practice consists in working with women's cancer care. Results A total of 1,608 (10%) of 16,008 FEBRASGO members responded. The OBGYNs are concentrated in the southern and southeastern states of Brazil. Gynecologic oncology was considered the 8th greatest area of interest in gynecology among the OBGYNs. A total of 95 (5.9%) of the OB-GYNs were considered OB-GYNs ONCO. Obstetricians and gynecologists are actively engaged in cancer care: > 60% of them dedicate up to 25% of their daily practice to oncology. The role of the physicians in screening and prevention, diagnosis, in the treatment of precancerous lesions, and in low complexity surgical procedures is notably high. Gynecologists dedicated to gynecologic oncology in Brazil have a heterogeneous, nonstandardized and short training period in gynecologic oncology. These professionals had a more significantly role in performing medium- and high-complexity operations compared with OB-GYNs (65.2% versus 34%, and 47.3% versus 8.4%, respectively). Conclusion The role of OB-GYNs and of OB-GYNs ONCO appears to be complementary. Obstetricians and gynecologists actmore often in screening and prevention and in low-complexity surgical procedures, whereas OB-GYNs ONCO are more involved in highly complex cases. Strategies to raise standards in cancer training and to encourage the recognition of gynecologic oncology as a subspecialty should be adopted in Brazil.

Resumo Objetivo Opresente estudotemcomo objetivo obter informações demográficas básicas, o nível de interesse e de treinamento em ginecologia oncológica entre obstetras e ginecologistas (OB-GYNs) brasileiros para criar um perfil destes profissionais. Métodos Umquestionário online foi enviado a 16.008 ginecologistas filiados à Federação Brasileira de Associações de Ginecologia e Obstetrícia (FEBRASGO). Nós consideramos ginecologistas dedicados à oncologia ginecológica (OB-GYNsONCO) aqueles que referiram atuar em > 50% de sua prática diária com o tratamento do câncer feminino. Resultados Um total de 1.608 (10%) dos 16.008 membros da FEBRASGO responderam ao questionário. Os OB-GYNs estão concentrados nos estados do sul e sudeste do Brasil. A oncologia ginecológica foi considerada a 8ª área de maior interesse em ginecologia entre os OB-GYNs. Um total de 95 (5,9%) dos OB-GYNs foram considerados ginecologistas dedicados à oncologia ginecológica (OB-GYNs ONCO). Obstetras e ginecologistas estão ativamente envolvidos no tratamento do câncer: > 60% deles dedicam até 25% de sua prática diária à oncologia. O papel dosmédicos na triageme na prevenção, no diagnóstico, no tratamento de lesões pré-cancerosas e em procedimentos cirúrgicos de baixa complexidade é notavelmente alto. Ginecologistas dedicados à oncologia ginecológica no Brasil têm umperíodo de treinamento emoncologia ginecológica heterogêneo, não padronizado e curto. Estes profissionais tiveram um papel mais significativo na realização de operações de média e alta complexidade em comparação com OB-GYNs (65,2% versus 34%, e 47,3% versus 8,4%, respectivamente). Conclusão Os papéis dos OB-GYN e dos OB-GYNs ONCO parecem ser complementares. Os OB-GYNs frequentemente atuam emtriageme prevenção e em procedimentos cirúrgicos de baixa complexidade, enquanto os OB-GYNs ONCO estão mais envolvidos em casos demais alta complexidade. Estratégias para elevar os padrões de treinamento em oncoginecologia e incentivar o reconhecimento da oncologia ginecológica como uma subespecialidade devem ser adotadas no Brasil.

Ensino da estomaterapia e suas repercussões para os egressos inseridos no mundo do trabalho / Stomatherapy education and its repercussions for the graduates inserted in the world of work

