Good morning, and welcome to Afya Day 2023. I'm Virgílio Gibbon, CEO of Afya, and today we will outline the evolution since the IPO, the consolidation of our strategy, and present our future perspectives. Afya is the largest hub for education and digital service for physicians in Brazil. We are the sole company that interacts with physicians at every stage of their career, spanning from higher education to successive specialization and even their day-to-day practicing. Our comprehensive suite of digital tools enhance productivity, accuracy, and ensures physicians stay updated on the latest protocols and treatments. Our first section today is called This is Afya. We will share a little more about who we are, our brand evolution, and how it will help us to strengthen our growth and positioning. A brand is only as strong as its results, and Afya has delivered strong results.
We have displayed ambition by taking the lead in an innovative and rapidly growing market and demonstrated remarkable resilience during challenging times that affect the whole world. These are the results that will be covered in our second section, This is Today, where we will go over our growth figures and demonstrate the power of our business. For our third section, This is Our Future, we will discuss our projections for 2028 across the three business segments: undergrad, continuing education, and digital health services. To illustrate how we tend to go from one point to the next, our fourth section, This is Our Plan, will provide detailed insights into our strategic roadmap, outlining the measures we will undertake to ensure the achievement of our projected progress. In our segment title, This is What We Stand for, we will emphasize our key ESG initiatives.
Then we'll proceed to our Q&A session. Before we continue, I'd like to take a moment to reflect on our journey and highlight our achievements until now. Our initial objective was to establish a strong presence throughout every stage of physicians' education journey and solidify our position as the foremost medical education provider in Brazil. Today, we proudly stand as industry leaders with over 40 medical institutions nationwide, catering to both undergrad and graduate programs. In 2020, during the entire pandemic and disruption of the physician professional life, we started our journey with digital services, offering tools that enhance productivity, assertiveness, and updates required by professionals in the medical field. Today, we are already the largest community of digital services for physicians in Brazil.
In 2022, we expanded our operations into the B2B market, effectively bridging the gap between physicians and the pharmaceutical industry with more than 45 pharma companies already in our portfolio. Today, we have established ourselves as the primary connection between the health industry and physician. I'm very proud of how much has been done and accomplished to date. Alongside the evolution of our strategy, we have continuously delivered consistent and solid results. Now more than ever, we are determined to reinforce our idea of a unique and integrated Afya that combines all the products offering the best value to those who have medicine as a vocation. While we are proud of the solid results, we are also committed to further consolidating and strengthening our brand. We are making a concerted effort to ensure that our culture is reflected in everything we undertake.
To share our vision and shed light on our efforts, I am honored to invite Stella Brant, Vice President of Marketing and Sustainability to the stage.
Thank you, Virgílio. Good morning, everyone. I am Stella Brant, and it is my pleasure to discuss the brand strategy, its new architecture, and how we will present our value proposition to all stakeholders. We recognize the importance of incorporating the value we create into our brand and the importance of strengthening an integration that reflects our sense of unit and mission. We already are the leaders and pioneers of a solid and profitable business. Now is the time to be perceived as such. We have almost 300,000 physicians and medical students using one of our solutions, but only some of them know Afya. This brings a huge opportunity to become the reference in solutions for medicine, to hook them up, improving the engagement, cross-sell and upsell along the journey.
Therefore, one of our main objectives is making Afya Hub known and relevant to students, physicians, healthcare companies, and society, becoming the top of mind and most recurrent brand by physicians throughout their journey. We have a monumental opportunity in front of us. Now, I will explain how we will do it. As you know, we are guided by three major pillars, medicine, education, and technology. When we put these three universes to work together, we are creating a new category, MedTech, with physicians in the center of everything. A universe that combines education and solutions for the entire medical journey. My role, along with the marketing and sustainability team, is to ensure that our strong results are maximized and connected by an equally strong brand strategy. Probably in this category, Afya will have a high level of relevance, credibility, and growth potential.
Now, I would like to explain how we will integrate the brand strategy and boost Afya's operations hub. We work to alleviate pressure at every stage of the medical journey a s medicine is a demanding field that requires huge dedication and presents many challenges. Ev en though physicians love what they do, they face enormous challenges throughout their education and careers. We have made extensive studies on physicians in different regions and stages of their careers to dive into the motivations behind their career choices, specialization, and education trajectories. We dive into the career expectations versus frustrations and surprises, context, emotions, and attitudes related to their profession. The key insight we have discovered is that they have a deep passion for being physicians and caring for others, but they strongly dislike the impact it has on their lives.
They endure immense pressure, lack of recognition, lack of mental health, and work-life balance. These challenges persist throughout every stage of their career. The major strength of Afya Hub lies on its ability to significantly alleviate these pressures and enable the medical journey to be centered around its most potential essence, the practice of medicine and the heartfelt commitment to caring for others. Therefore, our role is to operate in each of these pillars, serving as a trusted partner in the education, continuous learning, assertiveness, and productivity of healthcare professionals. That's why we aim to transform the daily practice of medicine to make it more powerful and enjoyable.
We combine medical knowledge, technology, and mentoring to engage in the education and training of medical professionals through a wide range of products, including undergraduate and post-graduate courses, specialization programs, always relying on a state-of-the-art infrastructure, modern teaching methods, and a focus on practical application. Two, providing solutions that support professionals in their daily journeys, d igital tools for clinical decision support, clinical management tools, and physician-patient relationships, e asily accessible and practical content for continuous updates. You can imagine how important it is for physicians to find a trusted partner that truly enables a more balanced, enjoyable, and effective journey, allowing them to make a greater impact on the life of others and their own life. This holds great value. That is why our next step is to capitalize on this strength within a single brand, elevating Afya to the next stage.
With great pride and joy, I am delighted to unveil this new chapter to you today. A new logo for a new and promising moment. With this new logo, we reviewed Afya's brand architecture to no longer let the value of Afya be fragmented or diluted. To consolidate all this value under a single brand, simplifying the comprehension of our portfolio, avoiding brand conflicts, and working towards strengthening Afya as the one-stop shop for physicians. The undergrad units that only have health courses will be named as Afya Medical Science School. The other ones will keep their current name as exemplified by São Lucas unit. To better understand this, I invite you to watch our manifesto video.
