The letter below, after being published (Brasil Medicina Portal and SBC Journal), stirred up outrage among physicians, owing to the negative weight of its message, and was disseminated by e-mail to colleagues all over Brazil. However, on showing the letter to Professor Irany Novah Moraes, I received a reply that deserves to be shared.
The Editor
Medicine at the Bottom of the Pit: The Price of Disunity.
Physicians, companions in the profession, how far we have fallen…
When my father, a physician, retired nine years ago, he said he was doing so because the medical profession had reached the bottom of the pit and he could not bear to watch the profession sink any lower than that.
Over those 9 years, salaries and even the CH (fee coefficient), created to protect medical work, lost 308.68% in value compared to the minimum wage (and we pay salaries based on the employees’ minimum wage); it lost 73.47% by the consumer price index (inflation), an index we know to be doctored by the Federal Government. If we “dollarize” our losses, they reach 351.81%. How far we have fallen…
At first we made budget cuts, then we increased our workload, taking on more shifts. We cut vacations, we became “special clients” of the banks — at first occasionally, today permanently. We do not even have time to organize ourselves. How far we have fallen!
We cannot even fight in court, because the Judiciary would never rule in our favor, even if we are right. The judges have already voted their own salary increase, and if they were to vote ours, there might be nothing left for them. In 1994 a physician earned R$755.00 and a public prosecutor R$1,300.00. Today, the physician earns the same R$755.00 and the prosecutor more than R$8,000.00. What difference in responsibility or in schooling accounts for such a disparity? Not to mention councilmen, tax auditors, and other posts which, thanks to their power to self-manage their salaries, kept advancing while we regressed. How far we have fallen.
And whose fault is it? Our own! We who let things run without reacting. Perhaps because of the famous phrase: “Medicine is a priesthood!” But even priests, today, mostly live well, eat well, have a car, dress well, travel. The fault is ours for having agreed to take shifts under minimal conditions. No water? We buy water. Bad food? We buy the food. No supplies? We improvise. All for the sake of keeping the service going and for the patient. The fault is ours for having created a medical cooperative that protects everyone except the physician. Look at a hospital daily rate today and 8 years ago. Who is protecting whom? The health plans have learned that we have no time to complain and pay what they want, when they want, and if they want.
We arrive in our little car, looking tired, exhausted — ragged, in truth — and are attended to by the plan’s manager: well-rested, wearing a tie, perfumed, and driving a brand-new luxury car at our expense. Pack mules is what we are. The Government too has learned that we have no strength to demand what is rightfully ours: it withdraws bonuses, suspends payments. It is as if we were exempt from financial obligations. Poor us! How far we have fallen!!!
We are afraid to ask a painter or a bricklayer for an estimate. We are pressed to pay for our children’s school. We think that if we go on like this, we will end up paying to work. We are mistaken! We are already paying, for the sleepless nights have brought us illnesses and health problems that our state pension of R$400.00, plus the INSS of R$800.00, plus perhaps a private pension, cannot cover. We pay, because our absence from home in the pursuit of maintaining a “standard of living” is priceless. Our children are at the mercy of drugs and bad examples, owing to neglect.
And how are we to tell our children that studying is worthwhile? They see the example of the father who studied so much, took so many courses, passed civil-service exams, and has such a poor quality of life. And then comes “Big Brother,” and other examples of people who live much better, even by illicit means. It is hard to make them understand that what keeps us in our profession, what nourishes our soul and our spirit, is two things: love for the practice of medicine and our inability to recoup all the investment we have made in it. If the fear is of paying to work, rest assured that we are already doing so. I think we ought to be more radical and refuse to accept impositions, because we know we are entirely in the right. We must earn more in order to serve our patients better. We must sleep well, in order to serve our patients better. We must study and stay up to date, in order to serve our patients better.
Like it or not, all of this depends on remuneration. That is why we should not be surprised when we come across “older” colleagues working the Saturday-night shifts. Or with their offices closed. Or former professors working in Family Health Programs (PSFs). Saturday-night revelry, for physicians, happens only in Rede Globo soap operas. What is shown are the exceptions.
May Hippocrates hear us!
Dr. Francisco Edilson Leite Pinto Junior is a Professor in the Department of Surgery of the Federal University of Rio Grande do Norte.
Reply from Professor Irany Novah Moraes
Alexandre,
When I graduated, the country had 19 medical schools. Today it has 113. Each year, 10,000 physicians graduate, and it is estimated that, at present, there are 5,000 openings for the new physicians. Annually there are 5,000 jobs. In Medical Residency there are 4,000 positions, from which one concludes that the thousand who exceed the Residency positions go directly into the job market, and since they know nothing, they call themselves general practitioners — not by choice but by exclusion.
The unprepared, when they find a place to work, last until their second mistake! Only the well-prepared, the competent, have and will always have opportunities. These will be greater for the best-prepared and thus the more competent.
*
Priesthood is not about the gratuitousness of the work but about the devotion with which it is done.
**
The comparison with a Public Prosecutor seems to me mistaken. What is being compared is a physician’s starting salary with a Prosecutor’s final one.
The starting salary may be R$755.00, but no one earns less than R$1,200.00. The breakdown is thus: base pay + bonuses + other items, minus income tax (the correct term would be a tax on the sweat of labor and never on income!), coming to roughly R$1,200.00. It is very little, but this is the result of the lack of planning in the country’s educational policy.
***
Of all this problem, remember that nothing withstands work done with intelligence, good sense, and devotion.
In work I always found pleasure, so I think I never worked — I only had leisure.
When I retired, I did not notice! I went on with the leisure…
I never took vacations; the leisure continued in my trips to the specialty’s Congresses.
In this “posture” lies the difference: the pit or the mountaintop.
Help to pull them out of the bottom of the pit! To do so, one must be above, with a lever to multiply the force and place them in the virtuous circle of health.
Your Grandfather
