Good morning, everyone. Welcome to the Fifth Edition of Afya Days. It is a pleasure to have you with us. We are very excited for our meeting today. We bring a lot of things that we have not brought to you. We are a company for physicians, by physicians. You will listen from our physicians today. So, we will talk about results, the figures we want to reach, and we want to show you, our DNA.
So, we have today a strong focus in our physicians and in our products. So, today we start with an institutional panel, which will be moderated by Virgilio Gibbon. Then we are going to have the head of our research center. He's going to talk about trends in medical career. And then we're going to have presentations from different BUs with Virgilio as well.
Then we're going to introduce you to our new Medical VP, Gustavo Meirelles. He's now part of the executive board, and he will invite other three physicians from three different BUs. They'll talk about our innovations and products.
Finally, we're going to have Blanco here. He's going to show you that everything we present brings great results and cash flow, so yes, we hope you enjoy this day. Our IR team is available, and we are going to have a Q&A session at the end. Hope you enjoy the event, and I give the floor now to Virgilio Gibbon, our CEO.
Good morning, everyone. What a joy to be in the Fifth Edition of Afya Days, sharing a bit of our story, our achievements, our challenges. Well, as usual, whenever we have events with investors and analysts, we try to bring something different. This day, we're going to hear from several physicians. They're going to talk about our innovations, everything that sets us apart, what we're looking for in terms of future trends.
So, this is going to be different today. We're not going to be stuck to cold figures. Of course, Blanco will have to mention some figures. That's his area. But we want to talk about innovation. What do physicians want throughout their journey and throughout their career? So, let's recap. Let's recap our ecosystem. Afya is the most complete and the largest medical education hub with digital solutions for physicians.
And we provide solutions for each stage of the physician's professional journey. Since they are GPs, then they mature in the career. They become experts. So, we have the appropriate resources to provide value for these professionals, to capture or to understand their behaviors and to understand their DNA. This is very important for a long-term relationship. So, what do we do in this ecosystem? We divide this into five major blocks.
The major one is medical schools, of course. Over 30 medical schools, over 25,000 students. It's a very resilient business, foreseeable. We have a very special business model and cash generation. So, students go into their residency, helping professionals to choose more than 50 different areas of expertise. Then we have this market with very specific dynamics. And we're going to talk about those. Then we have specialization areas, reports.
We have software courses, hard skills that add up to all this knowledge of medical practitioners. In the blue axis, when we look at solutions for medical practice, we can help physicians in their professional journey.
This is directly connected to the industry, and it retrofits training and studies. We do not believe in education. That's not just for the medical area. If you're not breathing the industry, the industry will provide jobs for the professionals we're training in the classroom.
At the end of the day, they will raise the bar for our educational project and for every single interaction we have. How do we create value at each stage of the journey? First, with development, training of these professionals in the health area, medical professionals. We have updating. They must be updated, of course.
In previous years, we've mentioned that every 70 days, the medical content of different areas more than doubles. It is a huge amount of knowledge because these professionals must be updated. They have to be assertive. They need specialized content on each and every protocol, so this is part of our mission, of our everyday work, and of course, we want to ensure productivity.
Physicians will need more time to dedicate to their work with productivity, and we're going to see some tools for that, tools that we are leveraging for productivity purposes, and then we want these professionals to have a health industry relationship, so living the best of the medical world.
When we are close to physicians, when we are connected to these professionals, we bring the industry closer. That means more jobs. That means connection with the health area players and these professionals.
So, let's have a look at the trends in physician training, new physicians that are coming in. What are their demands? What are their ambitions? Well, who could answer this question better than a physician, founder of Afya Whitebook? He's the lead of the Afya Innovation Center. He's a professor. And the physician, he's going to talk about demographic trends. And he's going to share what physicians look for in their journey. Eduardo Moura, please join us.
Thank you, Virgilio. Good morning, everyone. So, today I want to share an overview of the trends in the medical area, trends that drive Afya's strategy. So, I hope the next few slides show you that this is a very interesting scenario when we look at our products and what we want to do. Okay, let's begin with maybe the trend.
Demographic data shows that we will be 635,000 physicians in Brazil by the end of 2025. That means 116,000 new physicians in the market in Brazil. In 2035, we will be 1.15 million physicians in Brazil. So, the ratio of physician to population, this is a measurement of the availability of physicians for the population.
This ratio has more than doubled since the year 2000. There's something positive to that. We can move forward in physician training, and also, we can provide better services, health services to the population.
However, when Brazil is compared to OECD countries, rich countries, there's still a distance, a gap. And it's an important gap when we look at physician density. There are also other trends that are a reality in Brazil. We are now graduating more female physicians than male physicians. So, very soon, we will have more female physicians than male physicians.
And also, physicians are younger and younger. We are training more physicians, and the population of physicians is becoming younger. So see, this is the proportion of physicians aged 55 or older. So in spite of all that, we still have an issue in Brazil.
When you look at the number of medical consultations per capita per year, 3.1 in Brazil. That's less than half of what we see in OECD countries. And that is a problem. And it's a deep problem. We have huge regional inequalities in Brazil. We still have a greater concentration in the Southeast of Brazil.
You can see that we have more physicians than in rich countries in the Southeast. And we have, in the north of Brazil, for instance, the ratio of physicians per inhabitant is close to Sub-Saharan Africa. So, these are physician deserts, so to speak.
At Afya, we are proud of being part of the solution to this problem. This is a study that was conducted by the sustainability area, and we want to prove that having an Afya unit brings social impact. It brings impact for health metrics for these populations, so cities that have Afya units and cities, similar cities that don't have Afya units.
Through a sound methodology, we proved that these cities increased by 12% of physician density when they have an Afya unit. So in 2021, that means 3,900 new physicians in inner areas of our country, so that helps bring more physicians to these places that need them. That has consequences in health metrics, 20% less deaths from vaccine-preventable diseases, 14% less deaths from conditions sensitive to primary care. We've also avoided 4,100 hospitalizations, and the most important metric, 28,000 lives saved.
In Brazil, we have another inequality connected to specialization of physicians. For some areas, such as pediatrics, Brazil is training more pediatricians than in other countries. For OBs, we have figures that are close, but for psychiatrists, this is one of the areas where Brazil has the greatest gap compared to OECD countries, so maybe we should be training more psychiatrists.
Again, looking at areas of specialization, the number of specialists, we have moved forward in recent years. This is demographic data, and it shows that in the last 13 years, we grew by 154% the number of specialty titles granted to physicians. 59% of physicians in Brazil are specialists. 29% are generalists, and this is our data, right?
We believe we have 12% that are specialists in practice, although they are general practitioners in the official records, so in practical terms, they're specialists.
This is a slice of the market that will grow. It's a challenge for Afya. We can help these professionals develop with graduate courses or preparing them to take the tests required in Brazil. Well, becoming an expert is very important for physicians in Brazil. Let's look at the data.
The financial situation is very different when we compare specialists, whether they have a graduate degree or they are acknowledged by medical associations. When we look at the average salary of these three categories, generalists, postgraduates, and specialists, there's a difference of 30% in pay.
Pay becomes higher after you become a specialist. This determines not only pay, but other aspects. When we look at regional differences, there's this supply and demand impact, difference of salaries in capital and urban areas and in inner areas of our country.
When we look at the data, we realize there are different regional differences when it comes to pay, so these differences can be of 12% or 20% in the northeast of Brazil, so working in inner areas, that's where you have opportunities, now these are markets that can be explored by physicians.
These are areas where we have a deficit of specialists, so we asked physicians, "What is your aspiration? What do you see for your career?" We asked a very simple question. Do you consider to be at the peak of your career currently, well 16% says yes, and out of those, 94% already have one specialization at least, so yes, specialization is key for these professionals. 86% of these physicians are satisfied with the work they perform currently.
These are relatively young physicians. Brazil has young physicians. They don't have over 20 or 30 years since they graduated.
Their average age is 31 years, and the workplace says a lot about what they aim at. 37% have their own practice or clinic. 35% work in hospitals, and many physicians have both. They work for both places, and 27% also work for third-party clinics.
Well, let's now look at the physicians that say that they are not in the peak of their careers yet, so they're less satisfied with the medical career. 48% are satisfied, and we asked them, "What's your ideal field?" Well, 70% state that they would like to have their own practice or their own clinic. We were surprised to see these figures. 42% state that healthcare entrepreneurship is a goal, is one of their goals.
This is an area where they could feel that they are in the peak of their careers, so what is required to reach the peak of this medical career?
61% say additional training, specialization. They do understand that they need more to reach the peak and also capital to invest in their own practice or business. Finally, I have some data about the digital behavior of physicians researched.
These are two important topics for physicians: medical updates, so what physicians have to be updated, and also support in decision-making by the bedside, what they have available to them to help make decisions. This is a universal need of physicians.
Well, when it comes to medical updates, 50% of physicians use decision support apps and services. We knew about that, right? 36% do read scientific journals and articles to keep updated. And we have Afya Papers. This is our own content hub with a focus on scientific articles. 31% state that they read medical updates and news websites, such as the Afya portal.
As for decision-making processes by the bedside, 90% use decision support apps and services. We have our own Afya Whitebook, which is a market leader. I like to call it my child, if I can say so. Physicians also talk to their coworkers. They want to exchange knowledge about complex cases, exchange experiences. And also, 31% say that they read scientific journals and articles that are also a resource by the bedside.
Finally, we can talk about digital tools in the medical office. We just saw that many physicians want to have their own practice or clinic. And this is a work environment where we see many digital tools being used for productivity purposes. 52% of practice physicians use electronic medical records. Of course, there's room to grow here. Digitizing the medical office is something that is still taking place.
43% use decision support apps and services in their practices. 30% use e-prescription tools. We have our recently launched tool, Afya Receita Pro, and other resources in Afya iClinic. These are resources that are used by physicians in their office: electronic scheduling systems, telemedicine systems. 22% of physicians are using telemedicine, and 19% of physicians are using medical office management systems, and our Afya iClinic is a case in point.
So, with these data, I want to show you the information that makes our strategy and how we can offer the best solutions to help solve all problems throughout a doctor's career. Thank you very much. I'll turn it back to you. Thank you.
Okay, Edu, I think it has become really clear when we see this research, the survey that you led. When you look at a doctor's journey, first, their undergraduate studies.
So, you see there's lots of doctors that go to the smaller towns. When you look at salary and compare it to other elements, there are high employability numbers. So, there's a large number of people. The market is really heated there. The name of the game is how to stand out in the crowd. When you talk about specialization, there's an increasing need for doctors to stand out.
There's a greater number of general practitioners. Their lives are harder. They need more time for their families, and they need to work so hard. 40% or even more, they seek better opportunities when they look for specialization. This is part of their roadmap of desires.
So general practitioners or generalists, they're active consumers of support to decision-making, clinical decision-making. Most of them, we have, for example, the testimony of a former medical student. She cannot live without that support.
She logs in when she gets to the clinic, to the hospital. She needs her own device all the time, so they want to have their own clinic, their own medical record, and we are the center of this professional need.
So, now look at all of our segments. I won't spend so much time just giving you details. I just want to show how we have been innovating in each of these areas, so just an overview of our graduation processes.
We are doing great in that. Over 3,600 vacancies, almost 36,000 students. We have so many students in medicine and also better quality in the evaluation of our schools. Afya has new schools that were a greenfield on our curriculum, but there are many that we acquired, that we purchased respectively with good transition.
