Apresentação minha no SHM CONVERGE 2022, sediado em Nashville, no painel 'Hospital Medicine Around the World: Japan, Spain, Brazil & Qatar'.

1. Brazilian Hospital Medicine
session Hospital Medicine Around the World:
Japan, Spain, Brazil & Qatar
SHM CONVERGE 2022
Guilherme Brauner Barcellos, MD, SFHM
Brazilian Academy of Hospital Medicine (ABMH)

2. Our Country
• The largest one in South America;
• The world's fifth largest country, both by geographical area and by
population;
• There are private and public healthcare services. They should be
complementary, but dysfunctional competition is common;
• Public health care – universal and free - is provided to all Brazilian
permanent residents and foreigners in Brazilian territory as a
Constitutional Right through the National Health Care System, known
as SUS;
• Fee For Service predominates in the private health care, but new
payment models are [very slowly] coming;
• It is still a country of disparities, where overuse and underuse of
medical interventions coexist in both private and public practices, even
with the underfunding of the public ones.

3. Health Care in Brazil
A country of disparities:
• Disparities between private system and public system;
• Disparities between private hospitals;
• In the public system, some hospitals are islands of excellence,
including mine…

4. While Others….
Health Populism
It’s the same country where
Ivermectin for COVID-19 cost
the public coffers R$ 4.4
million for a city of < 200,000
people in Santa Catarina
state.

5. HM in Brazil
• We have news of at least one HM program in
practically every state in Brazil;
• Most are still in “early evolutionary stages”,
focusing on direct patient care and efficiency;
• As “double certification” is common in Brazil (in
Internal Medicine and a clinical subspecialty),
some HM enthusiasts ended up (reluctantly)
migrating to more lucrative or easy careers;
• Some programs have succumbed;
• But others are a source of pride...

6. Diego (on the left) started as a
hospitalist after finishing his
Internal Medicine residency. In the
meantime, he worked as an ED
physician very briefly, a role anyone
does in Brazil, a specialty with more
local challenges than HM itself.
He’s still working as a hospitalist in
a program that I founded in 2014.
Diego is a full-time hospitalist, just
bought a beautiful house in a fancy
condominium. HM could be a
sustainable career, even in Brazil!

7. Diego’s hospital
during pandemic
• Admitted ~ 1300 patients
between 2020-21;
• In the wards, all patients were
admitted to hospitalists;
• Daily news to family members by
phone;
• A semi-intensive unit was
created under the responsibility
of the hospitalists (use of NIV
and HFNC).
Recently, The Hospitalist
covered Reginaldo’s story:

8. The movement the helped
“Diegos and Reginaldos”
around the country…
• 2 HM professional societies, mine now is
the ABMH;
• Meetings with participation (and help) of
several US hospitalists and the SHM;
• We were the first frontline internal medicine
physicians in Brazil to instigate roles for
hospital MD’s beyond direct patient care
and to instigate new payment models;
• The ABMH Choosing Wisely list made a
huge success and helped to draw attention
to our hospitalist society.

9. 2004 2007 2008 2010 2011 2012
GEAMH -
when
everything
started
First
meeting
in Brazil
about
HM
National
Meeting
PASHA First
meeting
in Brazil
about
Pediatric
HM
Transition
of Care
National
Conference
2014/16/18
National
Meetings

10. * Group of Studies and Updates in Hospital Medicine
* 2005: First Website in Brazil about Hospitalists

11. * Porto Alegre, Rio Grande do
Sul, Brasil
* Participation of Jamie
Newman, at that time editor of
The Hospitalist
* Mayo Clinic support

12. * Gramado, Rio Grande do Sul, Brasil
* Participation of Jamie Newman, Jeanne Huddleston (former
president of the SHM) end other Mayo Clinic physicians + Neil
Winawer (Emory).
* Drove forward the first boom…

13. PASHA2010
* Florianópolis
* A multinational
initiative
* ~20 non Brazilian
speakers
* Drew the attention of the mainstream media -
article entitled “The hospitalists are coming” was
published in Folha de São Paulo, the largest
newspaper by daily circulation in Brazil.

17. * Porto Alegre
* Participation of Ricardo
Quinonez and Geeta
Singhal, Texas Children's
Hospital

18. * First meeting in Brazil (Florianópolis) on how to promote
effective transitions of care at hospital discharge as a
multispecialty initiative:
* Hospitalists representatives
* Brazilian Society of Medicine of Family and
Community (SBMFC)
* Brazilian Association for Emergency Medicine
(ABRAMEDE)
* Participation of Sunil Kripalani, Vanderbilt University

19. Participation of:
Neil Winawer (Emory University)
Aleta Borrud (Mayo Clinic)
John Bulger (Geisinger Medical Center)*
* Bulger planted the first seeds of the Choosing
Wisely Movement in Brazil.

21. Participation of:
Ron Greeno (Society of Hospital Medicine)
Neil Winawer (Emory University)
Aleta Borrud (Mayo Clinic)
Vandad Yousef (Canadian Society of Hospital Medicine)
Jeanne Huddleston (Mayo Clinic)
John Nelson (Society of Hospital Medicine)

22. Participation of:
John Nelson (Society of Hospital Medicine)
Amit Pahwa (Johns Hopkins)
Fernando Rivera (Mayo Clinic)
Thomas Kingsley (Mayo Clinic)
Adrian Dumitrascu (Mayo Clinic)
Neil Winawer (Emory University)

23. Electronic collection of almost all the presentations

24. And you are invited to visit us!
Twitter
@brhospitalist
gbbarcellos@gmail.com