Brazil's President Luiz Inacio Lula da Silva has signed a law making a national medical exam a condition for new doctors to practise, in a sweeping change to how the country trains and licenses its physicians.

The legislation, signed on Friday, 6 November, turns the National Medical Training Assessment Exam, known as Enamed, into a licensing hurdle for future medical graduates. It has been nicknamed the "OAB for Medicine", a reference to the bar examination that lawyers in Brazil must pass before they can practise.

Under the new system, students who began medical school on or after 19 June 2026 will sit three national tests during their degree, at the end of their second, fourth and sixth years. Their final result will combine the three tests, with the greatest weight given to the last one, and graduates will need to reach a minimum level of proficiency before they can obtain professional registration with their regional medical council.

Graduates who do not meet the required standard will be able to retake the final stage in a later edition of the exam, but they will not be allowed to treat patients while they wait for certification. They may instead obtain a restricted registration, known as an Inscricao de Egresso, for supervised research and technical-scientific work, but that registration does not permit clinical care, prescriptions or medical certificates.

The change is not retroactive. Students who enrolled before the cut-off date, doctors who already hold recognised Brazilian diplomas and foreign-trained doctors covered by the separate Revalida process are not required to take Enamed to continue practising.

An eight-member National Commission will define the passing scores, weightings and rules for the exam. Four of its members will come from the Federal Council of Medicine, two from the Ministry of Education and two from the Ministry of Health, while the National Institute for Educational Studies and Research, known as Inep, will continue to administer the examinations. The new model is scheduled for its first full application in 2028, once the commission has set the operational criteria.

The law also reaches beyond individual graduates to the medical schools themselves. Enamed results will feed into Education Ministry oversight of courses, allowing measures such as reduced enrolment places, suspension of new admissions, blocking the opening of new classes or closing courses after repeated poor evaluations. The scale of the problem was underlined by 2025 assessments in which 99 of 304 federally regulated courses, or 32.6 percent, recorded unsatisfactory performance. Former education minister Camilo Santana has warned against institutions charging high fees without delivering quality training.

Lula framed the law as a response to the commercial pressures surrounding medical education. "Medicine has become somewhat commercialized," he said at the signing ceremony, arguing that better-trained doctors offer greater assurance of longer lives. Supporters of the measure say it is intended to uncover gaps in learning before graduates reach clinics, hospitals and public health units. Physician and professor Ludhmila Hajjar defended the change at the ceremony, criticising the quality of medical training in Brazil and calling for mechanisms to evaluate students during their degrees.

The measure comes as Brazil continues to expand medical training, with hundreds of courses across the country producing large numbers of graduates each year. How strict the new proficiency threshold will be, and how many students clear it when the system is first applied in full, will now depend on the rules set by the National Commission in the months ahead.