We transitioned these schools to our teaching methodology, and then there's a lot of evolution when students, especially in the last year, they go through the tests, and we had our ENAMED exam, so we are expecting a lot, and we have sustainable differentiation of our teaching model, our educational model.
Now, what makes us stand out? The first point is we have an integrated curriculum, and it's highly integrated in detail. We have learning objects. We have content we're distributing every week that is standardized in 33 campuses, so we just have great business professionals.
We're also discussing the healthcare of all our patients from north to south. We have the best experts discussing a case on. We go to the lab. We do all the simulations, so from Monday to Friday, we finish the case. It's not based on discipline. It's not short-sighted.
It involves the entire learning system in a completely different way. Students suffer. They come from a content-based school. They don't know how to study in this new model. Teachers, also professors, they don't know how to teach, so there's a lot of effort for people to migrate and use our new methodology.
This does not exist in any other school. It's unique, and we will have the testimony of our students of ours who will talk to us how we stand out, and students don't even imagine how they can learn another way after they do our method, so we're training doctors for life. Many doctors who are recently trained, they're so afraid of their first patient. Now, our students, they have real cases from year one.
So, whenever we have a migrated school, then we have lots of problems because people have difficulty, but they'll have so many real-life cases. And that makes a huge difference in terms of practical experience and also in terms of simulation. So, point four, Afya is the only teaching school that has an environment, simulation environment that is recognized by its excellence, by accredited international accreditation agencies.
And we will tell you about the simulation system. There's a lot of difference in our unit, in our graduate schools. And finally, maybe the greatest differential is how to integrate this into our ecosystem. It's not a curriculum that is different, a different learning, teaching, and learning process, but also everyone used the office when they started.
And our doctors are also using this so that they know the tools, leading tools when they start working, when they have support in their clinical decision-making. If they need digital prescription, understanding also medical records. So this ecosystem really makes them stand out, and they're much better prepared for the labor market. And also the major employers are brought in-house because they want to hire doctors. They want to get closer to doctors.
They want also to distribute content to these doctors. And also, we raise the bar and make sure that our training process gets better and better. Now, how does that make us stand out in Brazil in the healthcare training sector? So, we had the entire executive suite, all our colleagues there. We were really discussing our brand change. You might remember that during the IPO, when we went public, we were an investment brand.
We had many schools. It was like an alphabet soup of brands with not much differentiation. What we did, we consolidated. And we always had this goal or focus on medicine and healthcare. It was very serious. And then we decided to change everything and have Afya. Afya means healthcare and well-being. It made all the sense. We became powered by Afya. All our products were empowered by this brand.
And in 2023, Afya became the name of all our products and services in all our units. And this is really outstanding when you see how much our brand is known in the medical. In other words, what's the awareness of our brand? Our brand awareness is about. It was 20% in 2023, beginning of 2023. So, the third bar is the beginning of 2025. So we are now close to 70%, 68%.
There's a new survey to be published, and I think we'll now reach 80%-90% in terms of brand awareness, and also its brand consideration of a high reputable service provider. It's growing even more, and that really helps us grow and attract students and doctors to our postgraduate courses, so we are getting increasingly more present. Now, more numbers, of course. Although there's been an increase in competition, reputation and differentiation are the name of the game for us.
We have a good ratio of candidates in seats, so we have the seasonality in different number of seats vacancies, five and seven, so we were really sustainable, and Afya today is an integrated brand. We have also a university admission exam that is wholly integrated. We are really flexible with students that choose to do the course in one of our units.
It's interesting to note as well that we use the concept of Hub in one particular state with five or six units, one in the capital city of that state and some satellite units, so many students can go and practice to these areas.
If they go back to the capital city or the smaller towns, if they want to specialize in a particular area, make partnership with a hospital, they can do internship with us, and that really gives them a lot much more resilience.
They stand out from smaller players. There was no acquisition we made that we had 100% of the vacancies of the seats that were taken. We also grew and had them brand in these units, really increased the number of students. Our ticket evolution also very resilient when you see new campuses, new doctors.
So, our gross margin is really highly efficient with our best operating result in the first quarter of 2025. Now, let's go to continuing education. Let's continue looking at a doctor's journey. So we saw that we had very positive dynamics. You might remember that in 2019, we had five units basically on the major capital cities of Brazil, Rio, São Paulo, Belo Horizonte, Brasília.
And now we increased to 20. We changed the concept from unit. We now are using the concept of Hub or the experience of doctors. In Afya, the concept is of one of membership. So, they enroll with us. There are special students from their undergraduate courses. So, they use all our infrastructure, all our medical offices so they can see their patients with us on Fridays and Saturdays. We have our graduate courses.
So, the Hub is like a whole club where students, doctors are members. We have over 25 such Hubs. Some others work together with us in over 70 courses on our portfolio and a very impressive NPS for highly demanding individuals. Our level is 70, and we have grown 13 points in the last few years. So our NPS is really high in postgraduate courses. We have over 80 that were extremely satisfied.
So, we're really proud of these results. Now, revenue. After we were acquired, after acquisition 2019, we grew at a very good pace in the first half of 2025 from 15,000 doctors using our Edu Solutions to over 50,000 in 2024. It's seasonal, of course. In the second half of the year, it will grow more at over 50,000 from 2024. Now, Educon talked about our dynamics.
We have 35,000 students that are graduating as generalists or general practitioners, and our residency seats increased as well. And these are taking about 80%. So the gap of generalist graduates and specialists increases even more, not only in terms of more competition, but also a higher demand for specialization courses and postgraduate courses as alternatives to traditional specialization in traditional residency courses. So we have over 600,000 doctors that are trained in Brazil.
So, Educon with lighter regulation, very positive market dynamics. It's less intensive in capital cities. Organic growth is really interesting. We have good return on equity, and it's a very interesting product, not only in terms of modernization, but also the industry is getting closer to professionals now. So, you have a pharmaceutical company or a provider that wants to maybe sponsor a particular course in dermatology or oncology.
So, they become an access or an access hub between B2P and solutions with our doctors and students. And finally, let's discuss FTM, the part about medical practice. So again, we saw the dynamics with Edu and the doctors are now seeking more digital solutions to stand out in their daily lives. There's a lot of our flywheel.
We have more solutions, champion solutions that help doctors from scheduling an appointment to bedside support and also following up of treatment of these patients.
So, you create credibility. You have more doctors consuming our solutions. They're better engaged, generating more data, not only as a premium user, but also a user that generates a lot more data. We have more patients, more appointments. So with more data, we create more value, add more value to our ecosystem, improve our system.
So, we have this feedback and we really get a lot from that. Now, how can we generate value? How can we add value to the industry? We have four levers. First, medical campaigns. We just imagine GSK or Pfizer producing a new molecule with a new protocol that's much more efficient than the traditional protocol. But 80% of doctors in the region of São Paulo are not aware of that.
So , the sales rep will just disturb doctors and try to give them free samples. This will be terrible. So, what we need is an awareness campaign with papers, with references for doctors to learn about that particular protocol and procedure that would be the best solution to that particular treatment. Now, considering this greater awareness that we can also measure through our analytics solutions, we're always looking for references like IPO.
Now, it makes sense that you run a marketing campaign where you have prescription ranking or the iClinic channel so they get more information about this new molecule that was produced by that particular pharmaceutical company. We're also running a marketing campaign to increase the conversion rate, and what is the final goal? To increase the prescription power and also the amount of sales of that particular molecule, then we have e-detailing.
In other words, free samples are delivered in a much more efficient way when you consider costs and opportunities, and it all with many insights so we have lots of information about the best way of delivering that content. What is the ideal medical agenda for them to get that sort of information so that you get a good efficiency level and also scaling a really high efficiency?
Now, I'd like to invite our B2P executive, sales executive. She has good relations with our major clients, Marilia Sabbato. Marilia will tell us about four real cases of over 120 contracts we had. So, Marilia, you have the floor.
Good morning, everyone. Thank you. Okay, so I wanted to share four tangible cases where we see the results of what we have presented for pharmaceutical companies. So, we have three pharmaceutical companies and one data partner when it comes to our medical engagement center. This is a global pharmaceutical company focused in lung diseases in Brazil.
And this is about primary care. So, we provide a communication strategy with physicians through our channels, informing physicians, talking about the product, and bringing awareness about the brand so that physicians prescribe more of this medication.
There was a 33% increase in total prescriptions and 29% increase from the total base of product prescribers. They would need 500 sales reps if they wanted to do this otherwise, so something that sets the situation apart is that we can measure the number of prescriptions. We divide the base into segments, and then we really measure ROI, the true impact, and the financial returns that they have. The second case is about specialty care, complex and rare diseases.
Maybe physicians don't have that much knowledge about new therapies, so we need to raise awareness about the disease, symptoms, signs they might see in their clinical practice so that they prescribe more and treat patients better, so for this campaign, 260,000 physicians were reached, and by that, we increased by 30% the number of genetic tests for this disease.
So, this is targeted communication for this specific audience, but it's also about research. We ask physicians before, during, and after the campaign, what do you know about the disease? Can you identify the disease? Then we ask, has your knowledge improved about the symptoms and what you have to look in the clinical practice for diagnostic purposes? And then we ask them if they could treat the disease.
This is a U.S. pharmaceutical company. They would donate genetic tests. This is a very expensive therapy. It's hard to find the patients. It's hard to diagnose the patients. So, we had an impact in 260,000 physicians. The third case is about sample distribution. Virgílio had mentioned that. This is where we expand the activities of the pharmaceutical industry, and we improve the results of sales reps. We can reach physicians quicker or physicians they wouldn't reach otherwise.
This is a digital campaign with physicians. We can communicate with a segmented base of physicians, and we deliver the samples to raise awareness about the brand and to start treating patients. For this case, 25,000 new physicians were onboarded, and the NPS was 4.7 out of 5, so we don't have to interfere in the physicians' everyday routines. We don't bother the physician.
They don't want to keep meeting sales reps, and they even receive the correct kit that they can give to the patient with our box. It's a box that we deliver with a sample. Case number four. That's quite an important case for us. It shows our maturity when it comes to data.
It's not just about impacting the physician database. Also, the data we generate provides lots of information for decision-making processes. This is a co-branding effort with a major data provider, international data provider.
This brings data into our digital records, and that gives in-depth information to physicians on what they should prescribe to patients. So this is electronic record data. We cross all the information, and co-prescriptions means more products and more information so that physicians can innovate.
This is a major partnership we began very recently, and we have an Afya product and a major data partner in Brazil. These four cases show that we are maturing in this market and partnering with pharmaceutical companies. We want to engage physicians. We want to change their prescription behaviors, and we also want to provide data that helps the market. I give the floor now back to Virgílio.
Thank you, Marilia. Yes, we have indeed a unique position in this connection between industry, physicians, pharmaceutical companies, providers, payers. We have some partners in that area as well.
I think this is still the tip of the iceberg, right? We're still scratching the surface. This is a model that is very new in Brazil. No one else does what we do in Brazil. The pharmaceutical industry is quite conservative. They really rely on sales reps. We still have regulatory restrictions.
Digital prescriptions or e-prescriptions, they are specific for some types of medication. The digital channel is not mature enough to improve the relationship between industry and physicians.
The question is, when will it happen? Because it will. This is going to be a very efficient channel, very safe because there's a lot of fraud. 10% of the national medication production is in the trunk of a sales rep. That means a lot of inefficiency, right? We have this unique positioning.
