By Brazil Stock Guide – Brazil’s Federal Public Prosecutor’s Office has filed a civil lawsuit seeking to force Hospital Israelita Albert Einstein, one of the country’s most recognized private hospitals, to adopt affirmative-action quotas in its medical residency programs. The case puts one of Latin America’s best-known healthcare institutions at the center of a broader debate over how far private hospitals must go in complying with public policy when they train doctors within Brazil’s national health framework.
The lawsuit asks the Federal Court in São Paulo to require Einstein to open complementary admissions notices for its 2026 medical residency selection process, reserving places for Black, Indigenous, quilombola, disabled and transgender candidates. Prosecutors argue that the hospital failed to apply federal rules requiring quotas in residency programs, even though medical residency in Brazil is not treated simply as a private educational activity.
In response to Brazil Stock Guide, Einstein said it had not yet been formally notified of the lawsuit and therefore had no knowledge of the case’s contents.
In Brazil, medical residency is a highly competitive postgraduate training program through which doctors specialize in areas such as surgery, pediatrics, cardiology or intensive care. It combines classroom instruction with supervised work inside hospitals and is regulated by the federal government. Because residents are trained in service, often within programs connected to the Unified Health System, known as SUS, prosecutors argue that these programs carry public obligations even when offered by private institutions.
A public-private fault line
The Einstein case is sensitive because of the hospital’s profile. Founded in São Paulo and widely associated with medical excellence, advanced technology and elite private healthcare, Einstein is one of Brazil’s most prestigious hospital brands. It is also active in education, research and public health partnerships.
That dual role is exactly what prosecutors are focusing on. The Federal Public Prosecutor’s Office argues that Einstein cannot treat its residency programs as purely private management decisions while also operating within federally regulated health education programs and benefiting from public incentives.
According to the lawsuit, Einstein holds Cebas, Brazil’s certification for charitable social-assistance entities, and participates in Proadi-SUS, a federal program through which leading nonprofit hospitals support the development of the public health system. Those arrangements can provide significant federal tax exemptions, including relief from social-security contributions.
In the prosecutors’ view, that public support changes the nature of the institution’s obligations. A private hospital may retain administrative autonomy, but when it receives tax benefits and helps train doctors for a system regulated by the federal government, it must also align with national policies aimed at reducing inequality.
Since when quotas apply
Brazil’s broader quota policy in federal education dates back to 2012, when the country approved its landmark quota law for federal universities and federal technical schools. For medical residency, the current dispute is tied more directly to newer health-sector rules. In November 2024, the Ministry of Health issued Ordinance 5,801, creating an affirmative-action program for the ministry’s initiatives and partnerships. The rule established specific reservation percentages: 30% of places for Black candidates, 5% for Indigenous candidates, 5% for quilombola candidates, 10% for people with disabilities and 5% for transgender candidates.
That framework was reinforced in 2025 by a joint rule from the Ministries of Health and Education creating the National Policy for Health Residencies. Prosecutors say that policy made clear that institutions offering residency programs must apply affirmative-action measures in their selection processes. The MPF had already taken a position on the issue in April 2026, when a technical opinion from its Federal Prosecutor’s Office for Citizens’ Rights concluded that quotas in medical residency exams are not merely optional for educational institutions.
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