What happened to health labour markets during COVID-19? Insights from a survey of medical doctors in Brazil

AO_SCPLOWBSTRACTC_SCPLOWO_ST_ABSBackgroundC_ST_ABSLimited evidence exists on impacts and adaptations of global health markets during COVID-19. We examined physicians perceptions of changing employment opportunities in Brazil, to gain an insight into labour markets in low- and middle-income countries (LMICs) during the pandemic. MethodsWe conducted secondary analysis of a dataset from a representative cross-sectional survey of 1,183 physicians in Sao Paulo and Maranhao states in Brazil. We estimated prevalence and 95% Confidence Intervals (CI) for proxy variables of demand and supply of doctors, and prices of medical services for facilities of practice in the two States, stratified by public, private, and dual practice physicians. ResultsMost doctors reported increased job opportunities in the public sector (59.0%, 95% CI 56.1-61.9), particularly in Maranhao state (66.4%, 95% CI 62.3-70.3). For the private sector, increased opportunities were reported only in large private hospitals (51.4%, 95% CI 48.4-54.4), but not in smaller clinics. We recorded perceptions of slight increases in availability of doctors in Maranhao, particularly in the public sector (54.1%, 95 CI 45.7-62.3). Younger doctors recounted increased vacancies in the public sector (64%, 95 CI 58.1-68.1); older doctors only in walk-in clinics in Maranhao (47.5%, 95 CI 39.9-55.1). Those working directly with COVID-19 saw opportunities in public hospitals (65%, 95 CI 62.3-68.4), and in large private ones (55%, 95 CI 51.8-59.1) ConclusionsOur findings suggest that health labour markets in (LMICs) may not necessarily shrink during epidemics, and that impacts will depend on the balance of public and private services in national health systems. KO_SCPLOWEYC_SCPLOWO_SCPCAP C_SCPCAPO_SCPLOWMESSAGESC_SCPLOW What is already known on this topiHealth labour markets are believed to shrink during epidemics, with fewer services and jobs available because of lockdowns and reduced demand. What this study addsThe doctors we surveyed in Brazil noticed increased job opportunities in the public sector during COVID-19, particularly in Maranhao state. For the private sector, increased vacancies were reported in large private hospitals but not in smaller clinics. How this study might affect research, practice or policyThe complementary roles of health markets and publicly or privately funded systems during a health emergency might need re-examining to improve pandemic preparedness in LMICs.