We want this relationship to be more efficient, and we want to provide a better value proposition, so we have this unique presence with physicians. One out of every three physicians uses one of our solutions where we can map behaviors, the type of protocol, the knowledge that they have, and how they want to have access to information.
This is a universe of 300,000 physicians that use and that have their eyes in our solutions every single day, and we have a recurring relationship with 54 partners.
Some partners are already signing the 10th or 12th contract with us. This business started from scratch. We began with a B2C model in 2021 until 2022, then in 2023, we had the first contracts with the industry, and the business grew 2.5 times. It is already efficient.
The business is scaling in 2024, and in the first semester of 2025, we invested a lot. We hired a team for this product. We're going to have lots of improvements with AI. We are segmenting this industry, and then we can tackle different clusters in the pharmaceutical industry. Our gross margin is quite interesting, and you see that we are very efficient in our area of solutions for medical practice.
I think the nice thing here is talking to our Medical VP, Dr. Gustavo Meirelles. He's our Chief Medical Officer. He will share everything that we do with physicians.
We have a former student who graduated, and actually, she had two graduations with us, and now she has two undergraduate diplomas, and now she's working on her graduate diploma. She's going to talk about our syllabus, what sets us apart, how we can help her in our clinical practice.
All students mention the wealth of resources we provide, and then we're going to bring medical directors from different BUs. They will talk about product innovation. What's in store? What do we have ahead of us? Whether that's in undergrad or graduate courses, digital solutions, they will talk about solutions we are implementing.
But Gustavo will begin by talking about the Afya Institute that has been recently launched. It was launched in August. That represents our engagement and the social impact we want to have, and of course, we want to give more visibility to our brand in Brazil. Dr. Gustavo, please.
Hello, everyone. Good morning. What a pleasure to be here with you. Thank you for joining us. Virgílio has just introduced me, but first of all, I want to say that I'm very proud of leading the medical area at Afya.
I'm a physician, and I've been working as a physician for 30 years. My area of expertise is radiology, chest radiology at the Federal University of São Paulo. I have a PhD from the same university. I was a university professor, and I taught residents and also in their master's and PhD thesis. I also did a study in Memorial Sloan Kettering, and I also worked for 18 years at Fleury Clinical Labs.
I was Medical Director and VP of a company connected to innovation. I founded a community that works with innovation, and I was watching closely what these folks were doing very well at Afya. This is a huge transformation from an educational perspective, but also health services, technology, connection with the industry. You will see that this really transforms the medical journey as a whole.
So, I would like to quickly talk about the Afya Institute. I am Co-President together with Stella, my colleague Stella. So, I wanted to show an institutional video, and then I'm going to explain a little bit more about the...
[Foreign language] The purpose of transforming health through ongoing and long-lasting care with impact in people's lives. This is a transformation that is essential in the face of an urgent challenge. Millions of people live with chronic diseases that have an impact on their well-being and that can prolong throughout the years.
These are the main causes of death in Brazil, and they bring an overload to the health system. At the Afya Institute, we have purpose, we generate knowledge and solutions, we foster health, and we work in a network.
Caring for every single life means having an impact in everyone's life, so this is the work of the Afya Institute.
T he Afya Institute is a not-for-profit organization. Our focus is fighting Non-communicable Chronic Diseases. These are prevalent diseases around the world: obesity, high blood pressure, stroke, diabetes. You probably know someone, right, that has one of these conditions, and the Institute has a social purpose of transforming health.
But we also want to give more credibility and reputation to everything we do at Afya. And we want to also highlight how our products and solutions set apart.
The purpose of our Institute is to conduct research, education, and partnerships with private and public organizations. We will create health policies that will help the public health system in Brazil. SUS is the acronym, and we want to reduce by a third NCDs in Brazil. 80% of these deaths are premature, so you will be seeing in the next few months relevant results of our work, and we want to increase these activities even more.
Now I have the pleasure of welcoming a colleague that has a medical degree from the Itabuna School of Medicine, which is an Afya school. Well, after she had her graduation, she decided to do her graduate course with us. Now she's studying Psychiatry in this very building at Afya Medical Education. Denis is the VP of this area.
Eduardo mentioned that we have a gap when it comes to psychiatrists in Brazil. And Loyani is a physician. She is now working on psychiatry, and she's going to share her trajectory with you. Loyani, welcome. Good morning. What a pleasure to have you with us this morning, Loyani. Well, Loyani has a background in engineering, actually. She studied engineering as an undergraduate course, and she's going to tell us why she decided to study medicine.
And I got my degree 30 years ago. I had a very traditional syllabus when I went to medical school. Now, as I get to know our medical schools, I am positively surprised with how modern our syllabus is. And it is the same one throughout Brazil.
Erico is our graduation VP. It's the same syllabus regardless of where you live. But Loyani, I think you can tell us your story. [Foreign language].
[Foreign language]
Initially, it was professional development. I wanted to learn English.
[Foreign language]
This was a company I worked for, a company. [Foreign language] It was a public and private company, [Foreign language] , and that's how I fell in love with medicine, because they also provided medical services, and I, you know, I just felt a connection to that.
My mother had an accident, and I had to come back to Brazil. I spent six months caring for my mom, and that's when I decided to study to become a physician. So, that was a full career transition moment.
[Foreign language] So, you decided to study medicine from the social aspect, right? You started at a traditional medical school, and then you decided to transfer to the Afya School in the city of Itabuna. Why? Throughout your journey, your academic journey, what were the differences that you realized or that you saw at this Afya School?
[Foreign language] Well, Gustavo, I did start studying medicine in another school. It was a traditional school. It was not problem-based learning, and when I got there, I was in shock, and I was sort of desperate, I have to say. So, I was used to a traditional methodology.
People presented the same slides over and over again. That traditional school did not demand any clinical decision-making. We didn't have to look elsewhere for other tools to develop, and there was no hands-on work, so I saw no patients at all, and I started fearing the profession.
So, I heard about Afya through a friend, and I was unhappy with that school because I had no hands-on practice, and that's when I decided to make this transition.
When I got to Itabuna in the state of Bahia, I was totally desperate. I thought I could not do it, and I had a colleague, a schoolmate that was in the same semester, but they looked as though they were on a Boeing, and I was just in a big old car. I thought, I'm not going to be able to make it. That's not for me. That's too much.
But the greatest difference, the greatest insight for me was that I was really welcome there in Itabuna. We had also a psychological service that welcomes us. So, I felt really welcomed. I would see the psychologist every week, and she would say, "You can calm down, just you're going to be able to make it, don't worry."
And then the tools, as you've shown us, Whitebook was one of the greatest differentials. Before, I saw no patients, and now I would see patients every day. I'd go to the outpatient clinic every day dealing with real cases. So, we really help people. We help the community.
Patients are referred there. So, we are always there feeling as though we're doctors. You feel that you're a doctor, really. And that's how it, that's what happened. And it made a huge difference to me.
I was just studying using slides, and now there was a whole new world where I could make a difference and really see and treat people, and that really helped me a lot. In order to catch that Boeing, I had a notebook, Afya's Portal with the scientific papers and book chapters in the edition, so that made a huge difference to me.
I had access to recorded classes. I had book chapters. I had a way of finding knowledge and developing my learning and also put that into practice, which was what I really wanted, so it made a huge difference, not only in psychological terms, but also in terms of content, medical content, so the big old car got its wings and became a Boeing. Now you're talking about our preparation course for medical residency.
So, after their first graduation, they have the internship and then the Whitebook. And Edu Moura is the founder of that. This is a tool that helps decision-making that's used by every, in every five students, f our students use this.
And then in postgraduate studies, we'll also discuss this, but also how you see patients. How does this device help you give you and feel more confident?
Well, we see many patients. Then we cannot, unlike what patients think, have everything in our minds. No, for every new patient, we need to learn something new. Even if it's the same disease, there's something to learn.
So, it's so important to have this book, the Whitebook. We have no way of doing internship without the Whitebook with us. So, if you have questions, it's great support. Everything is updated. It's also evidence-based medicine.
That's the major support that we get when we're treating our patients. So without this, a place where I can do your research, you might treat patients inappropriately, and you might even be sued. So, it made a huge difference, a huge turning point. I don't even give any patients without my Whitebook.
So, we're getting to the close, but last but not least, let's discuss postgraduate studies. We also saw the indicators Edu showed. We have an increase in the number of doctors. The vacancies in medical residency does not follow.
So, we have great graduate courses to offer that many in the market. And you chose to do this course in Afya. You're doing postgraduate study in Psychiatry. Why did you choose to do this course? And what are the differences in our graduate courses?
Okay. Well, I'm in love. I'm passionate about Afya.
This is no cliché. If anyone complains about Afya, you said you have no idea what it means to be in a poor school. So, I'm really passionate about Afya. I know it's a very serious company. And I came to São Paulo from Itabuna. So today, I'm on duty for 12 hours. I see 90 patients in 12 hours. And that is what Afya gave me, Afya Itabuna.
It's not just the institution, the school I studied. It is a family to me. I was so welcomed by them. So, I know how serious the school is. I have also friends who are studying Psychiatry that saw no patient in their practical lives. That's why I chose to continue being with my family, Afya. And I'm so happy for making this choice. I do this on Fridays and Saturdays. Of course, that's when I study on Fridays.
I spend the whole Friday doing the theory section. And on Saturdays, morning, afternoons, and sometimes even evenings, we see patients. These are real patients that come from the Brazilian healthcare units, people that cannot have better treatment. So they come to us, and we put in practice what we learn, not only in my undergraduate studies, but also now in my graduate studies. I'm so happy.
I'm not waiting for another two years to only then start using what I'm learning. I'm already applying what I'm learning from lesson one, from day one, everything that I learn. So, every 10 patients, at least five patients have some psychological complaint. And I can explain to these patients things that were not so clear to me. So now, with my graduate studies, I'm learning.
Oh, very good. Congratulations again on such a great journey.
Your undergraduate courses, the use of actual Whitebook, and now your psychiatry course. There's so we have this need for more psychiatrists and lots of problems in mental health. So, it's good to have you, and I hope you're really successful, and you want to also study endocrinology?
Yeah, I'm also in love. I'm passionate about Endocrinology and Psychiatry. I have a nephew that has autism. She's in the spectrum of autism. And he has also there's also the food problems. So, I think I'll also start this other postgraduate course in endocrinology.
I'm really proud to be here, to be talking to you. I talked to all colleagues since I learned about Afya and got to know the school for the first time. They really prepare us, train us for what we're going to face later on. So, as a student, I already felt like a doctor.
And now, as a psychiatry student, I already feel like a psychiatrist because I can understand what people need every day. It really makes me stand out. I'm really proud to be here.
Well, there's a good reason to be proud. Thank you so much. This was excellent to learn more about you and your journey. I think everyone liked it as much as I did. I hope you're really successful in your postgraduate studies and throughout your career. Thank you.
Okay, and we will now continue. First, of course, we had a perspective of a student, a medical student who is now doing her postgraduate course at Afya. We'll now talk about a major innovation we are already putting into practice in these three verticals: graduation, continuing education, and solutions for medical practice.
So, we will now have three of our medical directors, and we'll see the major innovation that is upcoming. So, we'll have the pleasure of receiving three colleagues and friends: Dr. Itamar Gonçalves, who represents our undergrad courses at Afya, then Dr. Isabela Dupin, who represents our continuing education courses, and Dr. Ronaldo Gismondi. He will discuss solutions for medical practice. A very warm welcome, everyone.
