High education companies are going to court to open medical schools, without going through the scrutiny of the More Doctors program law, which defines several requirements. Since last year, 400 places were authorized after injunctions forced the Education Ministry to analyze requests to open these courses without taking part in the federal program. With the favorable decisions, companies now seek similar injunctions and have already filed 180 suits, according to Anup, a trade group that represents private universities.
Lawyers are telling judges that the private education sector is free, so schools should not be forced to launch medical courses through public calls, as required by the More Doctors program and unlike what happens with other courses. Another justification is that there is a shortage of doctors in the country, with the need to call Cubans to regions far from large cities. The opening of medical courses was halted in 2019, in a moratorium valid by April 2023, according to a federal law.
Three education companies launched medical courses since last year. Bahia-based network UniFTC got 199 places in the Feira de Santana unit. Faculdade de Educação de Jaru, in Rondônia, was authorized to offer 120 places; and college Dom Bosco, with a unit in São Luiz (Maranhão), got 84 spots. These three educational companies obtained 403 places in the past year and a half. For comparison purposes, in this same period, 800 More Doctors spots were released through a public call. These 800 places were authorized in 2018, but only now the Education Ministry released them.
Educational groups that take an injunction to open medical courses manage to circumvent the More Doctors program and the five-year moratorium. The ordinance that prohibits the opening of new medical courses for public and private institutions until April 2023 was instituted after strong pressure from the Federal Council of Medicine, which complained about the quantity of low-quality courses and excess of students. In 2020, there were 142,500 students enrolled in medical courses, in the private sector.
About 75% of the private courses are located in São Paulo, Minas Gerais, Rio de Janeiro, Santa Catarina, Bahia and Rio Grande do Sul, since the institutions opted for the most populated regions. This is one reason for the current shortage of doctors in the North and Northeast regions, and in smaller cities. Given this scenario, in 2013 the government created the More Doctors law, which defined that private colleges can only operate medical courses in cities lacking professionals. Sixty-seven municipalities were chosen, and the colleges selected to operate in these cities must make commitments, such as transferring 10% of revenues from tuition fees for the municipalities to invest in public health. To serve the students, the city’s public infrastructure must have, for example, at least five public beds for each student, a hospital with 100 inpatient units, among other requirements. If the transfers are not sufficient, the college can invest more funds. By obtaining a court injunction, colleges are not obliged to follow these rules and can open their units in larger cities, which end up attracting more students.
“More Doctors program is a socially-oriented public-private partnership. The program serves private schools, but requires investments in public health in return. When another company manages to open medical courses through an injunction, this public policy is broken,” said Elizabeth Guedes, head of the Anup, which has already complained to the ministries of Education and Health, the Federal Attorney General’s Office (AGU) and the Federal Council of Medicine (CFM). “These courses are not illegal because they took court injunctions, but they are immoral,” she added.
“With litigation, the only restriction of More Doctors is no longer being met, which is the public call, which defines the region to install a medical school by social criteria,” said the physician Julio Braga, coordinator of CFM’s Medical Education Commission.
Bahia-based UniFTC Network, which obtained 199 places in Feira de Santana, says that the reason for filing a suit was the lack of medical schools in the region. “Health indicators already clearly demonstrated the lack and the social demand for the formation of doctors in the region, which has more than 3 million inhabitants. Until then, there was only one medical course at the State University of Feira de Santana, with only 35 places,” said Ihanmarck Damasceno, academic vice-president of UniFTC.
Esmeraldo Malheiros, a lawyer specialized in education who worked 35 years at the Education Ministry, says the injunctions are fair. “Private education is free, and educational institutions are free to operate. You can’t create barriers and have a protected market,” said Mr. Malheiros, whose office was the first to obtain a favorable decision, which encouraged others to file similar requests. Another point raised by Mr. Malheiros is that the requirement of the More Doctors calls for bids benefits large groups, which can prove better cash flow. “The large groups, which have more regulatory experience, got 70% of places authorized,” he said.
According to data from Hoper, a consulting firm specializing in education, in 2020 there were 142,500 students enrolled in private medical courses, 27.6% of them concentrated in eight major groups: Afya, Ânima, Cruzeiro do Sul, Kroton, Ser Educacional, Tiradentes, Uninove, and Yduqs.
The lawyer says that injunctions are for the Education Ministry to analyze the requests, not to approve the courses. “The ministry is free to approve them or not. If the course is bad, it rejects it. The issue is that with More Doctors, the Education Ministry doesn’t even analyze the request,” Mr. Malheiros said. The head of Anup argued that the ministry has the autonomy to analyze the requests, but the injunctions exert additional pressure. After receiving and analyzing the documents from the request to open a course, Education Ministry representatives make several visits to the college that made the request. By the normal rites, this process takes months, even years.
The wave of lawsuits may affect the market, which has already been suffering the impact of increased competition. The average tuition fee remained around R$8,300 and R$8,400 between 2019 and 2021. In the previous seven years, there was an upward curve, according to Hoper.
In 2020, the ratio of candidates for each place was 8.6 in the private sector. In 2013, there were 31 students vying for each medical school place. The estimate is that the year will end with 239 private courses, practically twice as many as in 2014.
The Education Ministry and Faculdade de Educação de Jaru did not immediately reply to a request for comment. Dom Bosco declined to comment.
Source: Valor International