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To ensure that this new moment truly becomes a milestone in our history, in our results, and bring about a real change in the lives of physicians, our launch plan is comprehensive and encompasses various initiatives. It includes institutional campaigns, participation in congress fairs, as well as value-driven activations and exclusive events. We will also have extensive media coverage positioning Afya as a trusted source for the matters related to medicine and physicians. Let's take a look on that. Everything I have shown you, the mission, vision, brand, and campaign, has undergone through testing and has been met with great enthusiasm by physicians from all over Brazil at different stages of their careers. We conducted in-depth researches with over 200 physicians. We are highly confident on its potential to build brand recall with credibility in a very distinctive way.
The insight has the power to generate self-recognition and curiosity to ignite experimentation. We firmly believe that this movement is crucial in our journey. It's thanks to this unit and energy that we will continue to transform health together with those who have medicine as a vocation. Afya enables physicians to experience the best of what medicine has to offer. As I mentioned earlier, a strong brand is only as strong as its results. To shed light on our journey so far and provide a detailed overview of our numbers, I would like to introduce Luis Blanco, CFO of Afya, who will lead the section titled This is Today.
Hello, everyone. It's a pleasure to be here sharing this moment with you. When we talk about Afya, two characteristics have always described the dynamics of this company very well. Our excellent execution and operational model allow us to maintain growth and profitability even in challenging times. This strategy was put into test shortly after the launching of our IPO, even faced with a pandemic and a global economic crisis with high inflation followed by an increase in interest rates. We continued to grow at high levels, maintaining our great level of profitability and generating cash flow. Looking at the guidance for this year, we can see that a stronger resilient growth and high profitability continued to be inseparable characteristics of our business.
Our current guidance is to reach an adjusted net revenue between BRL 2.75 billion to BRL 2.85 billion and an adjusted EBITDA between BRL 1.1 billion to BRL 1.2 billion by the end of this year. Considering the first quarter results, we are very confident of achieving the 2023 guidance. This means that Afya has grown almost four times in four years, consolidating as the leader in medical educational market and digital service for physicians in Brazil. Such great results give us confidence in our vision and strategy. There is a strong reason for this, our focus in medicine. We prioritize educational updating and daily support of the physicians. We operate in three distinct segments: undergrad, continuing education, and digital service. Let's deep dive into our undergrads, our major segments. Currently, we have 20,822 medical students across our different facilities.
The strong revenue growth comes from the increasing of the number of students and the price adjustments averaging 2.5% above the inflation since 2019. Even considering the strong organic and inorganic growth, we were able to improve our gross margins. Medicine represents 78% of our total tuition fees. It's a market with higher average ticket prices and margins, 100% seats occupancy rates, lower student dropout rates, lower DSO, and our students' profile consists of individuals with higher income. This is one of the key reasons why Afya delivers strong cash generations, enabling us to finance our inorganic growth and CapEx. As you can see on the chart, Afya had an average operation cash flow ratio of over 90% in the past four years. This allows us to maintain a very solid capital structure.
We have a conservative leverage position and also a low cost of debt, 12.1% per year, which represents roughly 89% of the CDI. Within this scenario, the cash we generate will allow us to reinvest in the business and continuing our strong growth pace, whether organically or inorganically. This is the market I want to talk about now. Going over our views for 2028. In the following section, This is Our Future. When we analyze our goals for 2028 and considering our three business segments, we have a very interesting configuration. We have undergrad with the drive to continue growing organically and inorganically, continuing educations with the mission to scale, and digital, where we can transform the healthcare. Allow me to share the specific goals for each one of these three segments. With undergrad, we have three avenues for growth. First, by maturing the existing seats.
Second, through organic growth of half of the requested seats that have been asked for Ministry of Education, and last, through acquisitions. The fact that undergrad is our biggest cash generator allows us to maintain a goal of constant growth with the plan to increase our available seats by 200 per year through acquisitions. Considering the increase in organic and inorganic seats, we will be able to reach a total capacity of 32,840 students and capture 15% of the market shares in terms of private seats by 2028. It is worth remembering that Afya manages to extract significant value from its acquisitions. When a new school is acquired, it goes through a process that requires a streamlined of discounts and scholarships, review on non-health courses, analyze all costs and expenses, implementations of Afya career plan, shared service center integration, integrations to Afya teaching model.
These measures ensure that new acquisitions become highly profitable once they become part of Afya. This is the case of Unigranrio, already fully integrated. Unigranrio is above what we projected and has an estimated IRR of 26.4% on invested capital. We have delivered the 2023 expected results in our original business plan in 2022, one year ahead than initially expected. Now let's talk about continuing education, which is the next natural step for those who study medicine. It is a product that has shown a great potential and despite being significantly impacted by COVID, it has experienced an expansion that exceeded our expectations and it still has a lot of room for growth. Through strong top-line growth on top of new units, plus 50 new courses, we expect to reach BRL 440 million as net revenues by 2028, four times higher than 2022.
Afya digital health is where we can expand beyond the physical structure and reach a vast number of physicians with tools that offer productivity, assertiveness, and updated information. Our strength in this field lies in serving as a bridge between pharmaceutical industry, payers, and providers, and the vast community of physicians at various stages of their journey. Our goal for 2028 is to increase penetrations and engagement in B2B sector and consolidate our B2B offering, reaching a net revenue of BRL 1.2 billion in digital service. To summarize, we intend to grow more than two times 2022 net revenue in undergrad in 2028, four times in continuing education, and more than six times in digital. This means that Afya will almost triple the net revenues between 2022 and 2028, b old but achievable goals supported by strong execution, focus on medicine, and a passionate team.
Now, I would like to invite our CEO, Virgílio, back to the stage to elaborate on our strategy for achieving these objectives.