So, dear Itamar, let me start with you. Loyani really discussed that or told how welcome she felt, how different that was, how positive that experience was when she was welcomed by our team. And we are also using what we call the academic memorial that is widely used at Afya.
The idea is that we can really welcome our students in the best possible way and also providing our teachers, our professors, an individual view of every student.
Can you tell us more about this new innovation, our academic memorial?
Okay, Gustavo, good morning, everyone. Loyani, when Loyani says that she felt really welcomed, what does that mean? What does it mean to welcome someone? When we look at the best trends in medical education, welcoming means going beyond figures. We already have figures, but how can we really use our words, not only figures, but also start a new era, a qualitative era, with more words?
What does that mean? That means that when we're evaluating our students, we not only look into the learning itself. In other words, I don't go until the end of every term, and only then we'll decide whether students can move on. Our evaluation starts from day one in every school term, day one of every school term. It's learning to develop learning. So, evaluation is now a more qualitative action.
This is something that only Afya does in Brazil, I can assure you. All our educational project was totally preserved, and we added to it. Erico gave us this mission of adding an additional two weeks every school term, every semester for our memor ial initiative that starts on day one with each and every student that is seen individually by each professor.
At the beginning of their semesters, a student is welcomed by Afya this way. We listen to these students on many different levels. We listen to students depending on the new curricular guidelines that were published last month for 2025.
This is how we prepared, and we've been doing this since January 2025. We listen to students based on every level of these curricular guidelines. Of course, again, commensurate with their level in every semester.
And we put up a skills tree for every student so we understand their qualitative positions considering these new curriculum guidelines. As a result, we are the only teaching educational company that reaches this level of. And those that do not do this just do half the work, even in a number of terms. So we need to increase quality. So the academic monitoring, it starts with the beginning of the school term.
Then at midterm, in another week, we also ask our students how they're feeling, how they're seeing their progress in that term. So, at the beginning of the term, together with our center of teachers, we have these centers for every student that provide psychological, in addition to educational support so students can structure. They really write an individual learning plan with individual guidelines or individual targets, sorry, at the beginning of the semester.
Then, midterm, we ask our students, "How about your targets that you wrote, that you set in your individual learning plan? Are you being able to attain that? Do you feel that you're making progress?"
So, we now ensure that we can look at students at this very detailed level, granular level, but the amount of data that we get. And this adds to what Afya has already been doing. And this is our progress test, individual progress test.
We currently analyze. We do quantitative analysis of how students go from term one to the last term per dimension, or if it's surgery or what surgery topic they have a gap to fill. In addition, we add the addition of these figures to individual analysis of every student. So, we have both quantitative, the numbers, and words, or qualitative evaluation. And this is aligned with the best international practices.
And that generates a student register that they carry from semester to semester. When an Afya student starts a new term or a new semester, all the professors that will welcome that student at that moment and also midterm, at the beginning and the middle of each term, they know how much progress the student made in the previous semester. This is why it's called a memorial. It's a story. It's an individual journey of every student at Afya.
Well, that was excellent. Itamar, just imagine 33 medical schools, 26,000 students. Medical students, so many variables. So, you use AI and big data to be able to provide individualized feedback to each student and also help professors. This technology is really so impactful when you're evaluating each student. And as we said, very welcoming. Is there any other technology you'd like to discuss in addition to the academic memorial?
Well, yes, the memorial, in itself, it means quality for every student. When you open up the memorial of each group, it's just mind-boggling. I mean, you have so much information about each group, about each class. If I spend 10 seconds to read every qualitative entry of students, I'll spend 67 hours to read. Just to read, not to mention processing that information.
So, our memorial that was approved by our data protector office, our DPO, we already use an AI engine in our data lake on Afya's data lake so we can get insights about the persona of every student.
For every student, I can define their profile. I can map it out using AI and also suggesting points for improvement, so reinforcing their positive points and also explaining about the students about DCNs and the class they are a part of. So, it's a psychometric qualitative tool.
When I take this data, then a professor will talk to the student. Just imagine how long that professor would take to read everything, all the qualitative trajectory, so AI now integrates all that information to do that processing of mass data, so when a professor talks to a student, meets the doctor, soon they get all the information about the student profile, both qualitative and quantitative.
Everything is there ready for that interaction to happen, and then they can work on the individual learning plan.
In 2025, for instance, this is written in the DCN that was published last month, and we've been doing this just January, and that's just Afya that does it. Yeah, that's a high reputation, welcoming of students, professors, and we talked about 70 days, doubling medical knowledge. Just imagine without the memorial, 67 hours to read all these variables.
I also remember that I graduated about 30 years ago, so it was so hard to learn so many procedures and seeing patients, also giving bad news to patients or the family. So, I started visiting Afya schools, and I was charmed with our simulation centers. It was really, really impressive. If I'd had that sort of education in the past, I'd definitely be a better doctor.
Can you tell us more about that?
Afya is very proud of our simulation center. Simulation in healthcare is still a national gap in Brazil, but not at Afya. I don't know if you understand the difference of practical training in our simulation centers and real life. These are both practices, right? In our simulation center, practice is standardized. What do we mean by that? We have all these learning outcomes mapped.
In our simulation center, we can ensure that all students will execute and will show how they would react and conduct practical medical procedures, so the simulation center has the advantage of using mistakes for learning purposes. We are learned by making mistakes, and that it's a safe learning environment. That's why our simulation centers are accredited by international societies.
Simulation centers' accreditation, well, most of those are for hospitals. Afya is a world pioneer in gaining accreditation for a graduation simulation center. Afya has the largest number of accredited centers in the world.
We have a multi-site project with the SSH. We have this unified matrix, unified governance, so, of course, we have a different perspective, and we are pioneers in tying this process to our undergraduate courses. We have three accredited simulation sites. We are also accredited by the Chilean and Brazilian societies, simulation societies.
That ensures safety for our students in their learning processes. We have the largest standardized patient program in Brazil, the largest program in Brazil. So, our students will not train with other students. They have standardized patients that are represented by professional actors. This is according to best international practices. Soon we will be talking about virtual patients.
And then we have our American Heart Afya Center. Our students, they work in clinical practice. So, it's not just a cardiac arrest simulation. Our students learn how to give bad news. They learn how to do ECGs. They learn how to operate portable equipment. This is all integrated.
And by the way, they can make mistakes. In the real world, which is different from the simulation, there's no tolerance to error. We cannot make mistakes with real patients. And here, students learn from their mistakes.
So, when they're in a practical situation, a real situation, they won't make mistakes. Our students have two certifications. An Afya student has a diploma, and they also have the American Heart Association accreditation that provides safety in their training, and it also provides safety for patients.
Thank you, Itamar. I think we have a video, right, to show our simulation center. I've seen it, but I think our guests could have an idea of how it works. Yes, this is a video that was recorded in one of our accredited units. [Foreign language] Unigranrio is one of our units. And we want to show you the potential of our centers.
Imagine standing before a life that depends on each of your decisions. Your heart races, your mind rushes, and within seconds, you must act with precision. This is one of the great challenges of medicine.
We know it's not easy. That's why we think of every detail, so the student's journey is complete and transformative. Across 33 Afya's higher education institutions throughout Brazil, our centers for simulation in healthcare bring students closer to the reality of medical practice in a safe, technological, and innovative environment.
From the first day of class, our students perform complex procedures, develop leadership and effective communication skills, and work as a team in interprofessional simulations across different healthcare fields. And this work transcends borders.
Three of our centers for simulation have already been internationally accredited by the Society for Simulation in Healthcare, a global recognition that proves in practice the excellence of our medical training. Our high-tech mannequins reproduce vital signs, physiological responses, and complex clinical scenarios, from intubation or cardiopulmonary resuscitation to multiple trauma care, burn treatment, and surgical emergencies.
Thanks to technology in control rooms, countless variables can be combined, creating an almost unlimited number of real situations that challenge students to think and act as if they were in an actual medical setting. The method is simple and powerful: briefing, scenario, and debriefing. A cycle that connects theory, practice, and reflection, consolidating a learning experience of true quality.
We also lead Brazil's largest national standardized patient program with real actors, and in a pioneering way, we've incorporated artificial intelligence, virtual patients who interact with students by voice and video, offering real-time feedback in a collaborative workspace.
In other words, our simulations go far beyond the classroom. It's as if each challenge were real, but with the opportunity to make mistakes, reflect, and try again. This ecosystem of innovation places Afya at the forefront of medical education in Brazil.
Because training highly qualified professionals is not just about teaching medicine. It's about preparing students for the challenges of life.
Gustavo, we also have a partnership with a research center. Afya is a partner of a simulation industry, and it's a new fellowship program for simulation, so we train students, and we train physicians and employees that will be working with our students in public health units and in hospitals. We also train physicians.
We currently have three fellows. It is the only Brazilian company that has fellows in health simulation. These fellows are dedicated to the simulation center. They receive a fellowship that is greater than medical residence programs. They spend one year with us. Understanding and protecting best practices is really important, so we are training simulation leaders.
Amazing, and we have other two innovations, right?
You mentioned digital patients, and I learned from you about the fifth dimension in physical examination.
Sure, Gustavo. Well, AI is not replacing patients, is not replacing physicians, or practical activities. However, we have these green areas where students can train and retrain several times. So, psychiatric patients, for instance, we don't have simulations for that, but now we can have e-brains, virtual patients. These are patients mediated by AI.
All of our units have an AI committee that is approved by Afya's Control and Command Center. We follow all governance processes, respecting data privacy laws, and also allowing us to make use of these technologies. I will quickly make a demonstration of an e-brain so that you understand how a student talks to this technology. It's an embedded technology in one of our simulators.
It can be embedded in a desk trainer or in a hybrid station with an actor. So, accessing our Afya workspace. This is a patient that is coming to assess surgical risk, and a student has to talk to the patient. So, AI will have this conversation, and after the conversation, AI will provide feedback to the student.
Good morning. How are you? I am Maria. I'm 58. We're going to talk about my pre-surgery assessment, right? Sure, yes. I am 58, and I am here because I will remove my bladder. It's a video surgery, and my physician requested a pre-surgery assessment. I have high blood pressure. I take all the medication, and please ask any questions you want.
Sure. What are the drugs that you use? Routine medication. Have you ever undergone any surgery? Tell me a little bit more about you. Sure.
I have losartan 50 mg, 25 mg in the morning, and that's how I control my blood pressure. I have no history of other surgeries. I lead a normal life. I try to take care of my health. I guess that's it.
Your physician, I think, has requested some exams, right, for our pre-surgery assessment: kidney and liver functions, a chest X-ray. Do you have the exams?
Yes. I brought everything the doctor requested. I have the blood tests. I have kidney tests and then the ECG and also the chest X-ray. All the exams are available.
Oh, great. I've looked at your tests. They are all normal. So, I am going to write a report, your risk to the physician. It's going to be level III. I want you to take this report to your physician, and if you have any additional questions, please let me know.
Understood.
Thank you very much, Doctor Itamar. Okay. So, I'll take these reports to my physician.
Itamar, great work. You asked the right questions about the medication. You requested the right exams. If I may say something, surgery risk should be rated as two because high blood pressure is under control. But your conversation was great, and that's how we learn.
I'm here to help. Okay. That's the end of the simulation. Thank you very much.
