# Flexible work hours at the SUS: labor legislation at a specialized outpatient facility in Brazil

## TL;DR

A new flexible work hour law in Brazil improved physician satisfaction and healthcare access while ensuring legal compliance.

## Contribution

The study introduces a successful model of flexible labor legislation for physicians in Brazil's public health system.

## Key findings

- Flexible work hours increased professional satisfaction and retention of specialists.
- Legal certainty was achieved through external audits and improved access to healthcare services.
- The model attracted managerial interest nationwide and enhanced collaboration between specialists and primary care.

## Abstract

The geographical shortage and poor distribution of physicians, their traditional
autonomy with multiple jobs, and low salaries they are paid in the public sector have
created a reality of widespread failure to comply with the work hours defined in the
Brazil Unified Health System legislation, causing legal uncertainty for managers and
physicians.

This report aims to analyze the perception of managers, health personnel, and users of
the Unified Health System about the corporate experience of a new labor legislation that
preserves statutory labor rights and sets flexible work hours for medical specialists in
Praia Grande, São Paulo, Brazil.

This is a qualitative study with a phenomenological basis, using ethnographic research.
A total of 42 social actors were interviewed in person or remotely with a digital
recorder, including managers, physicians, and clients of the Unified Health System at a
specialized outpatient facility (mean interview length 24.1 minutes [95%CI 17.7-30.6]),
and official documentation.

Emic and ethical perspectives from 489 units of meaning were compiled into 10
categories for analysis and presented in an ethnographic report for regrouping through
nomothetic analysis, and records from an ideographic perspective for validity through
integrative synthesis.

The new legislation provided professional satisfaction, atracting and retaining
specialist practitioners, providing legal certainty with external audit bodies and
improving access to diagnostic and therapeutic procedures, microregulation between
specialists and Primary Health Care, standing out as a successful experience for
external audit bodies and atracting managerial interest from all over Brazil.