O objeto deste estudo versa sobre as dificuldades e as facilidades para os egressos do Curso de Estomaterapia da Faculdade de Enfermagem da Universidade do Estado do Rio de Janeiro (ENF/Uerj) atuarem como especialistas no mundo do trabalho. Apresentam-se, portanto, como objetivos: 1) elaborar um questionário para coleta de dados sociodemográfico e profissional voltado para enfermeiros especialistas; 2) validar um questionário para coleta de dados sociodemográfico e profissional voltado para enfermeiros especialistas; 3) caracterizar os aspectos sociodemográficos e profissionais dos egressos do Curso de Especialização em Enfermagem em Estomaterapia da Uerj, a partir do questionário elaborado e validado anteriormente; 4) analisar a percepção dos egressos da Pós-Graduação em Enfermagem em Estomaterapia da Uerj em relação à atuação como enfermeiro especialista no mundo do trabalho; 5) discutir o processo de formação em Estomaterapia do curso de especialização da Uerj, na percepção do egresso, em termos de limitação e potencialidade para atuação no mundo do trabalho. O apoio teórico foi embasado nas discussões sobre o mundo do trabalho em saúde e em enfermagem, o modelo neoliberal e suas respectivas repercussões para o trabalho de enfermagem, aspectos históricos da formação do enfermeiro, além da abordagem a respeito da contextualização histórica da pós-graduação Lato Sensu no Brasil e da especialização em Enfermagem em Estomaterapia, com as perspectivas de inserção no mundo do trabalho. Trata-se de um estudo de natureza qualitativa, do tipo descritivo-exploratório, com um apoio quantitativo. Nesse sentido, foi utilizado o Método de Triangulação dos Dados (questionário, a entrevista semiestruturada e a análise documental). Assim, foi construído e validado um questionário para traçar o perfil socioeconômico demográfico e profissional de especialistas no mundo do trabalho. O mesmo passou pela avaliação de sete juízas e pelo pré-teste com trinta especialistas de áreas diversas da enfermagem. Após as sugestões realizadas, o instrumento já validado foi adaptado para a coleta de informações com os egressos de estomaterapia da Uerj. Traçou-se um perfil das juízas, dos especialistas e dos 43 estomaterapeutas que responderam aos questionários. Também foram entrevistados 22 egressos do curso de especialização em estomaterapia da Uerj, por meio de uma entrevista semiestruturada, através da qual se analisaram os discursos, compondo-se três categorias: 1) O sentido de ser estomaterapeuta: especificidades envolvidas na especialidade, em que se discutiu a multiplicidade de sentidos que a especialidade revela para os egressos da Uerj; 2) Atuação no mundo do trabalho: limitações e capacidades percebidas pelos egressos, onde analisou-se a percepção dos egressos no que tange à atuação no atual mundo do trabalho em saúde, destacando-se as facilidades e as dificuldades encontradas por estes participantes e 3) Formação do especialista em Estomaterapia: potencialidades e fragilidades, onde abordaram-se os temas relacionados à formação do especialista em Estomaterapia (entre 2008 a 2013), destacando-se as potencialidades e as fragilidades encontradas durante o curso e que permearam o processo de ensino-aprendizagem dos pós-graduandos, à época. Acredita-se que esta pesquisa impulsione o surgimento de outras e possa contribuir para os campos da assistência, ensino, pesquisa e extensão, a partir de seu apoio teórico e metodológico e das discussões quantitativas e qualitativas que foram realizadas, com o fito de destacar a Estomaterapia enquanto especialidade da enfermagem.

The object of this study is about the difficulties and the facilities for the graduates of the Stomatherapy Course of the Faculty of Nursing at the State University of Rio de Janeiro (Uerj/ENF) to act as experts in the world of work. Thus, the following objectives are presented: 1) to elaborate a questionnaire for demographic and professional data collection aimed at specialist nurses; 2) to validate a questionnaire for professional and demographic data collection aimed at specialist nurses; 3) to characterize sociodemographic and professional aspects of the graduates of Uerj's Specialization Course in Nursing Stomatotherapy, from the elaborated and previously validated questionnaire; 4) to analyze the perception of graduates of Nursing Post-Graduation in Stomatherapy of Uerj in relation to the performance as specialist nurse in the world of work; 5) to discuss the training process in Stomatherapy of Uerj's specialization course, in the perception of the graduated student, in terms of limitations and potential for acting in the world of work. The theoretical support was based on discussions on the world of work in health and nursing, the neoliberal model and their implications for the work of nursing, historical aspects of the training of nurses, in addition to the approach regarding the historical context Lato Sensu post-graduate in Brazil and of specialization in nursing in Stomatherapy, with the prospects of insertion in the world of work. This is a qualitative study, descriptive-exploratory type, with a quantitative support. In this sense, the Data Triangulation Method was used (questionnaire, semi-structured interview and documentary analysis). Thus, a questionnaire was constructed and validated to draw the demographic, professional and socioeconomic profile of specialists in the world of work. The same went through the evaluation of seven judges and the pre-test with thirty experts from different areas of nursing. After the suggestions made, the already validated instrument was adapted for gathering information with the graduates of stomatherapy. A profile of the judges, the specialists and the 43 stomaterapists who answered the questionnaires was drawn. Were also interviewed 22 graduates of the specialization course in stomatherapy of Uerj, by means of a semi-structured interview, through which the discourses were analyzed, composing three categories: 1) The sense of being stomaterapist: specificities involved in the specialty in which they discussed the multiplicity of meanings which the specialty reveals to the graduates of Uerj; 2) Acting in the world of work: limitations and capacities perceived by graduates, where it was examined the graduates' perception regarding the performance in the current world of work in health, highlighting the advantages and the difficulties encountered by these participants and 3) Training of the specialist in Stomatherapy: potentialities and weaknesses, where topics related to the training of the Stomatherapy specialist (between 2008 and 2013) were addressed, highlighting the potentialities and weaknesses found during the course and that permeated the teaching of post-graduate students at the time. It is believed that this research promotes the emergence of others and can contribute to the fields of assistance, teaching, research and extension, based on their theoretical and methodological support and the quantitative and qualitative discussions that were carried out, in order to value Stomatherapy as a specialty of nursing.