Amazing, Itamar. So first, she was Dona Maria. She was Miss Maria, and then she gave you feedback about surgery risk, ASA 2 and not 3. Can you talk a little bit about ultrasound in undergraduate courses? We understand that there's this fifth dimension, right? Students can use ultrasound for physical examination.
Yes. I don't know if you've heard about the fifth dimension in physical examination. This is a reality at Afya.
What is this?
This is when students make decisions in real time using a portable echographic device, portable ultrasound device. Because in the past, you had to call a radiologist, and of course, we still do. But now physicians have a portable equipment in their smartphone. They can connect the ultrasound machine to their cell phones. With that, they can make effective and quick decisions by the bedside, by the patient's bedside.
But they need to understand how to do that when they're students. So, what I'm trying to say is that now our students carry their cell phones as an ultrasound machine, and we have this in all our Afya units. Virgílio was mentioning anatomy. They increase their medical abilities until they reach real patients with portable ultrasound equipment. Of course, now we have many minimally invasive procedures, robotic surgeries.
So, this is a three-dimensional understanding of the situation allowed by ultrasound equipment. That's what we mean by the fifth dimension in physical examination. We start that in undergraduation with our students.
Congratulations, Itamar. Thank you for presenting all this innovation: simulation centers, digital patients, and we even saw the live demo and also the fifth dimension. As a radiologist, I can say that this is amazing. Now let's hear from Dr. Isabela Dupin. She leads the dermatology graduate course at Afya. Isabela, can you tell us a little bit about Afya Play? What is it? What is the goal of Afya Play?
Well, Afya Play is a free educational platform for medical students across Brazil, again, free of charge. And from their first semester in undergraduate medical school, they have access to over 5,000 interactive resources. So, 3D anatomy, videos, podcasts, flashcards. Our students really like flashcards, mental maps.
We have a smart study planner, which is tailor-made to their needs. This platform covers 800 topics in 51 specialties. Of course, this is aligned with the Brazilian National Curriculum Guidelines. We have a video to show the Afya Play platform. Let's watch it.
I'd like to stress that with the 26,000 students at Afya and all medical students in Brazil, those that are not in the Afya system, like with our master classes in undergraduate courses, also continuing education for doctors, and every doctor and medical student in Brazil. Now, Isabel, there's a second innovation, and that's Afya Assist. Can you tell us more about Afya Assist?
That's amazing, Gustavo. With free attention or treatment, we make medical education more capillary . And then we have Afya Assist. This provides support to medical learning for students.
It's a virtual assistant, a conversational assistant that is on our platforms that is available for every student since year one within Afya Play, and also for students that look forward to do their residency exams after they graduate, and also for our Afya Papers specialist students. So, what does this Afya Assist or virtual assistant do? It gives you information on our student searches.
So, that is a very safe searching environment for them because it's a closed environment. It's really focused. So, there's this safe curatorship that will give information about scientific updates, continuing education, evidence-based protocols that provide safety, of course, in medical practice, and also personalize these searches according to students' demands. And that's based on our platforms again within the Afya environment. We have a video to show you this.
Our students have Afya Assist by their side, an AI assistant that adapts to their needs, powered by Afya's trusted scientific knowledge base. For example, in the early years of medical school, when accessing Afya Play, a student might want to learn more about acute myocarditis.
A resident, on the other hand, might want to explore the main topics in cardiology. The answer appears instantly, meaning fewer doubts in less time so our students can stay focused on achieving their goals. Afya Assist, your AI partner in medical lifelong learning.
That's so good. Thank you, Isabela. So, we've just seen the innovation and also the trajectory of medical students, doctors, undergraduate studies, continuing education. And we will now discuss the solutions to medical practice because almost every day there's something new.
So, I'll talk to Dr. Ronaldo Gismondi, who is Director of this area, together with Lelio Souza, our vice president. So, Gismondi will tell us about the major innovation. Loyani, of course, talked about the Whitebook. She said, "I cannot be on call without a Whitebook." And now it was a son. Well, now you have a grandson. Tell us more about that.
Well, let me tell you. Whitebook was created based on Eduardo's study notes. Maybe the best student that we had in the Federal University of Niterói. The first text were his notes for his students, and he's still there doing such a great job.
Now, you've seen how doctors get trained, how Afya stands out in the market, and this is why we are leaders in this segment. And this will, of course, show or reflect our financial figures, which is your core.
And then there's a growing number of doctors in Brazil that need to stand out. It's so important. That's why specialization is important. And there's not enough residency vacancies for everyone. So, we have postgraduate courses and also face-to-face courses in many regions in Brazil. As a result of that, the market will grow much more. That will improve everyone's figures. Everyone will be happy at the end of the day.
And we want to provide medical assistance to the entire ecosystem, the entire journey from the beginning until they get very old. As you know, doctors never retire, so we want to follow them throughout their trajectory. But we start with their major pain. When doctors go to practice and there's no medicine without practice, they feel very insecure. And they're very inexperienced.
So, to help them feel more secure and really get rid of this fear of making mistakes, we give them the Whitebook, which is given to Afya interns for free. It's so desired that 80% of doctors, when they finish their graduation, they subscribe to Whitebook to have it at their side. It is an interactive tool from its beginning. It has content of all medical specialties. It's also updated regularly.
It's also based on scientific sources. It's also peer-reviewed. There's over 200 doctors who work with us. So, this Whitebook already had calculators. It already had diagnostic criteria. It also had flow charts that doctors could click on, and then it would help them flow through each medical appointment. But it's impossible now to talk about technology without AI. Not only do undergraduate continuing education courses have AI, we've also added AI for clinical decision-making.
Now, you may ask, why will a doctor use the Whitebook AI? Because if you already have a generic AI, well, it's a matter of trust. Generic AI uses databases from the entire internet, and there's many poor information sources. So, our Whitebook AI uses only our own content. In other words, our AI will not hallucinate. And our AI will have two use cases.
You can either talk to our AI, like with any AI, LLM, by asking a question, but you may also add to the system your patient information. This person at this age feeling this, I examined this person, I did these exams, and then what do I do?
So, it will give you an answer based on the information it has, Brazilian medical data. And they will also give the primary source of that information if they need to go further.
This is why this project is so successful. And we'll now show you a video showing how the Whitebook works in practice. And I also have my Whitebook on my phone. You can try it. We also have that on our megaphone. So, if you have any medical questions, this is the right moment to ask.
Okay, okay, sure, sure. I'm there. In an emergency, every second matters. Every decision that is made counts. It may change a whole life, the destiny of a person. If you have any clinical questions, you can ask any AI. But does any AI really understand what's going on?
Whitebook is the first smart doctor assistant that's integrated to Afya Whitebook, providing support for clinical decision-making, trained by Brazilian doctors developed for our country. So, it gives you answers in seconds that are safe and effective.
It suggests protocols, conduct, differential diagnosis, helping doctors go beyond the obvious when they found the possibilities that might not have been even considered based on proprietary content, scientific-based, curated content validated by an editorial board of Whitebook with over 200 specialists, medical specialists, with content and Whitebook tools that are related to that, which provides normal browsing.
Whitebook Assist is much more than just a search engine. It's a pocket clinical assistant, your right arm at the bedside, helping you, providing support from diagnostic prescription with scientific rigor that only Afya Whitebook provides. It's trustworthy as well like medicine should be.
It's available for all users. I have an invitation to all of you. Everyone has a friend who's a doctor. If they've been graduated for less than 10 years, ask them about Whitebook.
If they know Whitebook and what they think, I can ensure you that they will give you a great evaluation. Our NPS is the best in the market. You know that it's so hard to work in technology. So, we are a market leader, and this is a highly consolidated product.
Oh, Ronaldo, that was great. Now, I wonder, how about doctors who have been practicing for over 10 years? They're in their medical office. They still use Whitebook, but they have their own iClinic, their electronic medical records. They say, "I don't want AI here. I want to reduce this amount of red tape." So, what are we now launching in iClinic?
As years go by, when you feel insecure and slow, of course, you're faster and much more secure, and you have many more patients.
So, we have a product that's our iClinic, our electronic medical record that has been updated. So, when we listen to our users and interview doctors, we ask them, "What do you really need? What do you need the most?" And they say, "I need automation. I want to stop doing boring things to have more time to dedicate myself to talking to my patients."
So, if I'm a patient, I can schedule an appointment with the doctor or on our website. So, this patient gets a link to confirm that appointment, and the doctor can see it everywhere, from their offices, on their phones. They can see their agenda everywhere. They know where their patients will attend.
70% of our doctors work in medical insurance and HMOs, and they're coming to have no-shows. And that's what doctors and clinics hate.
If I have a patient that is missing or that has the practice of missing, they say, "Oh, this particular patient is coming." They miss their appointments easily, and of course, the less you see them, the less you remember, so the AI summarizes the latest appointments, and they say or show what doctors should pay more attention to.
A nd then what most doctors want is the ability of the AI listening from your appointment and transcribing it. I know many of you use transcription tools, but they're open, so our tool, it's all encoded following data protection laws, so that's good for both doctors and patients. They're all protected, and the transcribed information is the information that is saved with the medical record with a digital signature. We will show you how iClinic works in practice.
I came to you, doctor, because about five days ago, I have high fever, 38.5degrees C. I have a lot of muscle pain, headache behind my eyes. I vomited a lot, and I feel I'm going to faint. Do you have any other condition? I have high blood pressure, and I also have a heart condition. For years, medical consultations were split between care, note-taking, and bureaucracy. As patients spoke, doctors typed.
40% of their time was spent doing manual labor, routine tasks. While their eyes should be focusing on welcoming patients, they would be lost in screens. Now everything changes. iClinic Assist is a new way to consult, to treat, to care. The first intelligent AI assistant that is together with doctor before, during, and after medical appointments. So, they're ready during an appointment.
iClinic transcribes, summarizes, organizes, and gives you more. Free to do what you really need. Look at people in the eye and take care of them, so it gives back doctors what is the most precious asset: their time. When you get support, care prevails, flourishes, so you have that integrated to Afya iClinic now.
Have you ever felt when you go to a doctor in an HMO system or insurance, they don't even look at you, right? They're just taking notes. That makes a huge difference. Sometimes they're writing, or they need to renew a particular prescription that people say, "Just send me this particular prescription. I need this exam. Send me a prescription for an exam. How can we improve this?"
Okay, so when you're in the medical universe, you have Whitebook helping doctors make more correct, accurate, and faster decisions.
You have iClinic organizing their agenda, but then the final act, so to speak, of a medical appointment, asking for an exam or getting a medical report or getting a drug prescription. That's what we want when we see a doctor. So, Afya has a product that just is for doctors. That's Afya Receita Pro. It was already on Whitebook, on iClinic too. You have over 6 million prescriptions. It's now a standalone product.
And we decided to make it standalone. We also updated it. We also provide all commercial names to doctors, drug administration, price suggestions. We explain where people can get that particular drug at the lowest price. So, with Receita Pro, we also have AI, again, to make doctors' lives easier. So, you can type a prescription in. You can also dictate that or even photograph a manual prescription.
The doctor might renew that prescription not only from their offices, but also on their smartphones, on their smartwatches, or even on WhatsApp. Everyone that takes controlled drugs have already felt this. "Oh my God, I need a new prescription. I'm running out of my medication." And you need fast responses. In the old system, doctors needed to be in their offices or even with their phones at hand. Now it has become so much easier.
Some doctors only like to write their prescriptions by hand. Well, now they can take pictures, and they're digitized automatically. Let me show you how Receita Pro works.
