This Sunday (13), almost 100 thousand doctors and medical students take tests that could define the next step in their careers. The National Residency Exam (Enare), a kind of “Residence Enem”, received 98,036 registrations and offers 8,295 places, according to data from the Ministry of Education (MEC) sent to g1.
The dispute is even greater in "direct access" type residences: these are those that can be started by the recent graduate without a previous specialization. There are 89,935 applications for 6,019 vacancies, equivalent to almost 15 applications per vacancy.
⚠️VACANCY CANDIDATE RATIO: Competition varies greatly depending on the program. In direct access, the highest ratio is in Otorhinolaryngology, with 38.94 candidates per vacancy. Next come Legal Medicine and Medical Expertise (36.67), Sports Medicine (36), Dermatology (32.19) and Neurosurgery (31.49). Among the courses with the least competition are Acupuncture (3.33), Emergency Medicine (3.98), Infectious Diseases (4.33) and Homeopathy (4.50).
In addition to the "direct access" vacancies, there are another 1,301 "prerequisite" vacancies (requiring another specialty), 807 "area of expertise" (additional for those already specialized) and 168 additional year vacancies (practical training for already specialists).
The selection takes place amid a growing challenge in medical training in Brazil: the country has multiplied courses and undergraduate vacancies in the last two decades in the private network, but residency opportunities have not advanced at the same pace.
Between 2018 and 2024, the number of medical students grew by around 71%, from 167.7 thousand to 287.4 thousand. In the same period, the total number of resident doctors increased by approximately 26%, from 37,742 to 47,718.
The result is a growing number of doctors who finish college without a corresponding opportunity to immediately enter residency and who, ultimately, fail to provide even more complete care to patients.
In 2023, 32,611 doctors completed their graduation. The following year, there were 16,189 occupied first-year (R1) places. The difference between the number of graduates and these vacancies reached 16,422. In 2018, it was just 3,886.
The More Doctors Law of 2013 established the goal that the country would annually offer a number of medical residency vacancies equivalent to the total number of doctors trained in the previous year. The measure was supposed to be progressively implemented by the end of 2018, but the target was not met, according to experts interviewed by g1.
In 2024, 40.9% of Brazilian doctors did not have a specialist title. The proportion of specialists in the country, 59.1%, was also below the average of 62.9% of the 39 countries analyzed by the Medical Demography 2025 study.
The research was prepared by the Preventive Medicine department of the Faculty of Medicine of the University of São Paulo (FMUSP), in cooperation with the Brazilian Medical Association (AMB), the Ministry of Health, the Pan-American Health Organization (OPAS), the Ministry of Education (MEC) and Fapesp.
Graduation grows much faster than residency
In 20 years, therefore, the number of courses increased by 239% and the number of vacancies, by 251%. — Photo: Adobe Stock
The gap between undergraduate and residency expansion began to be built over the past two decades. In 2004, Brazil had 132 Medicine courses, with 13,820 annual vacancies. In 2024, there were 448 courses and 48,491 authorized places.
In 20 years, therefore, the number of courses increased by 239% and the number of vacancies, by 251%. The Brazilian population, on the other hand, grew approximately 18% in the same period, from just over 180 million to 212.6 million inhabitants.
The expansion of colleges accelerated especially in the last decade analyzed. From 2004 to 2013, 7,692 vacancies were added. Between 2014 and 2024, 27,921 were created — almost four times the increase in the previous decade. Of the vacancies open between 2014 and 2024, 91.5% were private.
Given the schools already open and the vacancies authorized by the MEC, the Medical Demography study estimates that Brazil should train, in the short term, more than 42 thousand new doctors per year.
Expert alert
José Eduardo Lutaif Dolci, scientific director and next president of the Brazilian Medical Association (AMB), warns that the difference between the number of trained doctors and those who manage to specialize tends to increase.
Antônio José Gonçalves, president of the Associação Paulista de Medicina and professor at the Faculty of Medical Sciences of Santa Casa de São Paulo, adds that residency is a fundamental step to complement training.
"Six years of graduation, even from the best schools, are not enough to train a good doctor. Medical residency is essential to improve the quality of the doctor", he states.