Especialidades derivadas de la cirugía general: revisión de brechas e intención de residentes de la especialidad en Chile / Gaps between country needs and intentions to obtain a subspecialty among general surgery trainees in Chile

The fragmentation of a general specialty in subspecialties or derived specialties is a widely spread reality. Chilean health care system is becoming more complex, requiring more specialists. On the other hand, doctors in specialty training increasingly choose a subspecialty to continue their training and professional development. This contrasts with the growing need for well-trained general surgeons. We aimed to compare the evidence about the needs for general surgeons and the perspectives of Chilean physicians about their specialty training. A literature review about the intention of specialization in Chilean general surgery residents and the gaps in the Chilean health system, was performed. As of December 2016, there were 2,103 general surgeons in Chile, of whom 598 (28%) also have a subspecialty. Among the latter, 49% are plastic or vascular surgeons, which are also the specialties with the greatest demand in the public system. According to estimates of the Chilean Ministry of Health, on that year there was a deficit of 285 general surgeons and 142 subspecialists. These figures correspond to 18.5% and 23.8% of the existing resources. A survey published in 2009 reported that 78% of trainees in general surgery would prefer to continue studying a subspecialty, following the trend observed in the USA and Europe. Therefore, there is a disproportion between the intentions of general surgery trainees and the needs for these professionals in Chile.

Geographical distribution of medical graduates from a public university / Distribuição geográfica e trajetória dos médicos egressos de instituição pública

Summary Objective: To evaluate the geographic distribution and career trajectory of medical graduates and the factors associated with their choice of practice location. Method: A cross-sectional study involving graduates from December 2001 to December 2010 was conducted. A self-administered questionnaire collected demographics and geographic information (place of birth, place of residence at the time of medical school admission, place of residency training and practice location), and reason for choosing the current location. Statistical analyses assessed trends in geographic distribution of graduates, and identified factors associated with location choice (through the population density of the location chosen for professional practice). Results: A total of 563 graduates completed the questionnaire. Of those, 4.3% (n=24) reported family medicine as their medical specialty, 19.9% (n=112) reported other primary care specialties (internal medicine, pediatrics, surgery and obstetrics-gynecology) and the others chose subspecialties. Larger cities were more likely to be chosen for practice, particularly for newly-graduated doctors. Job invitations received during medical residency training increased the likelihood of choosing high-populated cities. In contrast, job invitations received during medical school increased the likelihood of choosing cities less populated. Amongst those in cities with lower population density, proximity to family members was an additional influencing factor; those who chose more densely populated cities did so because of better infrastructure and recreational options. Conclusion: Most of the physicians included in this study pursue subspecialties training and were practicing medicine in large cities. Knowing the multiple factors that influenced the choice of practice location can assist in planning future strategies to reduce physician workforce misdistribution.

Resumo Objetivo: Avaliar a distribuição geográfica e a trajetória dos médicos e fatores associados à escolha para o local da prática médica. Método: Estudo transversal envolvendo graduados entre 2001 a 2010, utilizando-se questionário autoaplicado com dados sociodemográficos, informações de localização geográfica (local de nascimento, local onde residia quando entrou na faculdade de medicina, local onde realizou a residência médica e local de prática profissional), e as razões para escolha do local de sua fixação. Análises estatísticas avaliaram as tendências da distribuição dos egressos e os fatores associados com a escolha do local para a prática médica. Resultados: 563 egressos completaram o questionário. Destes, 4,3% (n=24) eram médicos de família, 19,9% (n=112) tinham especialidades em grandes áreas (medicina interna, pediatria, cirurgia e ginecologia-obstetrícia), enquanto os outros escolheram subespecialidades. Houve predomínio da escolha de cidades de grande porte para a prática profissional. Convites para trabalhar recebidos durante a residência médica aumentaram a escolha de cidades de maior densidade populacional. Por outro lado, os convites recebidos durante a graduação influenciaram a escolha de cidades de mais baixa densidade populacional. Para estes últimos, a presença da família no local foi fator de influência, enquanto, para os que escolheram cidades de maior densidade populacional, os fatores de influência foram melhor infraestrutura e mais opções de diversão. Conclusão: A maioria dos médicos deste estudo fixou-se em grandes cidades e escolheu subespecialidades. Conhecer os múltiplos fatores que influenciaram a escolha do local para prática profissional pode auxiliar no planejamento de estratégias para reduzir a má distribuição do trabalho médico.