As we have already mentioned, undergrad is the core of our group, providing the foundation and enabling Afya to invest and gain space in other sectors. And within undergrad, our focus is on medicine, which accounts for over 78% of our undergrad tuition fees. This factor is what drives our strong growth and set us apart in terms of profitability. It position us to sustain our expansion and venture into new markets. Today, we are already present in 30 campuses, 19 states, and our current number of medical students is 20,822 with 3,163 seats.
As you know, these numbers are even more significant when we look at their impact on our revenue, profitability, and cash generation. We have shown a steady growth in our net revenue, with our gross margin reaching 64.8% in the first quarter of 2023, and the net revenue almost achieved what we have delivered in the full year of 2019. If we only look at pure medicine undergrad courses, this gross margin jumps to more than 70%. Another positive and distinguishing aspect of our business is that the demand for medical studies is highly sustainable and resilient to economic downturns. This can be attributed for three main reasons. The first reason is that pursuing a career as a physician is highly profitable in our country. Physician careers offer significantly higher salaries compared to other occupations.
In Brazil, to be part of the top 1% income bracket, you need to earn BRL 180,000 per year. A physician earns, on average, two times this amount and significantly more than other careers. Add to this an impressive employment rate of 97%. Even though there is a significant investment to study medicine at a private school, the payback is usually achieved within an average of four years after graduation. The appeal and recognition of the medical profession are also closely tied to the increasing demand for medical services. While Brazil is not poorly ranked in terms of the physician-to-population ratio, there is still a disparity between Brazil and OECD countries. This disparity is even higher due to the uneven distribution of physicians across regions in Brazil, leading to a shortage of doctors in many parts of the country.
For example, in major cities of the southeast region, the physician-to-population ratio is two to three times higher than OECD average. However, in cities located in remote regions, approximately 90% of them have less than one doctor per 1,000 inhabitants. This disparity is even more clear when we consider these additional two factors. First one, the rapid aging of the population in Brazil, which consequently leads to a greater number of medical incidents. As you can see in this chart, Brazil is doubling the elderly population from 7% to 14% by 2033, faster than any other country in recent history. Second, the increasing population with access to private health insurance plans results in a higher demand for treatment and consequently, more demand for healthcare professionals.
On the other hand, despite the fact that the number of private medical seats has more than tripled since 2010, demand for undergrad medical education is still far from being met. The current federal law, known as Mais Médicos, more doctors, implemented in 2013, is quite strict and aims to address the issue of expanding medical education in regions with limited access to healthcare services for the population. In addition to this, there is a significant concern regarding the quality of the medical education. In both of these aspects, Afya stands out. As we have seen, we have a nationwide presence and our education programs meet the highest standards of excellence. This is what we will explore further now. What are the main differentials of Afya's teaching model? The first major differentiation is a nationwide integration and standardization of the curriculum across all Afya's medical facilities.
Let's take a deeper look at this.
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That's a huge differential. With the excellence of Afya's curriculum running nationwide, we can guarantee the quality and the required preparation for physician from north to south in our country. What does this standardization mean? Integrated and modular curriculum, i ntense immersion in medical practice, i ncorporation of the most modern TICs, m edical internship with exclusive model, and integration between extension, research, teaching, and innovation. What is the result of all this? When we conducted the progress test to assess the learning outcomes of students in the Afya curriculum compared to the other students following the original curriculum, it became clear that our students perform much better, particularly in the first and eighth semesters.
When you look at the ninth and 12th semesters, where we still have more than 50% of our programs still maturing in the new curriculum or running the original curriculum before the acquisition, the result is flat and even below the newer cohort of students that started in the beginning of Afya's curriculum. A strong improvement just five years after the first new curriculum was implemented. This academic excellence is shown on Afya's evaluation results. 90% of our medical programs have four or five as a score, and the average jumping from 3.9 in 2019 to 4.2 in 2022. These excellent results make our universities an extraordinary place of learning and pride for our students.
Even taking into account the significant growth of medical costs on offer, the differentials established by Afya have resulted 100% occupancy rate with an increasing demand for our facilities and a higher ratio of candidates per seat. In 2023, we reached seven candidates per seat, highest score since the beginning of Afya. As a result, our average ticket price, which already surpasses the national average, remains resilient and continues to grow slightly above inflation. These three pillars give us the confidence that undergrad, our growth engine, has the necessary power to achieve our projections to grow 2x 2 times by 2028. Now introducing our next section, continuing education, the primary focus and concern for medical students on the following day after graduation. As mentioned earlier, upon graduating as a physician, you already joined the top 1% income bracketed in Brazil.
However, even after six years of higher education, medical professionals are the ones who most need to pursue ongoing education and invest in continuous improvement to stay updated and ahead in the competitive market. This becomes clear when you observe that 74.5% of physicians believe that their current remuneration is unfair considering the time and dedication required. To bridge this gap, it is necessary to have a differential, something that helps to build value for their career. Working in a specialized field plays a fundamental role in this strategy. A specialist physician earns on average 39% more than a generalist and has a more predictable daily routine. The significance of this becomes clear when you observe that 96.5% of generalist physicians express a desire to specialize. Until recently, the traditional route to attain this differential was by pursuing a medical residency.
The problem is that a residency in Brazil is very difficult to be accepted. Currently, there are many more medical graduates than available residency positions, and this gap continues to widen. Every year, thousands of physicians are left without a resident position. As a result, by 2024, there will be more generalist physicians than specialists. Afya's continuing education programs serve to address the shortage of residency programs in the country and also as an alternative path to the physician career, where they can combine their daily routine with their specialization. To practice a medical specialty, a physician does not necessarily need to complete a residency program. What they do need is the knowledge and practical skills required for that specific field.