Imagine innovation that is born in your routine. That understands your time, that lives where you live. A new prescription experience with technology as an ally. No adaptation is needed. It will adapt to you. This is what is coming up.
And see from smart an evolution, but even a revolution, a breakthrough. Renew Camilla Suarez prescription. This is an intuitive system. You can prescribe wherever you are, on your phone, on your smartwatch, on your WhatsApp, by speech, text, photo. It's nimble. It's flexible. It's able to follow up the entire prescription process, medications, free medical subscription, and even the purchase at the drug store.
Straight from the future, now we have a new way of prescribing with AI, human intelligence, and scientific intelligence combined. Afya Receita Pro, an Afya solution that respects your time, your practice, your way of caring.
The free version, of course. I mean, just imagine that many of you, sometimes you need to go there in person. Our process, it is a partnership process. It's super-fast . You register in Afya Receita Pro. If you're a doctor, of course, you need your board registration number.
They say, "Would you like a free subscription?" And it can do this in 10 minutes. I tried it yesterday. You just register, you get a voucher, they then make a video call with you, and you get your digital signature ready. So, you have much more valuable users, more data.
Thank you, Ronaldo. It was a pleasure to receive these three great professionals in continuing education and medical innovation at Afya. Thank you so much.
We've covered the main innovations for medical practice. Now I have the pleasure of inviting my dear friend, Luis Blanco, who is going to talk about other types of innovation, financial resources. You have the floor, Blanco.
Thank you, Gustavo. Thank you, Isabel, Itamar. Besides the innovation we've seen, we also have financial innovations for our physicians. My name is Luis Blanco. I'm Afya CFO.
And CFOs are also thinking of solutions to increase the productivity of physicians in their everyday lives. So, I wanted to say that we've launched a marketplace with financial solutions for physicians. So, Afya Pay is our first product. This is a partnership with Stone. More than a payment solution, this will simplify the everyday life of physicians.
They can receive payment with credit card, Pix transfer, in person with a POS machine, or through remote payment. And this is fully integrated to iClinic.
You don't need anything else for the transaction. It's fully integrated to the iClinic, which is a system that physicians use every day. Afya Pay helps physicians transform their financial management in a safer manner. And physicians can focus on what they do best, which is providing excellent healthcare to patients. The second product in our financial marketplace is to receive anticipated payment.
Thinking of a unique financial management, this allows physicians to receive payment beforehand, all their financial resources, regardless of whether they come from Afya Pay or not. We look at the physician's tax ID. We talk to credit card brands, and we conduct the transaction. We can then pay beforehand for physicians. This is fully integrated to iClinic. And we don't create an additional debt or an additional cost because of debt.
We optimize this within iClinic. Physicians can then access this product. Well, we will launch other products for physicians. The first is a Pension Plan. We know that planning for the future, for the financial future, is super important. And physicians are not formally hired usually, right? So, to help with long-term financial planning, we decided to come together with a partner, Vinci. You know them, right?
Physicians can hire a pension plan for the long term through our marketplace. There's another product that we will launch this year, which is E&O Insurance. This is something we see for our physicians. It's a need of theirs. So, they have to protect their medical practice, and they can hire an E&O Insurance directly in our portal. It's very simple, seamless, and this is directly integrated into our marketplace.
This is a partnership with Forza Seguros, and it will ensure legal protection for physicians 24/7. Well, you've seen the main competitive edges, our products, our innovations. What's amazing is that we deliver all these features to physicians to increase their productivity, their assertiveness, and we still build sustainable value for our shareholders, you.
So, let's look at our track record here. Well, we had our IPO in 2019, as you know. So, let's look at our guidance.
Here you see the evolution of the figures. Top guidance since 2019. As you can see, year after year, we've delivered consistent results within guidance or sometimes above guidance, and we did not have one single failure since our IPO. That shows the foreseeability of our model, our discipline, and our execution.
In the second semester of 2019, our revenue was BRL 424 million. 2024, BRL 3.3 billion. That's the net income, adjusted EBITDA. Second semester of 2019, BRL 168 million, and in 2024, BRL 1.4 billion. What do we have in store for 2025?
Well, we have a strong guidance, of course, once again. Net revenue BRL 3.7-3.8 billion, and adjusted EBITDA at BRL 1.6-1.7 billion, so we are very much set to deliver another great year, as promised earlier this year. W ell, let's look at our cash flow.
At the top part of the slide, you see the evolution of our cash flow. In 2021, BRL 667 million, and in 2024, BRL 1.4 billion. And in the first semester of 2025, BRL 783 million. Sound cash conversion ratio. So, the cash flow, looking at operating activities and EBITDA, our cash conversion ratio is of over 100%. And we have consistently delivered 90% or plus in cash conversion. How is that allocated? Well, we have four lines.
First, we have CapEx. That does not include acquisitions. But that is the funding of all the innovations you've just seen. Intangible asset innovations, but also CapEx connected to our graduation operations, real estate, and so on. Then we have acquisitions. That's the second line. And I'm going to give more detail on that. 22 acquisitions conducted since the IPO. We've allocated BRL 4.5 billion for acquisitions.
But our growth is also supported by providing return to shareholders, dividends. In 2025, for the first time, we paid dividends. BRL 130 million were paid in April, and in 2021 and 2022 we also had share repurchase programs. In August, we have announced a fifth repurchase program, and with that, we will be executing this program in 2025. This shows amazing consistency in cash generation and capital allocation.
It supports our growth, and it provides return to our shareholders, and we do all that by keeping our net debt under control, and our net debt-to-EBITDA, adjusted EBITDA ratio is extremely conservative, so less than one time, that's 0.97.
Well, as I said in the previous slide, we're going to now look at our M&A track record. 22 acquisitions since the IPO. 11 for undergraduate assets, 3 for continuing education assets, and 8 acquisitions of Medical Practice Solution assets.
These assets add up to BRL 4 billion invested, so that's in the undergraduate assets and BRL 500 million in continuing education and medical practice assets. We are very careful in our asset selection. These operations are well executed. We preserve the legacy of the companies we've acquired. Eduardo is a case in point, and he's here with us, and this generates high strategic value for Afya.
That's how we have this ecosystem that serves our students and physicians in their everyday practices. Of course, this is all supported by a sound cash generation, well, speaking of innovation. There was lots of talk about innovation today.
42% of the physicians, as Eduardo said, want to become entrepreneurs in the health area. W ell, looking at the long term. We know that creating an ecosystem is about meeting all physician needs. That means facing several challenges.
So, we look at H2 and H3, and we want to fund that with Corporate Venture Capital initiatives, CVC. We have pitches for health techs at Afya every week. Every Friday, every Friday, health techs come in to pitch their ideas because we want to be connected with the innovation ecosystem in Brazil, not just in Brazil, in other regions as well. And here I have four investments conducted so far. This is all in our balance sheet.
The first one was Lean Saúde. This is a health platform founded by Eduardo and Francisco. It optimizes medical resource use, reducing claims. This was in 2023. Then in 2024, two investments of Corporate Venture Capital. First, Caveo. It's a fintech for physicians. They combine accounting, banking, and AI to simplify doctors' financial routines. They are also now working with shifts, physician shifts. They have a platform for that.
And they also have a very nice solution of banking as a service for physicians. Then in June 2024, we invested in Wellbe. They want to bring more efficiency to payers. They integrate health insurance data with primary care. That brings more efficiency and lower health costs for payers, whether these are insurance companies or corporations.
Then in August 2025, we invested in Marisa. Care, founded by Dr. João. This uses AI agents to support doctors and institutions in patient care. It brings more demand to health providers. They identify patient by patient at the primary care level, organizing data and expanding access to preventive medicine. So, this is a way to build our future with our partners as well. And there's value in our roadmap to support physicians all over Brazil.
Well, I'm really proud as a CFO to see the company's strategy bringing results, whether that's organic, based on organic or inorganic growth, and that's how we can reduce our leveraging levels, which is clear in this slide. You see our net debt adjusted EBITDA ratio with a very healthy debt cost.
A nd if I may just recap the debt we have with SoftBank. It started in 2021, BRL 822 million. That's the size of the debt. The cost is of 6.5%. This is in reais, okay? It's a convertible debt, so at $25.35 a share, that would mean more or less six million shares. In April 2026, we have the possibility of an early redemption, [Foreign language] so we decided to prepay the debt with SoftBank.
Last week, we announced an issuance of BRL 1.5 billion with Afya Participations. T wo series, series 1, BRL 500 million reais, CDI plus 0.7, and series 2, BRL 1 billion reais, CDI plus 0.85. Both series have maturity for, well, three years, series one, and five years, series two. Series two has payments in 2029 and 2030.
Well, why did we decide to issue these debentures? To prepay the debt. We have debentures existing in our balance, but we have the issuance also to pay SoftBank. Well, first, we want to increase the duration, 6.5%. We know that's not what the market is pricing. That was becoming short term, and we wanted to have cash in order to have more flexibility in our capital allocation strategy. But it's also about the cost of the debt.
0.7%- 0.85%, we can reduce the cost of the debt for existing debentures, which we're paying 1.8%, and now we have a AAA rating by Moody's, and we also increase duration. Finally, considering tax changes that are taking place in the Brazilian legislation, there will be a taxation of dividends for dividends issued against foreign investors.
S o, this taxation could have impacts for us next year, and that's another reason why we decided to pay the debt right now.
A nd that is included in our strategy to manage our debt. S o, this is my last slide with some final remarks, and I'm representing everyone at Afya when I say this. Afya is at its best. We have a unique ecosystem integrating medical education, technology, and clinical practice. We connect all the stages in the physician's journey.
We are leaders in undergraduate medical education, and we're present in all regions of Brazil. We want to train future physicians with excellence and innovation. In continuing education, we support physicians' development to become specialists, and this, as you saw, is really important for physicians. We want to support their lifelong development through digital platforms and tools that unite content and technology.
In medical practice, we are repositioning the daily lives of doctors with solutions that increase efficiency as well as their assertiveness with iClinic and their own prescription, Receita Pro, and that is supported by a very solid model combining predictable growth, cash generation, and disciplined execution.
Currently, Afya is a unique company, a profitable company that can keep growing sustainably and generating value to medical doctors and shareholders.
And more than numbers, we are moved by the purpose of changing health care for those that have medicine as their vocation. This has been a legacy we have been building together. We are strong, and we keep as enthusiastic as we've ever been. And we are really hopeful for what is upcoming. We now invite everyone to our Q&A session. Thank you.
Everyone, if you want to ask a question, please raise your hand. And please wait for your microphone and tell us your name and company during the Q&A, okay? Thank you.
Good morning, everyone. Thank you for inviting us. I'm Vinicius Figueiredo, Itaú BBA. So, I've heard you talking at the beginning and now about continuing education. So oftentimes, we are asked about how we have a greater supply of medical courses in Brazil. And people talk about the scarcity of continuing education for doctors.
There's difficulty having residency programs, and also postgraduate or graduate courses have not evolved or developed in the same pace. So, how prepared are you in this more competitive environment in the next five or six years?
Okay, I think I can take your question, Vinicius. We have shown you how we are preparing, right? We started in 2019 with the acquisition purchase of IPEMED. That was the greatest postgraduate center, and that was highly practical, and then you see we have 25 Hubs and over 70 programs, educational programs.
A nd we are also evolving to the concept of a hub experience in these 25 units. So, doctors, they can not only have practical experience, have their training, their specialization, also experience preparing for all the activities. There's a practical element and also their own appointments that receive their patients in this concept of membership that started.
