Postgraduate education among family and community physicians in Brazil: the Trajetórias MFC project

OBJECTIVE: Our objective was to describe the postgraduate education trajectories of family and community physicians in Brazil, where neither primary healthcare nor family and community medicine is recognised as a knowledge area for the purpose of research and postgraduate education (master’s and PhD degrees). DESIGN: An observational, exploratory study, using administrative data. A nationwide list of family and community physicians as of late November 2018 was compiled from multiple sources. Data on the mode of specialisation was obtained from the same sources and were correlated with data on master’s and PhD degrees, obtained from the curricula vitae on the Lattes Platform. SETTING: This study was set in Brazil. PARTICIPANTS: 6238 family and community physicians (58.3% female), of whom 2795 had earned a specialist certificate (identified from the list of physicians certified by Sociedade Brasileira de Medicina de Família e Comunidade) and 3957 had completed medical residency (identified from SisCNRM, the national information system for medical residency). RESULTS: A master’s degree was held by 747 (12.0%) family and community physicians, and a PhD by 170 (2.7%); most degrees were in collective health (47.0% and 42%, respectively). Men were more likely than women to hold a master’s degree (adjusted odds ratio (aOR) 1.24, 95% uncertainty interval (UI) 1.07–1.45) and even more likely to a hold PhD (aOR 1.86, 95% UI 1.35–2.59). Family and community physicians were also less likely to hold a PhD degree if their master’s degree was professional (oriented towards jobs outside academia) instead of academic (aOR 0.15, 95% UI 0.05–0.39) or in some area other than collective health or medicine (aOR 0.41, 95% UI 0.21–0.78, compared with a master’s degree in collective health). The postgraduate degree was more likely to precede specialisation for family and community physicians specialising through certification (master’s degree 39.9%, PhD 33%) than through medical residency (master’s degree 9.1%, PhD 6%). CONCLUSION: Family and community physicians in Brazil increasingly earn academic and professional master’s and PhD degrees, with an emphasis on collective health, even though women seemingly face barriers to advance their education. The consequences of different postgraduate trajectories should be critically examined.