A regulação municipal ambulatorial de serviços do Sistema Único de Saúde no Rio de Janeiro: avanços, limites e desafios / Ambulatory municipal regulation of the Unified Health System services in Rio de Janeiro: advances, limitations and challenges

Resumo O federalismo é o pilar da República, composta pela união dos Estados, dos Municípios e do Distrito Federal, tendo como princípio básico a descentralização político-administrativa, nas relações políticas, econômicas e sociais. Na saúde, o provedor de atenção primária deve ser capaz de integrar todo cuidado que o paciente recebe através da coordenação entre os serviços. Objetiva-se avaliar os resultados dos encaminhamentos de consultas e exames ambulatoriais da APS do município do Rio de Janeiro, demonstrando os avanços, limites e desafios para a gestão no nível local. Estudo quantitativo que utilizou as bases de dados administrativas do Cadastro Nacional de Estabelecimentos de Saúde (CNES) e o Sistema Nacional de Regulação (SISREG), além de uma "linkage" entre ambas as bases. Entre 2011 e 2015, o nº de procedimentos agendados teve um aumento de 86%, como reflexo da descentralização da regulação ambulatorial para os médicos de família. Pode-se inferir que não há falta de especialistas para atendimento ambulatorial no SUS carioca em quase todas as áreas. Existem gargalos artificiais pela ausência de regulação da maior parte da carga horária contratada na especialidade, ou seja, a oferta de vagas é menor do que a capacidade instalada das unidades municipal, estaduais, federais e conveniadas ao SUS.

Abstract Federalism is basis of the Republic of Brazil which is made up of the union of states, municipalities and the Federal District, with the basic principle of political and administrative decentralization in all political, economic and social relations. In the health sector, the primary health care provider should be able to integrate all care that the patient receives through the coordination of health services. This article aims to evaluate the results of referrals for consultations and outpatient examinations in primary health care in the municipality of Rio de Janeiro, highlighting the advances, limitations and challenges for management at the local level. A quantitative study was designed using administrative databases from the Registry of National Health Establishments (CNES), the National Regulatory System (SISREG), and a linkage between them. Between 2011 and 2015, the number of scheduled procedures increased by 86%, reflecting the decentralization of outpatient regulation for family doctors. It can be inferred that there is no shortage of specialists for outpatient care in the city in almost all areas. There are actually artificial bottlenecks that arise as a result of the lack of regulation of most of the workload contracted in specialist areas, that is, the number of vacancies is smaller than the capacity of health services available in health units at the municipal, state, federal levels and those contracted by the Unified Health System (SUS).

Odontólogos del Registro Nacional de Prestadores Individuales de Salud / Characterization of dentists registered in the National Register of Individual Health Providers, Chile

Objetivo Caracterizar a los odontólogos que ejercen la profesión en Chile, inscritos en el Registro Nacional de Prestadores Individuales. Material y método Estudio descriptivo, transversal, efectuado con la base de datos del Registro Nacional de Prestadores Individuales de la Superintendencia de Salud, solicitada vía Ley de Transparencia. Resultados A fecha de septiembre de 2014, se encontraban registrados 15.901 odontólogos titulados, desde 1945 en adelante. Su promedio de edad es 42,9 ± 11,46 años. El 54% son varones, y el 46%, mujeres. El 89,6% de los odontólogos chilenos estudió en Chile, el 73% de ellos en universidades tradicionales. Un 7,3% de los profesionales registrados son extranjeros, cuya gran mayoría estudió fuera del país. Para ellos, la vía más común de revalidación de título es mediante convenios con el Ministerio de Relaciones Exteriores. La universidad tradicional con más titulados es la Universidad de Chile, mientras que la Universidad Mayor es la privada con mayor egreso. En el último quinquenio, la cantidad total de titulados de universidades privadas superó al total de egresados de universidades tradicionales. Existen 4.339 registros de especialidad, un 49% de ellos certificado en el quinquenio 2009-2013. La especialidad más frecuente es Ortodoncia, con un 19,5% del total. La vía de certificación más frecuente es el posgrado universitario. Conclusiones Esta investigación constituye uno de los escasos estudios con información oficial y no especulativa sobre odontólogos en Chile. Consideramos que el Registro Nacional de Prestadores Individuales debe mejorar el acceso y registro de sus datos, para así caracterizar de forma adecuada, tanto demográfica como académicamente, a estos profesionales.

