By Camilo Diniz
Brazilian President Luiz Inácio Lula da Silva (Workers' Party, PT) on Friday (Nov. 6) signed a law making the Enamed exam mandatory for anyone who wants to practice medicine in Brazil. The rule had already been in force since June under a provisional measure, a decree with the force of law. It now becomes permanent. In practice, the test stops being a simple exam and becomes the gateway to professional registration.
Three exams, with the last one weighing most
The text approved by Congress goes further than what the government originally proposed. The provisional measure called for two evaluations during medical school. The law that was signed calls for three, at the end of the second, fourth and sixth years of the course. The final score will be calculated from the student's accumulated performance across the three stages, with greater weight on the last exam.
The government says the model is more advanced than the exam used for lawyers, run by the Brazilian Bar Association (OAB). Health Minister Alexandre Padilha said: “We are not creating the ‘OAB [Brazilian Bar Association] of medicine’.” He added that it is “a progress test in the second, fourth and sixth years.” For students, that means more exams, a longer period of scrutiny and more risk for people who have already paid dearly for their degrees.
Medical schools that failed and the cost to students
In the first edition of the exam, 99 medical schools, about one third of the total, did not reach a satisfactory score and are now being monitored by the Ministry of Education (MEC). In theory, the institutions pay for the failure. But it is the student who faces the barrier, and may have to retake the exam in later editions to get a license.
Anyone who graduated before June 19, the date the provisional measure was published, is exempt. Those who do not reach the required level can ask the Regional Council of Medicine for the Medical Graduate Registration (Inscrição de Egresso de Medicina, or IEM). That document has a clear limit: it is valid only for technical and scientific activities, such as research assistant or public policy consultant. Seeing patients, writing prescriptions and keeping medical records remain off limits.
Who runs the exam? The medical council won the fight
The dispute over who would run the exam marked the passage of the provisional measure. The MEC and the Federal Council of Medicine (CFM), the profession's regulatory body, fought over organizing the test, and the council ended up regaining a leading role.
The National Commission for the Evaluation of Medical Training, which will define what counts as proficiency and assess the results, will have two representatives from the MEC, two from the Ministry of Health and four from the CFM. The chairmanship rotates annually between the council and the government representatives. In other words, the profession being evaluated will hold half the seats on the body that sets the passing standard. CFM president José Hiran da Silva Gallo welcomed the signing and called it a “historic moment” for the profession.
Why it matters
Brazil has expanded its medical training sharply in recent years, and the new law is the government's answer to concerns about quality. Padilha pointed to the opening of almost 30,000 places in medical courses between 2015 and 2022, which he called a “debacle.” Education Minister Leonardo Barchini promised more precise oversight: “To know where we have to increase the number of places, where we have to close places.” If the problem is disorderly expansion, the open question is why the solution falls first on students who are already midway through their degrees.
The Enamed score may also be used in selection processes for direct-access medical residency programs, and the exam already forms part of the theoretical stage of the Enare. A student's performance will therefore count at more than one door. It remains to be seen how many future doctors will end up shut out.
VDD Analysis
The aim of improving medical training is legitimate, and society deserves good professionals. But a law that creates three barriers during the course, gives the council half of the commission and leaves students with a limited document to work with deserves scrutiny. Quality is built by overseeing medical schools from the start, not by piling exams onto students who are already in the final stretch.
