Implementation of the Residency Program in Family and Community Medicine of the Rio de Janeiro Municipal Health Department, Brazil

DOI: 10.1590/1413-81232015215.04342016 André Luis Andrade Justino 1 Lourdes Luzón Oliver 1 Thayse Palhano de Melo 1 Abstract The reform of Primary Healthcare in the city of Rio de Janeiro created various needs for improvement of the network, one of which was professional training/qualification of doctors to practice at this level of care. To respond to this the Municipal Health Department took the initiative of structuring the Residency Program in Family and Community Medicine. This paper aims to describe the experience of implementation of this program in the context of the reform of primary healthcare. It also reports on the process of structuring of the program to meet the objectives proposed by the reform, and how this is reflected in the network, and suggests investments in studies that can indicate impacts generated by the Program. Key words Family and community medicine, Primary healthcare, Medical education, Internship and residency 1 Programa de Residência Médica em Medicina de Família, Secretaria Municipal de Saúde, Prefeitura da Cidade do Rio de Janeiro. R. Afonso Cavalcanti 455, Cidade Nova. 20211-110 Rio de Janeiro RJ Brasil. article Implementation of the Residency Program in Family and Community Medicine of the Rio de Janeiro Municipal Health Department, Brazil 1471 Justino ALA et al. 1472 Introduction Family and Community Medicine is a specialty clinical practice oriented to primary care, that is to say: “They are personal doctors, principally responsible for the provision of wide-ranging and continued care to all the individuals who seek them, independent of age, gender or condition. They take care of individuals in the context of their families, communities and cultures, always respecting the autonomy of their patients”1. Since 1976, although it has not had the name of Family and Community Medicine, the specialty has been working on identifying its space as the medical specialty responsible for medical care in primary healthcare. The three first initiatives in formation of the General and Community Medicine specialty date from this time: The Murialdo Health Center School in Porto Alegre, in the southern Brazilian state of Rio Grande do Sul; the Vitória Project in Vitória de Santo Antão, in the state of Pernambuco; and the Integral Medicine Service of the State University of Rio de Janeiro (UERJ). The Brazilian General and Community Medicine Society (SBMGC) was created in November 1981. Five years later, in 1986, the Federal Medical Council recognized the specialty and the SBMGC as its representative. As from 1995, with the institution of the Family Health Program, the specialty received a new boost, and in August 2001 it was decided by an Internet vote to adopt the new name: Family and Community Medicine (FCM)2. Some residency programs in FCM have become important training and learning instruments, such as the Conceição Hospital Group, with 22 student places each year, and the Municipal Health Department of Fortaleza, which initially offered 100 places and now offers 763,4. In relation to our recognition of the specialty, there are various reasons why at present FCM does not have all the prestige or recognition that it deserves. On the one hand, both society and the medical collective in general continued to categorize it as the “Medicine of the poor”, mainly due to the way in which the Family Health Program was implemented in the country5,6, as if it were possible ethically to distinguish between doctors for rich people and doctors for poor people. In countries such as Canada, Spain, Holland and England the Family Doctor is recognized not only by his specialist colleagues but also by the population, completely independent of what social class he belongs to7. For the population, the family doctor is the doctor of reference for any health problem, since primary healthcare is established as the structuring basis of the health system. In Brazil, it is commonly believed that family doctors do not have sufficient qualification and potential to deal with the population’s demands. At the same time, this situation generates, among specialists in family medicine, an ‘inferiority complex’, when they compare themselves to their hospital colleagues and the processes of qualification for the two different professional groups. However, FCMs are the professionals of primary healthcare that are best qualified to deal with non-specific complaints, multiple illnesses in a single patient, and illnesses that undergo transformation over time8. Thus, the perception that many academics and interns have during their internship or residency in primary healthcare is of a medicine that is practiced in precarious facilities, without much ‘technological shine’, with professionals who are little qualified, and have little decision capacity, who refer many of the clinical situations that they attend to, to other levels9. This picture, added to attractive offers from the private market for secondary-level specialists, results in Family and Community Medicine being the last option among students. This model has clear negative repercussions for the health system and for society, because it offers a fragmented care, without coordination between the levels of care, and one that increases the potential for polymedication and iatrogenesis for an increasingly aging population, with problems that are more complex and who have a greater need for coordination of care9,10. To change this scenario, the Municipal Health Department of Rio de Janeiro (Secretaria Municipal de Saúde, or ‘SMS–Rio’), as well as carrying out a reform of primary healthcare, sought to implement its own Residency Program in Family and Community Medicine, and incentivize the programs that already exist in the municipality, for the purpose of training medical professionals for this level of healthcare. The aim of this paper is to describe the experience of implementation of the Residency Program in Family and Community Medicine of the Rio de Janeiro Municipal Health Department (Programa de Residência em Medicina de Família e Comunidade da Secretaria Municipal de Saúde do Rio de Janeiro, or PRFCM–Rio), in the context of the reform of primary healthcare. In this report of experience, data from the National Registry of Health Establishment (Ca- 1473 Role of the reform of Primary Healthcare in the emergence of the Residency Program in Family and Community Medicine The municipal management of Rio de Janeiro believes that primary healthcare should be the port of entry to the health system, and since 2008 has invested in the Family Health Strategy (Estratégia Saúde da Família – ESF), as directed by the National Primary Healthcare Policy11,12. As from 2009 the municipality of Rio de Janeiro, which had a history of a health system strongly based on hospital attention and with low coverage by the ESF, began an intense transformation by increasing the number of family health teams from 124 in 2009 to more than 780 compl (...truncated)