Government creates 3 thousand scholarships in response to the bottleneck
Amid the increasing difference between trained doctors and specialization opportunities, the federal government announced in February this year 3,000 new medical residency grants, within the Agora Tem Especialistas program. According to the Ministry of Health, with the expansion, the Union will finance more than 60% of the country's medical residency scholarships.
The number helps to measure the government's response to the size of the gap. In the comparison between 32,611 doctors trained in 2023 and 16,189 filled direct access R1 vacancies in 2024, the difference was 16,422.
The 3,000 new grants are equivalent to around 18% of this difference. The comparison does not mean, however, that the new scholarships directly eliminate this deficit, as not all of them necessarily correspond to direct access R1 places.
Updated data sent by the department to g1 show that, by August 2026, 2,872 of the 3,000 new scholarships planned had been financed through Pró-Residência. The notice continued with open subscriptions, expected to reach 3,000 by the end of the year.
The new vacancies are aimed at specialties considered a priority for the SUS, including oncology, anesthesiology, oncological surgery, pediatric neurology, ophthalmology and radiotherapy.
Residency also affects working hours and remuneration
The number of vacancies is not the only obstacle to specialization. Experts interviewed by g1 state that some doctors finish college with debt or need to start working immediately and, therefore, may opt for on-call instead of residency.
The programs have a workload of 60 hours per week and a minimum stipend of R$4,106.09 gross, according to the Ministry of Health. Dolci considers the remuneration to be insufficient given the workload and advocates measures to make the residency more attractive.
Given the difficulty of quickly expanding vacancies, AMB also proposes that the government finance scholarships for specialization programs maintained by medical societies.
According to Dolci, 32 of the 54 specialty societies have teaching and training centers that offer specialist training not accredited by the MEC and train more than 5 thousand specialists per year.
The entity's proposal is to take advantage of existing centers, teachers and structures to expand specialized training.
More doctors does not mean more specialists
The accelerated growth in graduation is already reflected in the total number of professionals. If the current pace is maintained, Brazil should reach 1.15 million doctors in 2035, with a density of approximately 5.2 professionals per thousand inhabitants.
For experts, however, increasing the absolute number of doctors does not alone solve the problem of assistance if the growth is not accompanied by qualifications.
Dolci draws attention to the consequences in primary care. According to him, doctors without adequate training may be less able to resolve cases at this level of care and, consequently, increase referrals to specialists.
"The qualified doctor who goes to primary care, in theory, should be resolving at least 75% of cases. But this does not happen in Brazil because this doctor is not qualified", he states.
The distribution of professionals also remains unequal. The Southeast concentrates 46.3% of the country's doctors, and 18 of the 27 units of the Federation have a ratio of doctors per thousand inhabitants below the national average. According to Medical Demography 2025, capital cities have 366% more doctors per thousand inhabitants than the rest of the states.
To encourage internalization, experts advocate the creation of a state career for doctors, along the lines of those existing for judges, prosecutors and delegates. The proposal seeks to encourage professionals to stay in smaller cities and more distant regions, with professional progression.
For those interviewed, this reinforces that training policy needs to consider not only how many professionals enter the market, but in which specialties and regions they are needed.
Quality of graduation is also a concern
The speed of expansion of courses adds another issue to the debate: the quality of training for new doctors.
The results of the first edition of Enamed showed that, of the 351 courses analyzed in 2025, 107 were in the two lowest evaluation ranges, more than 30% of the total. There were 24 courses with concept 1 and 83 with concept 2.
Gonçalves defends greater supervision of the requirements of infrastructure, hospitals and teaching staff at colleges. He and Dolci are also in favor of creating a proficiency exam to check whether new graduates are able to practice Medicine.
The exam would have a different function than Enamed: while the assessment applied again this Sunday measures students' performance and helps evaluate courses, the proficiency proposal would check the doctor's ability after training.
The challenge of public policies, therefore, does not end with the opening of undergraduate vacancies. With an increasing number of doctors leaving college, the country needs to define how many specialization opportunities to offer, in which areas and regions and how to make residency grow at a pace capable of keeping up with the expansion of medical training.
