New trends of practice arrangement among specialist doctors in brazil
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Federal University of Minas Gerais Brazil
Federal University of Minas Gerais
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A1747
Background and purpose:
Physicians practice arrangements are defined by a combination of structural and relational attributes that characterize the ways and conditions in which medical work is performed and remunerated. The objective of this study is to describe changes in practice arrangements of medical specialties in Brazil between 2010 and 2021.

Practice arrangements include: (i) type of practice; ii) practice ownership structure iii) employment relationship, iv) practice size, defined by the number of physicians working in the establishment and how it is remunerated. Data were collected from the Ministry of Health of Brazil referring to the universe of physicians working in health establishments in the country in the period from 2010 to 2021/2022.

There is a trend to increase practice in solo practice and in small single-specialty practice groups as well as in medium and large multi-specialty groups. The precariousness of work also increases and appears in different ways: through the increase in typical outsourcing, the use of employing agencies such as social organizations, by the use of fictitious firms constituted as legal entities to escape the tax and social protection obligations of the typical employment relationship; by the increase in formal temporary employment contracts and by the expansion of the use of work by residents in hospitals as well as self-employed workers in public outpatient clinics. There is a deepening of the trends observed in the last years of the series as a possible impact of the Covid-19 pandemic.

During the last decade, especially in recent years, with the Covid-19 pandemic, there was a trend to expand the precariousness of work and unstable flexible practice arrangements among specialist doctors in Brazil