Objective To characterise dentists who practice in Chile, enrolled in the National Register of Individual Providers. Material and method Descriptive and cross-sectional study conducted with the database of the National Register of Individual Providers of the Superintendency of Health, requested through the Transparency Law. Results In September 2014, there were 15,901 registered dentists, of whom 54% were male, and graduated from 1945 onwards. Their mean age was 42.9 ±11.46 years. The large majority (89.6%) of Chilean dentists studied in Chile, 73% of them in traditional universities, and 7.3% of registered professionals are foreigners, most of whom studied abroad. For them, the most common route of degree equivalency is through agreements with the Chilean Ministry of Foreign Affairs. The traditional university with most graduates is the University of Chile, while Universidad Mayor is the private university with most graduates. In the last 5 years, the total number of graduates from private universities surpassed the total of graduates from traditional universities. There are 4,339 specialty records in the register, 49% of them certified in the period 2009-2013. The most common specialty is orthodontics (19.5% of the total). The most common route of certification is a university degree. Conclusions This study is one of the few with official, non-speculative information about dentists in Chile. We believe that the National Register of Individual Providers should improve access and registration of their data, with the purpose of properly characterising these professionals, demographically and academically.

A cirurgia de mão como uma área de atuação dos cirurgiões plásticos / Hand surgery as a working area of plastic surgeons

INTRODUÇÃO: Estudos prévios têm revelado que o público tem conhecimentos equivocados sobre a atuação dos cirurgiões plásticos em cirurgia da mão. No entanto, não existem dados específicos na literatura científica brasileira. O objetivo deste estudo foi avaliar as percepções do público sobre o papel dos cirurgiões plásticos no campo de cirurgia da mão no Brasil. MÉTODOS: Membros do público brasileiro escolheram um ou dois especialistas que eles acreditassem serem experts para oito cenários relacionados à cirurgia de mão. Os padrões de respostas foram distribuídos como "cirurgiões plásticos" ou "não cirurgiões plásticos". RESULTADOS: "Não cirurgiões plásticos" foram significativamente (p < 0,05 para todas as comparações) mais reconhecidos como experts que "cirurgiões plásticos" em todos os cenários relacionados à cirurgia de mão. CONCLUSÃO: Os conhecimentos e as percepções do público brasileiro sobre o trabalho realizado por cirurgiões plásticos no campo cirurgia da mão são limitados.

INTRODUCTION: Previous studies have shown that the public has misconceptions about the work of plastic surgeons in hand surgery. However, no specific Brazilian data on this issue are available. The objective of this study was to evaluate the public perceptions about the role of plastic surgeons in the field of hand surgery in Brazil. METHODS: Members of the Brazilian public chose one or two specialists whom they believed to be experts in eight scenarios related to hand surgery. The patterns of the responses were distributed into "plastic surgeons" or "non-plastic surgeons." RESULTS: Non-plastic surgeons were significantly (p < 0.05 for all comparisons) more recognized as experts than plastic surgeons in all scenarios related to hand surgery. CONCLUSION: The knowledge and perceptions of the Brazilian public about the work performed by plastic surgeons in the field of hand surgery are limited.

Current panorama of temporomandibular disorders' field in Brazil

In 2012, the recognition of the specialty of Temporomandibular Disorders and Orofacial Pain completed ten years. Given this scenario, it is extremely important to track the current situation of this field of knowledge in Brazil, specifically in the area of research and training. We hope to discuss the importance of the recognition of this specialty and the inclusion of these subjects in undergraduate programs in Dentistry. Objective: The objective of this study is to perform a bibliometric survey of researches regarding Temporomandibular Disorders and Orofacial Pain conducted in the country, determine the number of specialization courses in Orofacial Pain and the number of specialists in the field. Methods: The bibliometric survey was conducted based on the Dissertations Portal of Coordination for the Improvement of Higher education Personnel (CAPES) and on PubMed. The panorama of the field of Orofacial Pain and Temporomandibular disorders in Brazil was determined by searching on the website of the Brazilian Council of Dentistry. Results: We found 731 theses and dissertations with Temporomandibular Disorders and Orofacial Pain as the main subjects; 81 accredited/recognized Courses on Orofacial Pain and Temporomandibular Dysfunction completed; 8 accredited/recognized Specialization Courses on Orofacial Pain and Temporomandibular Dysfunction still in progress, and 1,064 registered specialists in Orofacial Pain and Temporomandibular Dysfunction in the Brazilian Council of Dentistry. Search in the PUBMED database yielded 576 articles published with the participation of Brazilian researchers as first authors and/or co-authors in the period from 2000 to 2013. From this amount, only 5 were published in Portuguese, while all the others were published in english. We can also notice that the number of published articles increases over time. Conclusion: The number of researches related to temporomandibular disorders has increased over the ...