We provide knowledge through the supervision of highly skilled physicians who guide and share their experience with the students on a day-to-day basis, promoting the students' integration in the job market. For example, Anna does a dermatology specialization at Afya, and after two years of post-graduation, will have accumulated 237 hours of outpatient practice, dedicated 84 hours specifically to cosmetic dermatology, and had the opportunity to attend to 192 real patients. This differential is evident through the recognition from our students, as reflected in our NPS that has increased from -4 when we acquired the graduate platform to 70 in three years. Our referral program has experienced a significant jump from 5% to 45% in the same period. All these factors contribute to the growth of continuing education. Currently, we have partnerships with the most important medical societies and have 15 facilities spread across Brazil.
We offer over 70 courses and provide over 3,000 free monthly healthcare services, enhancing the practices of our more than 4,000 physicians studying with us. The results we are achieving reinforce our vision that expanding of continuing education is a wise and profitable move. You can see that our main specialization courses contribute to our strong profitability and operate with the same level of contribution margin of our undergrad medical programs. In the first quarter of this year, we increased our gross margin by more than 10 percentage points after jumping almost 18 percentage points in 2022. Beside the margin improvement, we also experienced a jump on our top line after opening 10 new graduate campuses and launching 50 new graduate courses. With this extremely promising outlook, we are optimistic about achieving four times our 2022 net revenue by 2028.
Now is the time to talk about a business sector that has the potential to surpass linear growth. It has the capacity to transcend our physical limitations and scale for exponential growth. I would like to invite Lélio de Souza, our VP of digital services, to the stage.
Thank you very much, Virgílio. We are all aware that the process of digitization represents an irreversible trajectory. It is a pathway that any company aspiring to be a pioneer must consistently traverse. However, mere digital existence is vastly different from being relevant. In the digital realm, there is a fierce competition for attention, rendering any sector incredibly competitive. In Afya digital services business unit, we are native digital, servicing physicians in our ecosystem with best-in-class digital solution to support them along their professional journey, and they are highly committed to support our B2B customer in their own digitization process to build a relationship and engagement with physicians being relevant to them through Afya digital ecosystem. It is a privilege to work in this space, always pursuing value creation to physicians and positively impacting the whole health value chain.
To achieve this, we are constantly refining and delivering increasingly superior solutions. This movement engages more physicians to our ecosystem, where they can consume an increasing amount of relevant medical content, use our bedside decision-making digital tool, and better management their practice in patient consultation at their offices through our practice management platform, encompassing EMR, electronic medical record, telemedicine, e-prescription, and financial handling.
The combination of all these factors yields a highly valuable outcome in today's landscape, an increased amount of medical practice data. Data and qualified and engaged audience of physicians in our solutions are crucial assets in the evolution of solutions for healthcare professionals, assisting them in staying updated, enhance their skills, and becoming more assertive and productive in their medical practice. More important, adopting a data-driven approach as we do, we are tirelessly looking for ways to value physician time, offering them content and solution when they need them and the way they want them.
Moreover, these assets play a significant role in our relationship with the healthcare industry, where we are also expanding and solidifying our offerings. This promotes a meaningful and valuable relationship for physicians and a more efficient partnership for the industry. Reinforcing that, we are always committed to foster relationship and engagement between health industry, meaning pharma, providers and payers and physicians that are relevant and create value to physicians, empowering them in this relationship, and consequently being more efficient to the health industry. From the outset, our focus has been on identifying activities within the medical practice where digital solutions could contribute to physicians being more assertive and productive in their continuous improvement and patient care routines.
Based on this logic, we have defined and have been building six areas of expertise in digital solutions, c ontinuous medical education, clinical decision support, practice management tools, including telemedicine and digital prescription, and physician and patient relationship, mainly in the chronic diseases treatment. For each of these areas in medical practice, we have developed or acquired digital solutions, many of which are already integrated into the daily lives of millions of patients and thousands of physicians. One of our currently main goals is to integrate these solutions in a business-driven approach to create more value to physicians in each phase of their journey. Let's take a closer look at how these solutions effectively participate in the physician's daily routine.
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This is what makes us believe in the growth potential of Afya in digital solutions, creating value for engaged and continuously growing community of physicians. We have already reached 295,000 active physicians in the last quarter, with 218,000 of them being paying customers. Every day, our team works hard to engage more physicians, deliver impactful value for them. Now, let's take a deep dive on our B2B, business- to- business strategy. As the largest and best network of solutions for physicians and medical students, we are also one of the main bridges that connects the medical community to the healthcare industry, facilitating a relationship that is relevant for physicians, efficient for the industry, and creates value and positive impact for the entire healthcare value chain. Our vision of how to generate value for this chain is focused in three key areas.
Access, providing the healthcare industry with access to our ecosystem of physicians, e mpowering physicians in this relationship, always being relevant to them, respecting their time. Consequently, being more efficient for the industry in this access, facilitating relationship in the time and means physicians want it, instead of annoying or being a spam to physicians. Demand, s olutions that facilitate patients' adherence to prescribed treatments, and consequently contribute to the generation of efficient demand for the healthcare industry. And efficiency, d igital solutions and data intelligence that facilitate the management of patient treatment for chronic disease, generating positive impact and efficient for the entire value chain, b etter quality of life for patients, improved monitoring for physicians, more efficient demand for consultations, medications, and procedures, and lower total healthcare cost. All of these areas have great growth potential. When combined, we have a total addressable market of BRL 24.4 billion.
In 2022, we prioritized structuring solutions offerings to provide pharmaceutical industry access to physicians. This year, we are strengthening these solutions and building now so data intelligence ones of interest to the healthcare industry, mainly pharmaceuticals. Our value propositions to the pharmaceutical industry is to assist them in investing physician engagement, always empowering physicians in this relationship and being relevant to them, thereby becoming more efficient for the industry. We act on this value proposition by offering solutions for four major stages in this journey. Medical education, we develop content for the education of physicians on new procedures, practice, and treatments, focusing on talks of interest to the pharmaceutical industry. We ensure the quality and impartiality of the content, distributing it in a relevant manner to physicians who have an interest in this subject.
