Medical school programs face new wave of litigation in Brazil

So far, 4,354 medical school seats have been authorized through court-ordered analyses. That number may reach 4,689 once all cases are processed. For comparison, there are 6,200 seats accredited through the More Doctors Program (Rounds I and II), which has been the official channel for authorizing new medical programs since 2012.

“The new More Doctors call for proposals had to be suspended due to a new wave of litigation. We’ve been receiving new court orders challenging our decisions and directing us to revisit them,” said Marta Abramo, Secretary for Regulation and Oversight of Higher Education at MEC, during a seminar hosted on November 6 by the Rio de Janeiro State Association of Private Education Providers (SEMERJ).

The ministry temporarily suspended, for 120 days, the third More Doctors call to reassess the availability of beds within Brazil’s public healthcare system (SUS), since many of these inpatient slots have been taken up by medical courses created under provisional rulings. All medical students—whether enrolled at public or private institutions—are required to complete practical training within the public health system.

There are also medical programs operating without MEC accreditation, having been launched under provisional rulings authorizing their entrance exams.

“MEC representatives updated and clarified important points for educational leaders. There is a new environment for medical training in Brazil, which makes the topic highly relevant,” said SEMERJ President Claudia Romano.

The seminar also included representatives from the University of São Paulo’s School of Medicine, Instituto D’Or (the research arm of Rede D’Or hospital group), Estácio, and Afya, as well as Minister of Health Alexandre Padilha. They also discussed medical residencies—which are facing a shortage of positions—and the new exam that will assess newly graduated physicians.

By mid-last year, there were roughly 370 lawsuits seeking authorization for 60,000 new medical school seats. The Supreme Court issued rules to bring order to this demand, and 89 cases qualified to proceed.

According to the Medical Demographics in Brazil study by the University of São Paulo’s School of Medicine, there are nearly 51,000 medical school seats in 2025, 80% of them at private institutions. Five years ago—before litigation accelerated—that number was 38,800. The surge in lawsuits began in 2018, when the Michel Temer administration imposed a five-year moratorium on the creation of new medical programs.

In this environment of abundant seats, colleges are already facing issues with student delinquency—an unthinkable scenario until recently. Medical school has typically been the most attractive degree in higher education, given its low rates of late payments and dropouts and the high value of tuition.

A survey by Instituto Semesp and Principia Educação—a firm providing factoring of receivables in education—shows that medical school now ranks as the fourth program with the highest delinquency rate. The top three are law, nursing, and engineering, considering in-person programs.

“The litigation around new program authorizations, combined with incentives to attract students through scholarships, has completely changed the delinquency dynamics in medical education,” said Rodrigo Capelato, Semesp’s executive director.

“This shift reflects the increase in available seats. In the past, students didn’t fall behind on payments for fear of losing their spot, because many others wanted it,” said Newton Maia, founder and CEO of Principia.

The rise in medical school delinquency goes against the broader trend in the sector. Data from Instituto Semesp and Principia show that the overall indicator fell: in the first half of the year, the delinquency rate stood at 8.73%, a 1.9% improvement over the same period in 2024. The study considers payments more than 90 days overdue.

The main causes of delinquency are job loss or reduced income (62.8%), lack of financial planning (58.1%), rising household expenses (44.2%), health problems (32.6%), delayed wages or reduced family support (30.2%), and personal financing commitments such as car, home, or motorcycle loans (30.2%).

Many colleges—particularly those located in remote areas—are failing to fill classes even after multiple call-back rounds. In 2014, the applicant-to-seat ratio at private institutions was 27 to 1. In 2024, that ratio fell to 7.4 applicants per seat, according to the National Institute for Educational Studies and Research (INEP), an MEC agency.

According to Maia of Principia, in other degree programs, it is common for students to skip paying for a semester and then request a transfer at re-enrollment time. But in medical school, this “modus operandi” is more difficult because tuition is so high. The average monthly tuition is R$13,000. “If a student goes two or three months without paying, the debt becomes very large. It’s a complex scenario for the institutions as well,” he said.

Principia does not provide factoring of receivables for medical programs due to the high tuition amounts. Maia noted that it would require a different model to calculate default risk.

The Brazilian Association of Higher Education Institutions (ABMES) stated, in a press release, that when the Supreme Court ruled on Declaratory Action of Constitutionality (ADC) 81, the understanding was that case analyses would follow previously established criteria, especially those outlined in the More Doctors program. “MEC’s Seres Administrative Rule No. 531/2023 introduced new parameters, such as regional indicators and population thresholds, which had not been used previously in authorization procedures, including those from More Doctors calls.”