Realidad de médicos especialistas en el sistema público no municipalizado: Chile 2012 / Reality of medical specialties in the Chilean public health system, not municipalized (2012)

En los últimos años, en el país se ha observado una falencia de médicos especialistas en el sistema público de salud no municipalizado. Probablemente ello se ha debido a una lenta formación de especialistas por las universidades, a una reducción del número de cargos en relación a la demanda y a un éxodo de especialistas hacia el área privada. El objetivo del trabajo, es analizar el número y características de los médicos especialistas registrado en un corte en el año 2012, en base a los datos suministrados por el Ministerio de Salud, CONACEM, Universidades Nacionales y Superintendencia de Salud. Se comprobó un aumento significativo del total de especialistas en el país al comparar las cifras con las correspondientes al año 2004, en el que tenemos también registros confiables, especialmente a las correspondientes al sistema público, que creció al doble. De igual manera observamos crecimiento significativo de los especialistas en Medicina Interna, Cirugía General y Psiquiatría en las Especialidades básicas y de Anestesiología, Traumatología y Ortopedia, Radiología y Oftalmología en las especialidades primarias. Sin embargo, la distribución regional sigue mostrando brechas de atención, especialmente en las zonas de menor población. El incremento de especialistas se ha debido a las medidas adoptadas en conjunto por el Ministerio de Salud y las Universidades, en base a comisiones de estudio y becas de formación. Dado el crecimiento socio-económico y cultural del país proyectado para el 2020/2030, parece necesario mantener un ritmo adecuado de crecimiento de especialistas, merced a la acción mancomunada de las instituciones comprometidas, incluyendo a la función catalizadora del Colegio Médico, en representación de los profesionales en formación.

In the last years, in the country has been observed a deficit of medical specialists in the Chilean public system of health, not municipalized. Probably this deficit is due to the slow formation of specialists from the universities, to a reduction of the “post offers”, in relation to the demand and to a specialists’ exodus towards the private area. The aim of this study, is to analyze the number and main characteristics of medical specialists registered in a period of the year 2012, according the existing dates of Ministry of Health, (*) CONACEM, the National Universities and the Superintendence of Health. It was observed a significant increase of the number of specialists in this year in comparison to the registered data on 2004, mainly oriented to the public sector, which grew doubly, according to reliable sources. Similarly we see significant growth in the specialists in Internal Medicine, General Surgery and Psychiatry in the basic skills and anesthesiology, Traumatology and orthopedics, radiology, and Ophthalmology in the primary specialty. Nevertheless, the regional distribution continues showing deficit of attention, especially in the zones with minor population. The increase number of specialists has been due to joined efforts of Universities and Health Ministry, based in financial support and qualifications studies. According to standard socioeconomic and human development of the country, the goals of WHO (World Health Organization), must be achieved by coordinated efforts of national institutions: Ministry of Health, Universities and Medical College.

A formação dos profissionais de enfermagem do trabalho na perspectiva das instituições formadoras / La formación de los profesionales de enfermería del trabajo en la perspectiva de las instituciones educativas / Occupational nursing training in terms of educational institutions

O estudo é continuidade de pesquisa realizada sobre a formação dos profissionais em enfermagem do trabalho na Região Sudeste e Sul do Brasil. O objetivo maior desta pesquisa foi caracterizar a formação do profissional especializado em enfermagem do trabalho em nível técnico e superior nas Regiões Norte, Nordeste e Centro-Oeste do Brasil. Teve um delineamento exploratório com abordagem quantitativa, tendo 290 instituições públicas e privadas de nível superior e médio do curso de enfermagem que participaram da pesquisa.O recorte temporal foi entre 1974 e 2008, sendo usado um questionário com perguntas fechadas para a coleta de dados. Portanto, há 391 profissionais formados em enfermagem do trabalho e 60 instituições responsáveis pelos cursos de especialização/qualificação. Conclui- se que as Regiões Norte e Centro-Oeste do Brasil apresentam um número reduzido de instituições formadoras de profissionais especializados/qualificados em enfermagem do trabalho, principalmente quando comparadas à Região Nordeste.

The study is a continuation of research into occupational nursing training in Southeast and South Brazil. The main aim of this study was to characterize specialization training in occupational nursing at the technical and higher levels in Brazil’s North, Northeast and Midwest. The design was exploratory and quantitative, and the population studied were occupational nursing trainees at 290 participating technical and higher education institutions between 1974 and 2008. Data were collected by a questionnaire of closed questions. There were thus 391 graduate occupational nurses and 60 institutions responsible for the specialization/qualification courses. It was concluded that the North and Midwest regions have a limited number of institutions training occupational nurses, especially as compared with Northeast Brazil.