We started designing and launched. So, you follow a very positive market dynamic with lots of significant growth, and it's attractive not only in terms of higher income, but also a better personal life because they don't need to be on duty all the time, to be on call all the time to get more control of their lives and careers.
This is part of our strategy. We keep expanding the operation. We have all the preparatory exams that are not only the study prep for residency, but also for all specialization. In other words, we're betting our cards on organic growth in this market that is expected to be really interesting in the next six years.
Can I just ask you something else?
When you compare this to what the competition has been doing, the other similar groups, what they've been doing in terms of continuing education, do you think you are well ahead of them?
Well, the difference is really significant. When you look at this volume or scale, the national level on our hubs, there's nothing that's close to us. Maybe in the state of Pará, you have six units in Belém. The capital city of Belém, we don't have an undergraduate course there, but we have specialization courses there.
So, there's this migration of professionals, those that not only go to smaller towns and also those that come to the capital city for specialization courses. And you have three or two or three hundred students there in partnerships. It's a completely different scale. And we can have 50,000. It's completely different.
I'm not excluding, of course, small players that have highly qualified products, but again, local brands with some good reputation, good partnership with hospitals, but it's a completely different approach to us.
Can I add those that were not here last year? I'm Denis. I work in the Continuing Education unit.
And I think this answer has three or four components. First, capillarity. We made this decision of moving forward. We're present in more states in continuing education than all the other undergraduate courses. So, capillarity is one of the major points that make us stand out. We are really close to doctors, and we might be in capital cities, but this capital city is also a Hub for the smaller towns and cities.
Those that live in the state of Pará can more easily go to the capital city of Belém than go to other cities or other capital cities. Number two, portfolio. When you consider the competition, we're not considering only education groups, but we see other healthcare groups that are doing continuing education, influencers also. In other words, everyone is on this bandwagon. And I think we have a wide portfolio.
You can help doctors do their residency, doctors that have already finished their residency, doctors that want to change their specialty, or those that want to have double specialization. So, this is a portfolio that is that diverse that really very few can deliver all of that together. Now, there's a third element, and this is integrating all these elements together. When you look at integration, physical channels, digital channels. I don't see anyone matching us.
Thank you, Denis.
Next question, please. Mirela.
Good morning, everyone. Thank you for inviting us. Mirela, Bank of America. I have two questions. First, a follow-up from Vinicius' question. What do you expect from Educon when you consider the importance of this segment to the entire business? What, five years, three years? What is your expectation of becoming more representative? How will that represent your totals?
And then number two, about B2P. We have seen you entering that market. We saw the difficulties there. It takes time to address all these initiatives. Maybe can you give us a summary of what happened in the last three years in this segment? What was the performance? What was the performance level? What are you expecting from now on?
I'll take one part about continuing education. Number one, you see the dynamics of this market, right? This market is buzzing. You have lots of generalist doctors.
There's a wider gap between generalists and specialist doctors. There's more competition between doctors. They need specialization. This is really positive for continuing education. This is growth that is totally organic with shorter life cycles. So, you go to the market, you put out a product. We have shorter life cycles. You need to make the most of that wave, so to speak.
So, we grow more than the market. This is growth of, in the next two digits, 10%-20%, totally organic growth in the next two to three years. So, we grew a lot. We remained flat in profitability, but we're expecting to grow more, having more mature Hubs so our margin can scale up.
It's more about intangible capital, but it is extremely important and profitable, not only in B2C, but also as major differentiation channels. So, B2P will be closer to these experts.
And that's about 50,000 people that, in a way, are with us on some platform or on some of these Hubs. Then you mentioned B2P, right? B2P, business to physicians. Okay. Oh, business to pharma. Okay. Okay, right. B2P is business to physician. It's analog to B2C. All right. Okay. Good. Clear. So B2P, we were expecting to scale that up faster with the pharma industry. In the last two years, we've grown 20%-30%.
Our B2P contracts, it was wrapping up. But there were two limiting factors to this growth. First, penetration. In other words, digital prescription is vital when you want to monetize. And digital prescription accounts for 10%-20% of all prescriptions in the market. It's not that significant to many molecules that we have today in the market. So that's one limiting factor.
The industry is still based on physical channels, and that's really recurrent. Now, the other point or limiting factor is traditionalism. The pharma industry depends on their sales reps. As you know, about four years ago, there was a movement, and some of the great pharmacies were just laying off.
One of them laid off 100% of their sales reps, and then they needed to rehire them. They thought that during the pandemic, as everything became digitized, but this did not turn out to happen, and it's not just about if. It's not about if. It's about when.
We are insured. Our position is very good, but this will keep growing, and that return on investment is easy to measure, and it reduces fraud.
I can give you one example of a very common when you buy antibiotics in a drugstore, and the drugstore sales rep says, "Okay, I can put this on a CRM without," in other words, pretending that this was a physician medical prescription, because it was totally analog, but everything will become digital. It's a matter of time. Everything will become 100% digital. You want to say something, Edu?
When you think about the number of contracts and cases, we have over 160 contracts, but that's still, we are innovating. 90% of the budget is not in innovation. 90% is about our daily marketing and sales activities. Of course, the pandemic gave us a proxy that did not stay because people could not make medical appointments, so people believed digital channels would take off, but it didn't happen, and it's still very strong the way it's always been.
But we are proving this model every day, increasingly more. So, one thing is about scale, the volume of doctors and prescriptions and data. So, the more representative digital channels become, the more they are used. And then measuring that return, that feedback, that's what we call medical engagement stimuli. So, have the sales reps, they'll always be there. They've always been there. They'll still be there for a long time.
But there's more stimulus when you consider, for example, educational content, medical content that focuses on particular topics, like rare diseases, for instance, something that doctors do not prescribe because they don't have enough knowledge, because they have a completely different professional life, daily life. So, if this is diagnosed early, I have much better treatment, much more successful treatment. And it's all about knowledge, and this is something we can provide, as we showed here.
So, things will scale up. Maybe the timing will be a little longer, a little longer than we expected, but yes, it will. Now, when you think about what happened in other countries, there are some countries that have companies that want to have digital access, but it was already there 10, 15 years before, until it finally sped up and scaled up exponentially.
There's a lot of investment in differentiation and also charming doctors in their daily lives, increasing engagement, penetration, coverage.
You see how much effort we put into adding AI to all our solutions to increase compliance, especially young people that are graduating from medical school. They shouldn't do ChatGPT irresponsibly. And then one thing is you may have one player doing this, but no one is doing it. But maybe there's another one doing prescription. There's someone doing B2C all alone.
They're doing medical records only for a marketing agency that's producing content. But there's no one with an integrated vision, integrating all the points. That's only up here. It's about timing. We are speeding up our investment. We are segregating our sales forces to subsegment the industry, pharma, for instance, and others with a more niche value proposition.
This is our bet. So, we need to scale it up correctly, sustainably, according to market maturation levels.
Thank you, Samuel.
This is Samuel Alves, BTG Pactual. Thank you for your presentations. Let's discuss undergraduate courses. You've talked about brand differentiation and all the initiatives you've had in the last few years. Can you talk about competition now? How do you feel competition these days? Are you more concerned about any particular city? And also, there are many players that are using PS. What do you think would be an optimal point?
So, geography or competition in different geographies, and then PS or funding. We see increased competition, and when you look, we should look at different places in isolation. There are two cities where we had a small player, local player, that were taking radical measures.
So, if you come from Afya, you get 50% discount in your tuition. Just imagine that you would get students in year two studying. Our tuition was BRL 13,000, and they would pay BRL 6,000 rather than BRL 13,000. And they're with the same person, but people would pay different prices, different tuition prices. That would be complicated.
I think these are some desperate initiatives, really. And they kind of hurt us taking maybe five students, but then there will be some report with the public prosecutor's office. And this will not be sustainable.
In other words, we are still working hard in our initiatives at capturing students, not only for the course, for the entire journey. I was so proud to see that former student of ours and how passionate she is about us, and we equally admire her so much. It's a great story we want to really replicate, and then funding for students. FIES, is a tool that is increasingly more used, so you have lots of agencies.
For example, B2, you have almost no seats. You always have students from the funding for higher education students or the FIES system, and in some of our units, we have about 16-17% of our student base have this funding, FIES funding, so some of these units, we purchase them, and we have a large number of students. The unit of Pedro, so we sped up that process.
Rather than capturing 100 or 150, we would capture 350, so we used the FIES funding system to attract more people in that particular unit. A nd also, the Mais Médicos units, where you also have about poorer people, and even with a different tuition, when you go from a larger city to a smaller town, you have much less.
The difference is marginal when you consider the efficiency between one unit in a smaller town and a normal unit, and these are the units where we need more than 10%.
Yeah, you will not see Afya bringing students with FIES or the student loan program or at a discount. We have many partnerships for funding in our marketplace, many creative solutions, solutions that are more efficient than traditional funding. Many students are looking for private funding now for their studies, and we have these partners in our system.
If I may add. Good morning. I'm Erik. I'm responsible for undergraduate courses. Yes, it is more competitive. We have many new courses and schools. Everything we just showed you this morning shows that there is consolidation, and that's how we need to set ourselves apart. It's important to understand that deciding to study medicine involves the whole family. Because of that, parents, grandparents, sometimes even uncles are part of the decision. They visit our units.
They all come to our units. Some of these students have physicians in their families. And when they visit our units, they see that we are special. And that shows that we can consolidate in the regions we're present. Another interesting point: we have many remote areas in our country. We have a structure for medical education in all capitals. That's what we call 4 plus 2.
Students can spend four years doing their studies in a remote university, and the two years of residence, they can keep in their region, or they can go to a capital.
Virgílio and Denis mentioned the city of Belém. Great example. We have many units in the state of Pará. We are still not in the capital, Belém, with a graduation. But we use this structure to support us in the two years of residence when they can go to the capital. This is really interesting for students because they will work with hospitals, and they will have access to a larger network of hospitals. It's been super helpful.
From the brand perspective, my name is Stella, by the way. I'm a marketing and sustainability VP. The brand has had amazing growth. I've been with this industry for 30 years, and this is the brand that grows faster.
It's a very consistent proposal. When a student joins one of our institutions, they don't join just one single university. They join our ecosystem, so this is a choice for their whole career. This brand is very strong and sets us apart. Students understand that this has value for their whole career as physicians, not just for their undergraduate studies. They have Afya Play. They have the Whitebook. It's a package.
They become an Afya member, a member of our community. That means more learning opportunities, knowledge exchange and this community will probably make it easier to find a job, so this is something that really sets us apart.
Hello, I'm Eduardo Resende from UBS. We're still talking about undergraduate courses. I wanted to ask about Mais Médicos 3, a public program. This program has been suspended earlier this year.
And I wanted to understand, do you have any interaction with the Ministry of Health in Brazil? What is your base case when it comes to this call for proposals? Are you looking at a downside possibility? Could that accelerate your M&A pipeline? Could it have an impact on your guidance?
Yes, we are in contact with Brasília, with the Ministry of Health, not just the Ministry of Education. Mais Médicos is a huge national program. So, this program needs to be balanced. That's how we see it. We had many positions open for physicians in different cities of Brazil. They want to reach 90 cities with this program.
So, everyone who is accredited in that region, you might win the bid, but there are no beds for the patients. And then the media is going to cause problems.
