Brazil Proposes National Medical Licensing Exam

A significant shift is underway in the Brazilian medical landscape as lawmakers debate the creation of a mandatory national proficiency exam for new doctors. This proposed measure, often compared to the Ordem dos Advogados do Brasil (OAB) exam for lawyers, aims to establish a uniform standard of knowledge and skill before a physician can practice.

The discussion has gained urgency following the recent release of evaluation results for medical schools. Data indicates that a substantial portion of the country's medical programs are underperforming, prompting calls for stricter oversight and a new barrier to entry for the profession.

The core of the legislative push is the Exame Nacional de Proficiência em Medicina (ProfiMed). The goal is to institute this exam as a prerequisite for new graduates to register with regional medical councils and begin their careers. This would add a critical step between graduation and professional practice.

Currently, a medical graduate can immediately request their professional license (CRM) and begin working. Under the new proposals, approval in the ProfiMed would become mandatory first. The exam is designed to assess a candidate's professional and ethical competencies, theoretical knowledge, and clinical skills based on minimum standards for the profession.

The initiative is supported by the Federal Council of Medicine (CFM), which issued a statement endorsing the proposal currently in the Senate. The council believes this measure is essential for public safety.

“The Federal Council of Medicine reiterates its position in defense of the Brazilian population's safety and maintains that the National Proficiency Exam in Medicine is absolutely necessary for the protection of Brazilian society's health and the proper practice of medicine.”

The call for stricter standards is not happening in a vacuum. The Ministry of Education recently released the results of the Exame Nacional de Avaliação da Formação Médica (Enamed), an annual test measuring student performance and educational quality.

The findings were stark: approximately 30% of medical courses in the country received poor evaluations, scoring a 1 or 2, which the INEP considers unsatisfactory. These institutions will face tangible consequences, including restrictions on FIES (a federal student financing program) and the suspension of new student vacancies.

Senator Dr. Hiran (PP-RR), the relator of the Senate bill, framed the issue as a matter of public protection, citing a crisis in medical education.

“We consider, in the country's medical movement, this as the most important law of this century, mainly to protect the Brazilian people, because we live in a very dangerous crisis of fragility in the formation of the Brazilian doctor, as a consequence of an uncontrolled, irresponsible, mercantile proliferation.”

Two primary projects are currently advancing through the Congresso Nacional, each with a distinct approach to implementing the proficiency exam.

Senate Bill (Authored by Senator Marcos Pontes): This proposal has already been approved by the Commission of Social Affairs (CAS). It mandates the ProfiMed for all medical graduates and introduces several other instruments to monitor medical education. Key provisions include:

• Fourth-year students must take the Enamed to measure course quality.
• A residency expansion plan aiming for 0.75 residency spots per doctor graduated by 2035.
• Exclusive federal authority to authorize and supervise medical courses.

Chamber of Deputies Bill (Authored by Deputy Doutor Luizinho): This project, which was granted urgency in July 2025, will be analyzed directly by the full chamber. It proposes a serial exam format, requiring students in their 3rd, 4th, 5th, and 6th years to achieve a minimum score of 60% on each test. It also includes provisions for makeup exams for those who do not meet the threshold.

The debate over medical standards has been further highlighted by recent high-profile incidents. A notable case involved a woman in Bauru, São Paulo, who was declared dead by a SAMU (Mobile Emergency Care Service) team after being hit by a car, only to be resuscitated minutes later by a doctor from the road concessionaire.

The attending physician from SAMU was subsequently suspended, and an internal investigation was launched to determine what went wrong. This incident has underscored the arguments made by proponents of the ProfiMed, who stress the need for guaranteed competence.

If passed, the legislation would also impact foreign-trained doctors. The ProfiMed would serve as a pathway for revalidating international diplomas, creating a single, standardized test for all physicians seeking to practice in Brazil. The final implementation, however, depends on the approval of both legislative houses and the subsequent sanction by President Luiz Inácio Lula da Silva.

The creation of a national medical proficiency exam represents a potential paradigm shift in Brazilian healthcare regulation. By establishing a uniform benchmark for all new doctors, the government aims to address concerns about the variable quality of medical education and enhance patient safety.

While the proposals have strong backing from medical councils and lawmakers concerned about educational standards, their journey through the legislative process is ongoing. The coming months will be critical in determining whether Brazil will join other nations with a mandatory licensing exam for physicians, fundamentally changing the path from medical school to clinical practice.