Marketing, o ur high capacity of segmentation allows the pharma industry to deliver the right message on the right format at the right channels. E-detailing, p hysicians can easily opt in and subscribe to receive free samples of medications at their homes or medical offices without any hassle. Insights, t hrough extensive data analysis, we provide the pharmaceutical industry with valuable insights into prescription behavior and decision support research, enabling them to make better-informed decisions, always protecting physicians' unit data. As a result, we currently have over 100 contracts with more than 50 pharmaceutical companies. To demonstrate how we are contributing innovatively to the relationship between pharmaceutical industry and our ecosystem of physicians, I would like to invite an executive from a leading global company that has been driving innovation and setting trends in this segment.
Mr. Eduardo Miyake from Pfizer, it's great pleasure to have you here today to share your experience with us. Thank you for coming.
Thanks for considering me in this amazing, very interesting conversation.
Nice. Could you share with us what are the advantages you see in Afya as a partner, and how we are contributing to Pfizer's digitization process?
Great question, Lélio. I think that I would like to start with one experience that I had in the beginning of our relationship, where some executives from Afya shared some numbers that called my attention. The first one was related to the number of digital solutions that Afya has. For example, 23 digital solutions are very important, very interesting. Another number that called my attention was related to the number of doctors that has access to medical or to the solution from Afya. It is one in considered to four. Considering this, I think that this is the big picture that I have, when we talk about excellence, when we talk about how we can deliver value to the doctor. This is the first one.
Additionally, I think that considering this scenario, when we started our relationship, something that called my attention was more related to the partnership that we created in the beginning between the two companies. In this scenario, Afya started with us with one single contract, one single solution where we worked together. However, during these advances, unfortunately, in the beginning, I think that we had lot of learnings. Basing on these learnings, something that changed our relationship was some chances that Afya and with us, we took in the beginning. That was a clear communication, first of all. The second one, a single goal that we can have focus together. The third one, working together weekly by weekly, on a week basis, having, for example, some interesting results.
After this change, I think that the relationship and with the excellence that Afya has, we took a lot of great interesting results.
Thank you very much. Glad to hear that. Actually, Pfizer, as one of our first customers, was kind of patient in building this relationship. We learned a lot, and we keep learning with Pfizer and enhancing our services to provide you the best we have. The largest ecosystem is really one of our strengths, and building this relationship that brings value to the physician, it is what we are pursuing on a daily basis. Thank you very much.
Excellent.
Another interesting question to share here. Has Pfizer developed any sort of similar partnership with other companies? If so, what are the differentiators you guys are seeing in the relationship we are building together?
Excellent. I think, Lélio, as I know, this is the first relationship that we established with one company that was very, very interesting and made the total difference related to our results, but more than this, related to the impact that we can generate to the doctors, for example, to the journey that the doctor has. Consider this, I think that this is the main point that we can establish, that is, after this initial relationship or this partnership, we saw evolution from one contract, as I mentioned before, up to more than 10 contracts. More than contract, I think that relationship is more related to the business or the main goals. We have one purpose from Pfizer. We would like to have innovations that can support or generate more quality of life to the patients or to the people.
Based on this, I think that Afya can generate this value in this excellence of this partnership. For example, having these learnings and failures, understand based on our retrospective what we can do differently together. Also from our side, from Pfizer, for example, what we can do internally in order to optimize our relationship more than this, the day-by-day activities, for example.
Perfect. It has been our strategy with Pfizer and other customers. We call it a land and expand. Building long relationships, we first have to prove our value to the industry, to Pfizer and others, and then we can grow, generating value for both sides. Glad to hear that. What are the opportunities of enhancements, of improvements should us, Afya, working on to better service this company like Pfizer?
Okay. I think that the point that I shared before related to this partnership was interesting. However, during this journey, 1% per day, I think that we evolve our relationship. Today, if you ask me, as you asked before, what is the things that we can enhance related to the partnership or what Afya can enhance, for example, I don't have one answer right now. However, I think that this mindset of 1% per day changes our relationship and the results and the impact that we are looking for. Probably something that I can share here, Afya, now today is a big company. I think a very interesting company with interesting position in the market. However, I think that it's very important to not forget the startup mindset. Trying to do things as a startup.
Even Afya has more than, I don't know, 10 companies inside with different type of solutions. Having this type of mindset, let me try to understand the customer. Let me try to understand how can I deliver value to the customer. I think that this is the best thing.
Thank you very much for this clear feedback. It is really a challenge that we have inside to attend all the industry expectation. It is a good problem to have, but we need to evolve fast to catch up with the industry expectations. Well, considering that customer centricity, it is a hot topic in most of C-level agenda, in global companies and probably in Pfizer as well. How does Pfizer see the intimacy Afya has with physicians, with the final customers as a contributor to this kind of strategy?
Yeah. Great. As Pfizer, we started to create a different type of advisory board where we started even more than share our experience or our thoughts to the doctors. We try to listen to doctors, understand what is the best way that they consume content, for example, materials, or they prefer digital media, or they prefer, for example, something is more physical. So we try to understand this opportunity with the doctor, for example. Inside our journey inside Pfizer with the doctor, I think that Afya enter here in order to provide material excellence with content more than this different type of solution during the journey that the doctor has during their life in their profession, for example.
Makes a lot of sense. Glad to hear that. It is really our commitment to protect, to be meaningful, to be relevant to physicians, and I think one of the key success factors of this relationship is that Pfizer trusted us since the beginning as the mean to communicate with physicians in a meaningful way to physicians, empowering them in this process. Very interesting. Finally, how can us keep growing this partnership and participating as an important partner of Pfizer's in the marketing investments to connect with physicians?
Oh, good question. Good question, Lélio. I think that the best thing is to, as I mentioned before, and I think that concluding this conversation, is to maintain this relationship as we are doing right now, for example. So having this startup mindset, trying to look in for the evolution of our business, understand our strategy, and try to connect the solutions or the things that are very good from Afya to the strategies that we have here in Pfizer. So connecting these two dots, for example, we will have a very interesting journey with us.
Great to hear that. Thank you very much for giving us the opportunity to work with you and count on us. We want to build a long relationship with Pfizer and succeed together. Thank you very much for coming and sharing your valuable ideas with us.