El estudio es continuidad de investigación sobre la formación de los profesionales en enfermería del trabajo en las Regiones Sureste y Sur de Brasil. El objetivo más grande de esta encuesta fue caracterizar la formación del profesional especializado en enfermería del trabajo en nivel técnico y superior en las Regiones Norte, Nordeste y Centro-Oeste de Brasil. Tuvo un delineamiento exploratorio con enfoque cuantitativo, en 290 instituciones públicas y particulares de nivel superior y medio del curso de enfermería participantes. El recorte temporal fue entre 1974 y 2008, siendo usado un cuestionario con preguntas cerradas para la recolección de datos. Por tanto, hay 391 profesionales formados en enfermería del trabajo y 60 instituciones responsables por los cursos de especialización/calificación. Se concluye que las Regiones Norte y Centro-Oeste de Brasil presentan un número reducido de instituciones que forman profesionales especializados/calificados en enfermería del trabajo, principalmente cuando se compara con la Región Nordeste.

Formación de médicos especialistas en el Sistema de Servicios de Salud de Chile: Su evolución en el período 2007-2010 / Training of specialists in the Chilean national health services

Several institutions, such as the Ministry of Health, Universities, the Chilean Medical Association, Scientific societies and public opinion, recognize that there is a deficiency of specialized physicians in Chile. To overcome this shortage of specialists, the Ministry of Health, along with universities, is developing diverse initiatives to train specialists and cope with the requirements of the country. Seventy five percent of posts offered were filled by physicians. The number of positions increased from 173 in 2007 to 576 in 2010, with a cumulative total of 1582 physicians in four years. Fifty two percent are being trained in Basic Primary Specialties and 48 percent in primary specialties. Thirty three percent of graduates have the obligation to continue working in the public service during a certain lapse. This figure will increase to 50 percent in the following years. These specialists are mainly working in the more densely populated regions of the country. The universities that offer the higher number of training positions are the University of Chile, The Catholic University of Chile and the University of Santiago.

Disponibilidad de médicos y especialistas en Chile / Availability of physicians and specialists in Chile

The availability and planning of Human Resources are important issues in many countries, as it is a key factor to cope with the critical challenges of Health Care Systems. In Chile, the Ministry of Health has undertaken several studies in order to improve knowledge about the medical workforce both in public and private sectors. The aim of this paper is to update and systematize the existing data on physicians and specialists availability in Chile. Several information sources were crossed to obtain new and more precise figures about this topic. According to the Internal Revenue System, 29.996 physicians practice medicine in the country, 43 percent of them hired in public services, part or full time. There is a high concentration of professionals in the central regions of Chile. Being the overall density of physicians of one per 559 inhabitants, the figures in the central region is one per 471 and one per more than 800 in the South and North. Between 2004 and 2008, the public sector increased its physician workforce by more than 80 percent in primary health care and more than 20 percent in the secondary and tertiary levels. This paper presents a method for a more rigorous identification of the categories of general practitioner and specialist respectively, and the results obtained from the databases used.

Primer censo nacional de recursos humanos en salud: desarrollo y presentación de los primeros resultados / First national census of human resources in health: development and presentation of the first results

La realización del Primer Censo Nacional de Profesionales de la Salud se enmarca en el proceso de fortalecimiento de las funciones esenciales del Ministerio de Salud Pública y del ejercicio de la Rectoría sobre el conjunto del Sistema Nacional Integrado de Salud (SNIS). Esta orientación a su vez forma parte del proceso de Reforma del Estado, con el objetivo de modernizarlo y ponerlo al servicio de la población y de las grandes mayorías. Este Primer Censo contribuye en primera instancia a superar las debilidades históricas de registro de los Recursos Humanos en Salud que tenía el MSP, y nos permite conocer con mayor grado de detalle las características básicas de las personas que se desempeñan en el campo de la salud. Constituye un instrumento primordial para actualizar los sistemas de información, y nos abre el camino para avanzar en el diseño de políticas de desarrollo de los Recursos Humanos en Salud, compartirlo con los demás actores del Sistema y de común acuerdo planificar la formación, las competencias, y la distribución geográfica y por niveles de atención. Los profesionales de la salud constituyen un conjunto humano esencial para el funcionamiento del SNIS. La información que aquí se aporta es un insumo básico para su gestión, así como para el cambio del modelo de atención a la salud. La consolidación de ámbitos de negociación permanentes en los cuales participen las instituciones formadoras, las instituciones prestadoras de salud, los gremios, las organizaciones de usuarios y los Ministerios implicados nos permitirá, a partir de un abordaje integral de los problemas existentes, alcanzar acuerdos de corto, mediano y largo plazo que mejoren el desempeño y las condiciones de trabajo en el sector, prevengan los conflictos, y lo más importante, contribuyan a mejorar la salud de la población. (AU)