And even the ministry, you have a school of medicine there, but you don't have the beds for the patients. So, there is pressure. So, the Ministry of Education is also involved, and they decided to suspend the program. They want to look at the cities that need beds, that have new beds, and they might reduce the number of positions. They have to see whether it is feasible to open a medical school in a specific region.
So yeah, this is a moment to rebalance this program. Regarding M&A opportunities, it is the same strategy, regardless of the federal program. We are always looking for good assets. And we are looking at 200 positions. We have this allocation strategy. We are deleveraging our company. We are buying back shares, paying back dividends, and we have the slow leveraging levels.
If I may add regarding the M&A strategy, our most recent operations were focused on capital cities, and that is connected to the Mais Médicos Federal Program, so if there is a change, we can balance our portfolio of assets. We acquired an operation in Contagem, Minas Gerais, Salvador, in the state of Bahia.
So, our acquisitions are always focused on urban centers. B ut yes, if there is a change after this suspension, we can reassess our target for M&A. Yeah, and with the new debenture cash is preserved.
The speaker is not asking his question in the microphone.
[Foreign language]
Well, we have a very well-crafted playbook. From IPO until today, 22 acquisitions. But that started before the IPO moment. So yeah, we had a track record for different types of institutions. And this is mature in our company.
Suppose you are acquiring a local brand, a very strong local brand, or if you are acquiring a university center that is a strong regional brand. Or you might be acquiring a university, a university that is present in the whole state. So, for all these three situations, a smaller acquisition, maybe a university center, and then we have Unigranrio, which is a national brand.
We have strategies for all these cases, strategies for the first 90 days. Top line is the first lever. And then we have COGS. We implement our educational model. We look at partnerships. Then we change the career plan for professors. So, we base our work on these guidances. And after we have this revenue line or the COGS line correct, then we start working with the academic system, with management. We bring this to our shared services center.
That means 10 percentage points of margin just because of synergies. The brand is the left heart. You need to win over the society that orbits around that unit and that they say, "Yes, you are generating value for students and professors." They do understand that there is value to this acquisition. They see that it's an important journey for health professionals. It's important to be part of an ecosystem such as Afya.
And then we change the brand. If the NPS is not high, we don't use our brand. Of course, all changes cause pain, right? We wait for the academic community, for professors and students to acknowledge the importance of our presence. And that's when we use our brand. We have about 100 people working full-time with integration. So, it's a well-tested model in our company. You mentioned the soundness of the results, right?
When we look at M&A models, we do the math, right? We don't acquire anything just for the multiple. No, we have models. And these models are based in the experiences we had in our own units, looking at the results, at the sound results we have. So, the assumptions are what we see in our units. Could we increase our assumptions? That was your question.
Well, we increase if the operation is better. But we've had 11 acquisitions in undergrad after M&A. Because of that, we have become faster in the integration. There's less pain in the integration process. We had the Contagem acquisition. Then we have Unidom.
Closing was on July 2024. And in April 2025, it was fully integrated, fully migrated into the Afya brand. So, it happens fast. And that is why we can capture or take advantage of our integrated system.
We do this very fast today. It's a game changer for top line and EBITDA. If I may add, Unidom is a very interesting case. Closing July 1st, 2024. Classes were about to begin August 1st, 2024. So, we had one month before classes began.
We needed to be swift to start with our academic model at day one, August 1st. This was really important for us because this will have an impact six years later when the students take their exams to become full-fledged physicians.
So, in just 30 days, we implemented our academic model, and we started classes on August 1st with our model. Our partnership with medical educators was key. We have our clinical practices in the city of Salvador, and that was connected to the students so that undergrad students could use that academic clinic, as we call it.
So, this synergy is very helpful in the swift integration process in everything we do so that we can ramp up faster. Yes, that's the importance of the ecosystem. You can use graduate and undergraduate courses. Lifetime value is very important.
Afya is one of the few players that are still making acquisitions. Very few players are acquiring. But there's a lot of offering. So, we are well-positioned, and we can be very selective in our choices and in the price we pay. We know time is over. We have time for two questions.
Thank you. I'm Leandro from Citi. Looking at undergraduates, you talk about candidates' position, the ratio year on year. Can you talk about the quality of these candidates? We have feedback from list management, and this is a little bit behind inflation. Can you talk about this funnel, the ticket outlook, the spending outlook?
Now piggybacking on the Mais Médicos question, I would like to talk about regulation. The ministry says that the EduMed program is going to be different. It's going to require different proficiency levels. Well, as for the profile, there were no changes. We are improving the process. Our brand is more renowned among physicians, and I think that affects other impacts. Yes, there is competition, but our students have a similar profile. We don't see major changes.
If we look at the income of our students, 75%-80% of our students come from an income bracket of about BRL 15,000 a month. Then we have students coming with public funding systems. It has always been like that, and we saw no changes in the profile of our students. Average spending, well, our average spending has grown above inflation rates. The problem is the public funding program.
Unidomp edro is a case in point. There's a 27% discount. Well, the gross spending is over inflation, but the net spending is different. That has no impact in our profitability. We are still very competitive, and the gross spending is what matters from a market perspective. What was your third question again?
Proficiency tests. Well, we support the quality bar has to be very high. Many schools will be shut down, and they should be shut down. There's no quality. They have no professors. The syllabus is ridiculous. We see terrible things in many schools.
They have accreditation to open schools, but the quality is terrible. So yeah, these schools will go belly up, and we will receive emails from real estate brokers selling these buildings of the schools that will be shut down.
I do hope that the Ministry of Education is severe in its assessment of medical schools. If you have no capacity, if you have not prepared your students, you will be hit hard. Of course, we can perform better than average. We have sought old preparation to help students in ENAMED, which is a national exam for physicians.
So, Afya wants the bar to be very high. Of course, you need people to inspect these medical schools and to shut down schools that should not be open. So, that's how we see this. We fully support the Ministry of Education in these efforts. We want to have an annual exam for medical schools to solve this problem. Yeah, that's our position.
And one more question. Hello, everyone. [Inaudible name] , JP Morgan. T hank you for taking my question. I want to talk medical practice solutions, a topic we haven't discussed yet.
What is a healthy level? What are potential growth drivers? And finally, AI, do you understand AI as a disruption risk in your segment or as an opportunity for your growth? How would you answer these two questions?
Thank you for your question.
I'll start. As for guidance, we don't provide guidance per segment. It's a consolidated guidance, and we believe that medical practice has a great growth potential. And how do we do this? How do we seek medical practice?
Medical practice is about increasing assertiveness and productivity for doctors, right? We provide the best tools. We engage a qualified audience so they have effective use and a daily activity use that's very high with high engagement levels. Now, these tools that we call B2P, business to physicians, these tools, they have a recurrent revenue.
In other words, every doctor pays a sum every month, and it's limited because, of course, there's a limited number of physicians in this country. If we have 100% of our doctors, we will have 635,000 doctors. So, growth in B2P or medical practice is not a result of B2P, but rather as a result of this connectivity.
In other words, doctors engaged to our tools and the healthcare industry. And what is the healthcare industry? In other words, what values can we provide the healthcare industry? And where are they?
We have three major parts. Number one, access. So, the whole time that was presented with medical advertising, delivery of free samples, that's what we call access of the industry. Now, what industry has access to these doctors? The pharmaceutical industry. Part two, demand. Demand to whom? To providers, healthcare providers, hospitals, drug stores, laboratories, or diagnostic laboratories.
And number three, the peers. Who are the peers? HMOs, health insurers, and corporate plans. What do they want? They want a lower cost of service, cost structure so a good part of the growth in medical practice comes from B2P. And when you consider the focus, how is that? How was that addressed? B2P is the pharmaceutical part. So, we went deep into that part with Marilia presenting four cases.
And the products are focused on the pharma industry. So, we decided to avoid attacking in this first moment so that in the future, we can then address providers, players. How do we participate in the value chain with the CVC to provide efficiency to peers? Because at the end of the day, peers, they have an MLR of 70% of the market. That's about BRL 350 billion a year.
In other words, a good part of the growth will come from B2P. You have these three major value propositions. When you think about metrics, when you think about undergraduate courses, we have 25,000 students. That's a lifetime of six years. If continuing education with solutions to medical practice, then the lifespan is much longer, of course, much longer lifetime. Even when students, it's from graduate students to their retirement.
Of course, it doesn't generate as much money. It doesn't monetize as much as our 25,000 students. You see that in the financial market, right? $6 million. And what's their profit? It's 40% of doctors in the United States, and we have 40% of doctors in Brazil using our solutions every day. We've been testing and scaling up monetization theses. That comes for 30% of our market share, doctors, students.
We're really aggressive with two assets, a qualified audience. In other words, doctors that use our solutions intensely, both to keep learning more in continuing education platforms and also medical practice support, and that generates another extremely valuable asset, so these are the two major assets we have, and they provide scaling up cash both in the industry, pharma pharmaceutical industry, providers, peers, marketplace.
In other words, we have health insurers. We have financial companies that are also providing these services. Also, we're instrumentalizing doctors, and we really want to serve this public, this audience, so this is a good course for us to increase the capacity of our ecosystem, and we're also testing out and scaling up our monetization thesis. Thank you. I apologize, everyone. We ran over time. Our investor relations team is available for your questions. The executive team.
In the question about AI, just one more thing. I'll talk to you later about AI, okay? Our executives, also if you're available, they're all available to talk to you.
Thank you so much, everyone, for coming. If you have any questions, our investor relations team is available not only today, and Virgilio will now close.
Thank you, Renata. Thank you, everyone, for coming. I know everyone is so busy, and it's not easy to move about in São Paulo. We prepared this event in detail to talk not only about numbers and predictions, but to show you what we are building.
We wanted to show our doctors, to show you in practice, show you how our students, our former students, all recognize and see us. We're working really hard, a lot of dedication. We're developing products for our three segments, and I'll take the cue about AI.
AI is not anything special. It's our everyday life. It's impossible not to use AI in teaching, learning, in support to doctors in their daily professional decision-making practices, in the summary of patient records, patient data. Without AI, doctors will not survive. If doctors do an anamnesis and everything, this is a greater impact than when the internet came and education became a commodity. The internet became the distributor of content. We became moderators of that content.
Now students will come, will go to their schools, and they'll see more content. They will have thought and reasoned more on content generated by machines rather than people, and these changes, everything, all curricula have to be rewritten. AI is critical, but it's a great opportunity and with Afya, we are following up the entire AI journey, so you see the needs of those that are really now mature and older.
How can we prepare people that are beginning their careers in day one? Let me also mentioned that we strongly believe in SEM, the whole ecosystem we are putting up. It really makes you stand out. There's an intrinsic value that we cannot even measure. You see lots of references outside, people that haven't even started monetizing, but there's an audience, there's behavior, there's data, there's insight of a whole community. It's niched.
And that's what we're doing. We have 30%, 40%. When you consider the entire student base, we're testing lots of monetization channels. The whole industry is growing more mature. The Brazilian healthcare education career, it's still super traditional. Data integration is still inexistent. It's not there. It's nonexistent. It's infancy when compared to other countries. And no one is looking at this.
We say this is like a jewel that we have, that we're cutting it, polishing it, and that it's super resilient. What we have in continuing education, so whenever it generates so much value, we don't even, it's unmatched, really, so this is our greatest bet in the future.
That's our brute diamond that we are cutting and polishing here. Thank you, everyone. Have a great day. Those that have a little more time, please stay here. Let's have some coffee together, okay? You're very welcome. Thank you.