Thanks for this opportunity, Lélio.
Bye-bye.
Bye-bye. See you.
This type of testimony leaves us very proud and confident in the path we are treading. Thanks to all our pharma customers for the trust and the partnership in delivering this innovative way to access physicians, committed in creating value and empowering them in this process. As a result, we present an expectation of continuous revenue growth for the fifth consecutive year in our digital services business unit. To have a better perspective for the coming years in the digital field, it's important to have more consolidated markets as references. When we look at the current results of the Japanese company, M3, founded in 2000, and the American company, Doximity, founded in 2010, it becomes clear that we are only at the beginning of this journey. We are already very pleased with our performance in the digital realm.
But I'm confident that by pursuing our plan, we will have incredible news to share with you in our upcoming meetings. Now, it's the time to talk about our ESG efforts and results. I'd like to invite Renata Couto, our IR Director, to the stage.
Good morning, everyone. Thank you for joining us today at Afya Day 2023. My name is Renata Couto, and I'm here to talk about ESG, a crucial issue for Afya and the future of our planet. Education, health, and technology are ingrained in our DNA, making it natural for Afya to approach its ESG journey with absolute seriousness. Since its inception, Afya has contributed to social and economic development through initiatives that stimulate progress and improve quality of life for society. Our activities have had a genuine impact. Proof of this can be seen through the numerous awards we have won, such as Great Place to Work, Bloomberg Gender-Equality Index 2022, TOP 100 Open Corps 2022, and Women on Board certification 2021. This commitment is reflected by impressive numbers. Today, I can reveal firsthand some highlights from our 2022 annual sustainability report.
You can download the full version through the QR code displayed on your screen. On the environment front, we have reduced scope two emissions by 63%. We have increased our use of solar energy and impact approximately 5,440 people with our environmental education and awareness initiatives. On the social front, we have collected and donated over 3 tons of food. We have implemented social responsibility initiatives that have positively impacted nearly 8,000 people, and we take pride in having a significant number of female employees and a high percentage of women in leadership positions within our company. As for governance, we have a diversified board that is well advised by our audit committee and our people and ESG committee.
Consistent with our vision of transforming health together with those who have medicine as a vocation, we have brought close to our management doctors who are a reference in their activities they carry out. At the end of 2022, we launched our Physician Advisory Committee, formed by four renowned professionals in the medical field and led by the company CEO. This forum sets out to face an enormous challenge, thinking about the medicine of the future. In the healthcare front, which holds significant social impact and is deeply ingrained in our DNA, we have made more than 470,000 free medical consultations and made a positive impact on the lives of more than 14,000 people through our health and disease prevention initiatives in 2022. Since our inception, we have graduated more than 18,000 physicians.
These numbers bring us immense joy and in alignment with our company's purpose, they genuinely embody our core values. But in addition to celebrating our results, I would like to show you how this works in practice and the scope of the impact we promote. One of these ways is through technology.
[Presentation]
You have just witnessed the potential of our digital solutions, which provide assertiveness and productivity to medical students and physicians. Making a positive impact on people means being present for physicians, precisely when and how they require our support. And with the power of our digital solutions, we will extend our reach even further. But technology is far from replacing medical history and the doctor-patient relationship. At Afya's educational facilities across the country, our medical students, professors, and physicians actively engage with local communities. In 2022 alone, we provided nearly half a million free healthcare services. And today, we are excited to provide you with an insight into the services, with particular emphasis on a segment of society that is often overlooked: indigenous communities.
Isn't it incredible? That's right. Between the second semester of 2022 and March of this year, Afya provided more than 45,000 free healthcare services, specifically for indigenous communities. Many thanks to everyone who took part in this section. I now kindly invite you to start our Q&A session. Before we start, I would like to mention that our presentation is already available in our investor relations website. We are going to start our Q&A session. If you want to ask a question, just click on the option "Ask a question". We will start with our sell-side analysts. Lucas Nagano from Morgan Stanley is the first question. Hi, Nagano.
Good morning. Can you hear me?
Yes.
Great. Good morning. Thanks for the opportunity here, and congratulations on the presentation. We have two questions. The first one is related to the medicine regulatory framework. The Ministry of Education should announce a new round of Mais Médicos in the next month or so. Do you have any expectations on the potential format or what has been mostly discussed between the sector and the regulators? Could you also share some thoughts on the outlook on the resolution of the Supreme Court debate? My second question is related to the B2B. We know that there is a large addressable market, and you are pretty advanced in terms of product development but y ou mentioned that there is some work to do in terms of monetization and pricing. What are the initiatives taking place in order to accelerate and unlock this potential revenue?
Thank you.
Thanks.
First question, Virgílio.
Okay, Lucas, thank you. Thank you for your question. I will take the first one here, and Lélio can help me with the second. Regarding the Mais Médicos new rule that was released four months ago, we expect to have the final version by beginning of August. What we expect is that they will follow at least the same procedure, the same process that was in the Mais Médicos one and Mais Médicos two. In terms of size, we expect that can be something between both of them, between the Mais Médicos one, that was around 4,000- 5,000 additional seats, and the second one was 1,400 seats. This is at least our expectation here about the Mais Médicos three, what comes up in the beginning of August.
About the Supreme Court, they are in a recess in the month of July, and we expect. So everything that we are seeing from the Ministry of Education, all the interaction that we are having is that they are very concerned and keep the dynamic that we still need to open more seats or to open new additional medical schools in the region that we have scarcity and lack of health services. So this is one thing. Another thing that can be is how will be the regulation, the process to keep asking for additional seats in the country. But this is too early. We will have to wait what is going to come up on the beginning of August, okay? Thank you. On the B2B, Lélio.
Yes. Thank you for the question, Lucas. We are growing fast in the B2B side, mainly in the pharmaceutical right now, where we put focus in this last year. On the pricing side, we see an opportunity here to set the correct pricing approach based on the value we are delivering. So we are working right now with a global specialized consulting company supporting us in defining this pricing approach. We have good global references like M3 and Doximity. That is the global pharmaceuticals are used to work with as well. So we had a good reference here and we work on this and develop new products based on what we have been learning this first year of operation and on the data that we are building on the B2B, business to physician side.