Evolución de la oferta de médicos. Chile 1993-2008 / Evolution of the availability of physicians in Chile

There is a significant increase in the physician availability in Chile in the last 15 years, due to the immigration of foreign physicians, but mainly due to the increasing number of graduates from private universities with medical schools. In the last four years, the number of physicians increased from 25.542 to 29.996 and the number of graduates, from 918 to 1.136. These figures show a nearly exponential growth. The number of physicians/number of beneficiaries' ratio increased from 1/630 to 1/569 in the last four years, due to the greater increase in the number of physicians than in the number of inhabitants. The future will show a similar trend in this ratio. The specialist/general practitioner ratio remains practically the same, as the number of physicians/beneficiaries ratio in the public system. The oversupply of physicians should alert authorities about the inconvenience in creating new medical schools and a careful plan of relationship between the offer and demand of medical services.

Formação e experiência profissional dos médicos prescritores de antirretrovirais no Estado de São Paulo / Professional background and experience of antiretroviral prescribing physicians in the State of São Paulo

OBJETIVO: Analisar o perfil dos médicos que prescreveram antirretrovirais (ARV) no Estado de São Paulo para o tratamento de pessoas infectadas pelo HIV. MÉTODOS: Foram analisadas as características sociodemográficas, de formação técnico-científica e a experiência dos profissionais que prescreveram os ARV entre outubro de 2007 e maio de 2009, utilizando-se informações obtidas nos bancos de dados do Ministério da Saúde, Conselho Regional de Medicina do Estado São Paulo, Comissão Nacional de Residência Médica e plataforma Lattes. RESULTADOS: A prescrição regular de ARV para 74 mil pacientes foi realizada por 1609 médicos, que apresentam distribuição similar segundo sexo, têm entre 30 anos e 49 anos, residem principalmente na região metropolitana de São Paulo, são formados em média há 16,1 anos, em 93 escolas médicas do país e possuem alguma formação em especialidades médicas (67,5 por cento), especialmente em infectologia (38,9 por cento). Cada médico prescreveu ARV em média para 10 pacientes, sendo que 51,6 por cento prescreveram para 20 ou mais pacientes. Entre os profissionais, 62 por cento reúnem conhecimento específico ou experiência para o tratamento de pessoas com HIV, sendo que 2,7 por cento das prescrições foram realizadas por profissionais que não apresentaram nenhuma dessas condições. Regiões com alta incidência de Aids apresentaram menor número de prescritores, como Barretos e Baixada Santista, reunindo as maiores concentrações de profissionais sem conhecimento específico ou experiência no Estado de São Paulo. CONCLUSÃO: A maioria das pessoas com HIV recebem prescrições de médicos que apresentam os requisitos de conhecimento e/ou experiência. Porém, o grande número de prescritores sem as qualificações mínimas e o reduzido número de médicos em regiões de maior incidência de Aids implicam importantes desafios para universalizar adequada atenção à saúde de pessoas com HIV.

OBJECTIVE: Analysis of the professional profile of physicians who prescribe antiretroviral drugs (ARV) to HIV infected persons in the State of São Paulo. METHODS: Databases from different sources, namely Ministry of Health, São Paulo State Regional Medical Council, National Commission on Medical Residency and the Lattes platform, were consulted. Data concerning socio-demographic characteristics, academic and professional background and experience for the period from October 2007 to May 2009 were analyzed. RESULTS: The regular ARV prescription for 74 thousand patients was issued by 1,609 physicians whose characteristics are: evenly distributed according to gender, aged between 30 to 49 years, live in the metropolitan area of Greater São Paulo, graduated 16.1 years ago on the average, come from 93 different Brazilian medical schools, hold a specialty diploma in 67.5 percent of cases, most of them in the field of Infectious Diseases (38.9 percent). The mean number of patients per physician was 10, though 51.6 percent of physicians prescribed for 20 or more patients. Of these physicians 62 percent reported specific knowledge or experience with HIV care , although 2.7 percent of all prescriptions were issued by physicians without this specific qualification. Regions of high AIDS incidence showed a smaller number of prescribing physicians. The cities of Registro and Ribeirão Preto showed the highest concentration of physicians lacking proper credentials. CONCLUSION: The absolute majority of HIV patients receives their prescriptions from duly trained and experienced physicians. Nevertheless, the large number of non-qualified physicians together with the reduced number of physicians in HIV high incidence regions make up the major challenge for comprehensive and adequate care of HIV patients.