Medical Education, Public Policy, Health Workforce, Medical Schools, Social accountability - March 22nd, 2026

Sep 6, 2026

Rapid expansion of medical schools is widely used to address physician shortages and improve healthcare access, yet evidence remains uncertain about whether large-scale growth sustains educational quality and reduces access barriers. This observational, descriptive, cross-sectional analysis examines all active undergraduate medical programs in São Paulo State listed in Brazil’s e-MEC system from 2013 to March 2025, using administrative and official performance data (ENADE 2023, CPC) to assess expansion patterns, regional inequities, and associations with institutional characteristics.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages22

Reading Time55 min

AccessFree to download

Study scope and data sources

Expansion patterns and geographic distribution

Educational performance measures

Methods

Statistical approach and group comparisons

Multivariate association models

Results

Seat authorization and drivers

Regional socioeconomic disparities

Institutional age, ownership, and performance

Discussion and implications

Limits of market-driven expansion

Policy needs for quality and equitable access

University of Campinas (UNICAMP) Foundation for Advancement of International Medical Education and Research University of Campinas (UNICAMP) Medical Education, Public Policy, Health Workforce, Medical Schools, Social accountability March 22nd, 2026 [https://doi.org/10.21203/rs.3.rs-8622396/v1](https://doi.org/10.21203/rs.3.rs-8622396/v1) 􀁱 􀅏 This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License No competing interests reported. The rapid expansion of medical schools has been widely adopted as a strategy to address physician shortages and improve access to healthcare. In Brazil, a national policy implemented in 2013 substantially increased medical training capacity, largely through private-sector participation. However, concerns persist regarding whether rapid expansion improved access for students and patients while sustains educational quality. São Paulo is the most populous and economically developed state in Brazil, with structural, regulatory, and market characteristics comparable to those observed in middle-and highincome countries. This offers an informative analytical case to examine the effects of large-scale medical school expansion in a complex health professions education market. This observational, descriptive, cross-sectional study analysed all active undergraduate medical programs registered in the Ministry of Education’s e-MEC system in São Paulo State between 2013 and March 2025. Expansion patterns, geographic distribution, and regional socioeconomic characteristics were assessed using publicly available administrative data. Educational performance was evaluated using o cial data, the National Student Performance Exam (ENADE 2023) and the Preliminary Course Concept (CPC) . Descriptive statistics and non-parametric tests were applied for group comparisons. Multivariate generalized linear models were used to assess associations between institutional characteristics and student performance. Between 2013 and 2025, 42 new medical programs were authorized, resulting in a 74.7% increase in available training seats. Expansion was predominantly driven by private institutions, which accounted for 80. 5% of newly authorized seats, and was spatially concentrated in regions with higher socioeconomic development and stronger healthcare infrastructure. Regions with lower development indicators experienced little or no expansion. Medical schools with further from their establishment date and public ownership achieved signi«cantly higher student performance scores, whereas newer, predominantly private institutions showed greater variability. Although public institutions demonstrated stronger student performance, they received lower ratings in infrastructure and didactic–pedagogical organization. In multivariate analyses, institutional age and ownership remained independently associated with student performance, while no variables showed signi«cant associations with the overall institutional performance score. The expansion of medical education in São Paulo State produced substantial quantitative growth but failed to reduce territorial inequalities. Educational quality was more strongly associated with institutional maturity and public ownership than with expansion alone. As an analytical case re¬ecting dynamics seen in other regulated health education systems, our example highlights the limits of marketdriven expansion and underscores the need for integrated policies that align growth with quality assurance, accreditation, and workforce retention strategies to promote equitable and sustainable healthcare access. For more than a decade, international literature has highlighted persistent shortages and maldistribution of physicians as a central challenge for health systems worldwide 1–3. One commonly adopted strategy to address these imbalances has been the expansion of medical schools and the increase in training capacity. In Brazil, longstanding inequa

FAQs

What time period and data source are used to analyze medical school expansion in São Paulo?

The study covers all active undergraduate medical programs registered in Brazil’s e-MEC system in São Paulo State from 2013 to March 2025, using publicly available administrative data and official performance indicators.

How did medical training capacity change between 2013 and 2025?

Between 2013 and 2025, 42 new medical programs were authorized, producing a 74.7% increase in available training seats.

What factors were associated with student performance and educational quality?

Institutional age and public ownership remained independently associated with student performance in multivariate analyses, while expansion alone showed weaker links to educational quality.

Sep 6, 2026

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