Lélio, if I may add something on that. Nagano, all the monetization that we got from the B2B, is based by campaigns to pharmaceutical industry. Right now, we just launched a new product that is RX Insights. That will be the first product that will be recurring revenues for us. We are very excited to transform that campaigns that we are monetizing within the pharmaceutical industry and r ight now establish the first recurring product for the pharmaceutical industry that we are very excited to start this relationships with all the industries.
Very nice. Just to put some more color in this new subscription product that we are delivering right now to the pharmaceutical industry. It's a statistical analysis real time of prescription behavior. It means a lot to the pharmaceutical, so they can follow in real- time base what is happening in the market regarding prescription behavior and tie this with their initiatives of engaging physicians. Now we have all the content and marketing distribution from pharmaceutical to physicians in a meaningful way, to physicians. The result of this is the prescription behavior. We are bringing this in a real-time report to the pharmaceutical. It means a lot to them. It's one of our major pricing driver to connect with physician, being relevant to physicians. So that one is a unique driver value creation and a driver for our pricing model.
Yeah, great. Thank you, Nagano.
Thank you. Very clear, very helpful.
For our next question, we'll have Maurício Cepeda from Credit Suisse. Hi, Maurício.
Hi, guys. Thanks for the opportunity of asking questions. I have two questions from our side here. The first one is about the preparatory courses. I understand this is a significant part of the economics of the digital BU. My question would be, if with all this replanning of a new strategy and rebranding, if you aim to position yourselves differently in this kind of activity, given all the competitive pressures that this part of the business have been suffering or if you want to prioritize other digital business instead of it. My second question is a little bit about the future of the career of medicine. You mentioned this a little bit during the presentation. Now that we know that the active physician base in Brazil is growing significantly and faster than it grew in the past.
If in your view it would compromise, in a certain point, the economic return of the profession, and if all these regional imbalances that we see currently in the medical profession, rather than being solved by positioning schools in remote regions. If you see that there will be any kind of government incentive to economically incentivize the doctors to shift the geographies instead of establishing the colleges in place. These would be my two questions. Thank you.
Thank you. First question, Lélio.
Hello, Maurício. Thank you for your question. The first question regarding the residence preparatory offering, we combined it with the other two acquisitions we made last year. Além da Medicina with mentoring for residence preparation and CardioPapers. As you mentioned, the residence preparation, we have a very competitive market, but we are doing good in our restructuring. 49% of our students could achieve a position in a residence in Brazil. We are improving our value delivery to our students with a blended combination of mentoring from Além da Medicina and the residence preparation from Medcel. In the specialization side, we combined it also what we had in Medcel with CardioPapers. Just to give you some numbers, 60% of our approved physicians in the endocrinology, which is a new community that we built. They were our students in endocrinology papers.
We are extending the experience of cardiology to another five specializations, c apturing the space we have in this market, not so competitive as the residence preparation is. We see opportunities here. We are putting focus here and combining the acquisitions we made to better deliver value to our students in the market.
Maurício, taking the second part of your question about incentives, how we can drive more physicians to the remote areas. I think the answer is no. The incentives today is already in place. Physicians, they have a strong incentive in terms of salary, to go to remote areas, to suburb areas, not in terms of salary if they are working in the public sector, but even in the private sector, we have this experience. Our physicians, they make much more money on this region, these small cities. On the other hand, if they do not have the right infrastructure, if they don't have support by a specialist in the region, they will not stay on there. They do not want to lose lives. We need to have, besides all the incentives that's been building, the right infrastructure.
We have to have good hospital beds, good primary care for the population. Otherwise, you can put any kind of incentives, but the guy will not go to the battle alone. We need specialists, we need infrastructure, we need money. Mais Médicos, I think, helps to get all the efforts, not only in terms of infrastructure, but also driving more specialists to these regions in order to support not only the interiorization, but also to help these guys to keep improving and specializing on the remote areas.
Yeah. If I may add, Virgílio, I think that is important point here on Cepeda, that to have economic incentives for these professionals to go to the countryside in the interior of Brazil, it is important for a short-term solution. But for a long-term, you need education, you need nice hospitals with the right infrastructure. Otherwise, for the longer term, the problem is not going to be solved. It is something that can be a mixed up, right? A solution that can bring not only a better distribution of physicians, but a better health for society.
And about the physician base that is expanding faster, if it interferes in the economics of the profession.
Yeah. Well, we show the dynamic on my part of the presentation here. We are seeing that, well, not only the healthcare treatment demand, many people are entering more health insurance plans and also having more events for health treatment during the year. So demand for physicians is keeping going exponentially. So we are still seeing a very positive dynamic in the middle and the long term, without any disruption in terms of demand and supply. So this year, we just have the highest score in terms of candidates proceeding in Afya, so it is seven candidates. So it is the biggest in our last five years here in our operation. So we are not seeing any disruption in terms of demand and supply for the next years. Okay.
Great. Thank you.
If I can add some figure here. Just giving you a spoiler, Maurício . As we are seeing high demand from providers in all of the country, we are building a new solution right now, which is physician recruitment. Providing both sides value, delivering value for both sides, hospitals and providers who needs to hire physicians, and physicians in our ecosystem that are looking for new job opportunities. It somehow reinforce there is demand for physician. It is not so easy to find the right physicians providers want.
Thanks, Cepeda.
Great. Thank you, Maurício.
Thank you.
Before we jump for the next question, I have a question from Carolina, from MFS. Could you comment on the integration of the acquisitions? When are we going to see the synergies on the company results? Blanco, can you take this one?
