Analysis of employment relationships and length of service of primary care professionals in Brazil

Abstract

This study analyzed the employment contracts of Primary Health Care (PHC) professionals in Brazil and their relationship with municipal social vulnerability. Using data from the National Registry of Health Facilities, from April 2024 to March 2025, the study included professionals working in PHC teams. The main variable was the type of employment contract, and social vulnerability was measured using the Social Vulnerability Index. Fewer than 50% of professionals held permanent civil servant positions. Among higher-education professionals, temporary contracts were frequent: 38% of nurses, 30% of physicians, and 42% of dentists. Civil service contracts were more common among community health workers (62%). With regard to physicians, 16% held statutory positions, and 24% were part of the Mais Médicos Program. In less vulnerable municipalities, the prevalence of statutory physicians was ten times higher than in more vulnerable areas. The average tenure of statutory professionals in PHC teams was three times longer than that of temporary or third-party professionals. High staff turnover, especially in highly vulnerable contexts, may hinder continuity of care and the establishment of strong bonds between professionals and the community, core principles of the National Primary Health Care Policy.