Regional inequalities and low physician retention in Brazil: Evidence from 15 years of cohort analysis

Abstract

This study aimed to describe the application of an innovative methodology to measure physician
retention rates in Brazil’s health regions from 2009 to 2024. Using microdata from the National Registry
of Health Establishments – Professionals (CNES-PF), annual cohorts were constructed and analyzed
through churn, survival, and cohort analysis techniques, based on unique encrypted identifiers. Retention
was measured by the continuity of physicians working in the same health regions over time. Results showed
a national median retention rate of 51%, with higher values in the South and Southeast regions and lower
rates in the North and Northeast. The Federal District had the highest retention (80.4%), while Maranhão
had the lowest (36.5%). Intra- and interstate inequalities were identified, with state capitals showing higher
retention levels. A strong positive correlation between retention and the physician-to-population ratio (r =
0.748; p < 0.01) suggests a direct impact on healthcare coverage. This study addresses a gap in the literature
by offering a replicable method for nationwide analysis of medical workforce retention, contributing to
strategic healthcare planning within the Unified Health System (SUS) and informing public policies aimed
at strengthening professional retention in vulnerable areas.