Trajetórias de vida, marcadores de diferença e as escolhas, caminhos e permanência de médicas de família e comunidade na estratégia saúde da família

Abstract

INTRODUCTION: Family Medicine (FM) is widely regarded as low prestige medical specialty that struggles to attract and keep professionals. The Family Health Strategy (FHS), which is the largest field of work for FM specialists in Brazil and a poorly regarded program in itself, suffers from having a high turnover rate as a consequence of its lack of prestige. The growing trend towards the feminization of medicine and FM begets the need to study the factors that influence the decisions and trajectories of the medical workers' careers in the area. This study proposes to deepen the understanding of how the effects of categories of difference influence the daily lives of family physicians who have settled in areas of high social vulnerability, and lack of prestige in the FHS. METHODOLOGY: A qualitative study based on aspects of cartography, using discourse analysis of in-depth interviews with eight women who are family physicians, selected by intentional sample. Participants work in the FHS, in a metropolitan region of Brazil, in areas of high social vulnerability and violence rates. RESULTS: The intersectional analysis of the statements pointed to two major axes of category of difference: gender and a relationship between social class/race-ethnicity. An explanatory rhizomatic cartographic model was created to illustrate the forces and statements involved in the gender axis map from the maternity category perspective. Due to the strength of this perspective, during field research, we highlight gender as the main analytical lens for this moment. The class/race-ethnicity articulation, although less mentioned or perceived by the interlocutors, seems to play a significant role in the affective trajectorie. However, it was the findings of the implications of being a woman and the project of motherhood, which re-signified the daily life of their work in their lives, influencing their career paths. Questions about ethics and duty of care circulate and blend between the balance points of personal/family life and work life. The devaluation and invisibility of the functions performed in both points dialogue with factors such as the amount of work hours, labor benefits, remuneration and sustenance, division of tasks at home, and child care. Women physicians identify the bond with the community and the ethical-political exercise through work, as a point of subjectification and significance of the positions of privilege and oppression they occupy simultaneously in the movement between these points. CONCLUSION: Gender perception and motherhood have been shown to act significantly in the choices and paths of these family physicians. These categories of difference are of great relevance because they comprehend, in a intersectional way, structural issues that can be influenced by the institutions contract policies and work environment and by government programs that aim to reduce gender and social inequalities. Managers should pay attention to the indicative findings on the influence of gender on the attractiveness and permanence of family physicians in the FHS, considering the feminization of the specialty.