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

Background Limited 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. Methods We conducted secondary analysis of a dataset from a representative cross-sectional survey of 1,183 physicians in São Paulo and Maranhão 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. Results Most doctors reported increased job opportunities in the public sector (59.0%, 95% CI 56.1-61.9), particularly in Maranhão 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 Maranhão, 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 Maranhão (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) Conclusions Our 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. What is already known on this topi Health labour markets are believed to shrink during epidemics, with fewer services and jobs available because of lockdowns and reduced demand. What this study adds The doctors we surveyed in Brazil noticed increased job opportunities in the public sector during COVID-19, particularly in Maranhão 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 policy The 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study on whose findings this paper is based, received support from the Confap-MRC call for Health Systems Research Networks. Giuliano Russo received an award from the NEWTON FUND, MEDICAL RESEARCH COUNCIL (UK), grant reference MR/R022747/1. Mario Scheffer and Alex Cassenote received an award from the Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP-Brazil), 2017/50356-7. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The original survey received approval from the Research Ethics Committees of the Federal University of Maranhao, Brazil (CEP UFMA 3.051.875) and from the Faculty of Medicine of the University of Sao Paulo, Brazil (CEP FMUSP 3.136.269). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors