Impementation of specialist workforce policies: a qualitative study on territorial and labor market constraints
1
Center for Education in Public Health (NESCON), Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
2
Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiros, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A3529
ABSTRACT
INTRODUCTION:
In 2025, Brazil’s Ministry of Health launched the More Doctors for Specialists Program (Programa Mais Médicos Especialistas – PMME) to expand access to specialized care in underserved regions. Although specialist shortages affect all of Brazil, they are most acute in the North, where long distances, river-based transport, and sparse urban networks constrain health system capacity. Santarém, a regional hub in the Baixo Amazonas, provides secondary and tertiary care for more than one million people across 20 municipalities. This study examines how territorial and labor market constraints shape the implementation of federal specialist workforce policies in the Amazon.
METHODS:
This qualitative study was conducted in late 2024 as part of a national workforce planning initiative. We conducted 24 semi-structured interviews with healthcare managers, service coordinators, and medical specialists, complemented by on-site technical assessments of hospitals, Emergency Care Units, and diagnostic services. Policy-relevant indicators, including waiting lists and referral flows, were analyzed to identify implementation bottlenecks and system performance.
RESULTS:
Severe shortages were identified in neurology, rheumatology, psychiatry, and cardiology. These gaps have generated prolonged waiting lists, including more than 27000 pending ultrasound requests. Federal specialist provision is undermined by high workforce turnover driven by precarious employment models and the absence of structured public career pathways. In the Amazonian context, high logistical costs and outdated Unified Health System reimbursement rates further weaken the capacity to recruit and retain specialists, even in regional hubs with residency programs.
CONCLUSIONS:
The Santarém case shows that national workforce policies face predictable implementation hurdles when territorial and labor market constraints are not addressed. While the PMME represents a promising policy milestone, expanding specialist access in the Amazon requires differentiated financing, regionally adapted employment models, and governance mechanisms capable of sustaining specialist teams in remote, river-based health systems.
In 2025, Brazil’s Ministry of Health launched the More Doctors for Specialists Program (Programa Mais Médicos Especialistas – PMME) to expand access to specialized care in underserved regions. Although specialist shortages affect all of Brazil, they are most acute in the North, where long distances, river-based transport, and sparse urban networks constrain health system capacity. Santarém, a regional hub in the Baixo Amazonas, provides secondary and tertiary care for more than one million people across 20 municipalities. This study examines how territorial and labor market constraints shape the implementation of federal specialist workforce policies in the Amazon.
METHODS:
This qualitative study was conducted in late 2024 as part of a national workforce planning initiative. We conducted 24 semi-structured interviews with healthcare managers, service coordinators, and medical specialists, complemented by on-site technical assessments of hospitals, Emergency Care Units, and diagnostic services. Policy-relevant indicators, including waiting lists and referral flows, were analyzed to identify implementation bottlenecks and system performance.
RESULTS:
Severe shortages were identified in neurology, rheumatology, psychiatry, and cardiology. These gaps have generated prolonged waiting lists, including more than 27000 pending ultrasound requests. Federal specialist provision is undermined by high workforce turnover driven by precarious employment models and the absence of structured public career pathways. In the Amazonian context, high logistical costs and outdated Unified Health System reimbursement rates further weaken the capacity to recruit and retain specialists, even in regional hubs with residency programs.
CONCLUSIONS:
The Santarém case shows that national workforce policies face predictable implementation hurdles when territorial and labor market constraints are not addressed. While the PMME represents a promising policy milestone, expanding specialist access in the Amazon requires differentiated financing, regionally adapted employment models, and governance mechanisms capable of sustaining specialist teams in remote, river-based health systems.
| eISSN: | 2654-1459 |
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