Clínicas populares de saúde: processo de trabalho na perspectiva de médicos

Abstract

The Low-Cost Clinics (LCCs) are companies that offer diagnostic tests and consultations with specialist doctors at so-called popular prices. The scientific production about these companies indicates a centrality in the figure of the physician, who represents their main labor force. Physicians are the main social actors of the health work process in these companies. The objective of this study is to understand the work process in LCCs in São Luís, Maranhão, from the perspective of physicians. This is a qualitative research conducted between the months of May to July 2021, with young doctors. For the fieldwork, the snowball technique was used. Eight professionals were interviewed, using an interview script with questions about work experiences prior to LCCs, working conditions, including dynamics, technical and social relationships in current companies, and finally, future professional plans. The results showed that the interviewed physicians were hired at the end of their medical residencies. The professionals have no formal employment ties. They are paid by production, that is, by the number of patients seen. Another form of linkage is by contract as a legal entity, called pjotization, a contracting model that allows doctors to accumulate multiple links in LCCs and that gives these companies the advantage of a specialized workforce without the costs of the consolidation of labor laws (CLT). Given the limitation of these services, physicians use their personal and professional networks to make informal referrals of patients from the LCCs to the Sistema Único de Saúde (SUS). This is one of the dilemmas faced by such professionals in their daily work in these companies. On one hand, there are limitations of a fragmented service, and on the other hand, there is an ethical commitment to the exercise of medicine and the production of a more qualified care. Another dilemma is linked to the strategies adopted to consolidate professionally. The LCCs are seen as a work field and as a place to acquire professional experience. Therefore, it is understood that the physicians' work process is challenged by the limited and fragmented nature of LCCs services. In this scenario, these professionals in search of consolidation in the labor market find themselves subjected to conditions of labor exploitation.