Yes. Thank you, Carolina. Let me address that in two different segments. Regarding the undergrad, we have a proven playbook. As I showed in my presentations, every time we acquire a new school, a new medical school, we pass it through a playbook that access the right leverage to increase the results. We access the scholarships, the discounts, and streamline them. We revise all non-health courses. We revise all costs and expenses. We integrate the institutions to our shared service. We put our national curriculum to the new intake of the students. This proven playbook, we can increase the results of the institutions of it. We can increase revenues and decrease costs and expenses, even further, as I showed it in my part of presentations, as I showed the case of Unigranrio, one of our latest and largest acquisitions. This is the part of the undergrad.
Regarding the digital, it's a different playbook that we are building through it. We had to build our digital segment. We had 11 business combinations, in a window that was more or less of two years from the first one that was IPEMED to the last one that was iClinic. The playbook, it's a different one. It's a business that we are building a complete ecosystem, a new hub for the physicians, and we put the integrations through each one of the values, through each one of the pillars that we have on our mandala on the six pillar strategy. Giving an example, under the pillar three, we integrated Medicinae within iClinic. Under the pillar one, we integrated, as Lélio mentions, the Medcel with the CardioPapers and Além da Medicina's team. We're doing that by pillar.
Right now we are moving ahead, and right now we are connecting every, these pillars into a single ecosystem that we can provide for the physician. It's different playbooks, and we are pretty confident that we'll have the success that we had on the undergrad on this digital strategy.
If I may add here, we are always adopting a value creation to physician approach. When we combine products in pillar one, the medical education is to better serve our physician. In pillar three, in iClinic, now we have a content channel, we call it Medicina em Pauta, which is Portal PEBMED content delivered through iClinic. It has value to physician, and having physicians more engaged, a qualifier audience is a lever for us in the B2B side. It has been done since the acquisitions, starting work with us. Very driven by business sense.
Yeah. To give some more color, Carolina, in terms of the undergrad, it is important to mention that mostly of its value, we can capture in one year after the acquisition. Unigranrio that we acquired in 2021, it is already integrated, and UNIT that we acquired in January, probably will be integrated until January next year, and you can see the improving margins.
Until November.
Oh, November. Okay. Good news. Okay, I hope that is clear. Our next question will come from Yan Cesquim from BTG.
Good morning, guys. Two questions on our side here. The first one is regarding the inorganic pipeline of medicine courses. You shared with us that you have a guideline of pursuing around 200 seats per year, and you just consolidated units and fits. I just wonder, how are the ongoing negotiations, if you believe there are any other moves happening in the short term? What is your thermometer for this inorganic expansion pipeline? The second question is also a follow-up, is if you consider a capital raise to help financing all the organic and inorganic expansion plans you shared with us in all the business units. That's it, guys.
Okay. Thank you. Luis, can you help us?
Yes, of course. Thank you for your question. The first one regarding the pipeline, we have a fertile pipeline, for that we are pretty confident that we can deliver the guidance of 200 seats per year inorganic growth. It's not a linear one. You know that this kind of negotiations always took time. We go two step ahead, one step back, but we're pretty clear that we're going to achieve this one. When we give this guidance, it was from 2022. Ahead, we had already to now 340. If we took in a linear term, right now we are ahead of this guidance, and we are pretty confident that we're going to achieve that. The good news that we're seeing that even the amount invested in each one of these business combinations is decreasing right now.
We see that it's more a market that we have a pricing power right now for new transactions that, of course, will increase the returns that we expect in each one of these future business combinations. This take the first part of your questions. Regarding how we can fund it, we don't expect any kind of capital raise. We want to do that within our own leverage. As I mentioned in my part of the presentations, we have more than 90% cash flow conversions through our EBITDA, through our operational cash flow. Taking the CapEx, taking the interest payments of deeds, that's the free cash flow resulting from that, gives us confidence that we can do these new business combinations within our own capital structures right now and do that with our leverage to the market.
Yeah. Thank you.
Thank you.
Thank you.
Yeah. Before going to the next question, I think that's important to mention, Virgílio mentioned earlier, that the prices, when you consider inflation, is even lower than we ought we saw in some years ago, right?
Yes. This is the case, even the case of UNIT. If we compare the two latest acquisitions that we've, business combinations that we made, that was Unigranrio that was closed in August 2021, and UNIT that was closed here in January 2023. If we put the one metric that we don't like a lot-
Yeah.
That's EV per seat. But if we do that, the adjustment by the inflation, the period, you're going to see that's pretty much the same value. We always look at the EV per EBITDA for each one. As I mentioned in the Unigranrio case, we are pretty satisfied with the return that we are extracting for each one of these business combinations.
Okay, great. Our next question will come from Fred Mendes from Bank of America.
Hear me now?
We are hearing, but not seeing you.
Yeah.
Okay. I am going to go ahead. I think the camera is on. I am going to go ahead and ask the question, if that is okay.
Okay.
Good morning, everyone. I have two here on my end. The first one is also on the B2B for the pharma, on the pharma front. Just which stage of this partnership are we, not partnership, of this, are we already in a stage where we should see some scale and eventually some margin expansion on this front? Now I think the camera is on. And also, as a second point on the digital service, if 2023 is a year where we are going to see a break even on this front or should be another year to focusing on growth that eventually going to have margin under pressure too? Thank you.
Perfect. Thank you, Fred. First question on the B2B side, we are already seeing a very interesting growth. Just remember that we are adopting a land-and-expand strategy, so proving value and kind of educating the marketing in the offering we are working on. Just to give you some numbers here, five of our main customers now have contracts over BRL 1 million, so that is one of the KPIs we are following. And some of them more than 10 contracts. So we are expanding inside those companies in new marketing areas, new products. That is what we are working on and expecting. So as we grow, we will see more contracts inside each of those customer and more customers with more contracts. Right now, we have more than 100 contracts in 50 different pharmaceuticals. Right?
So we will see this path of growth ahead as we are delivering more products as the one I just mentioned. RX Insights. We have another data intelligence product, Whitebook Insights, which are providing insights real time and subscription reports. It is a way to raise the revenue, delivering more value and a way to have more contracts inside those companies, right? Second question, we keep very focused in growth. Both market share, which is important KPI for us physicians, right? Number of physicians and top line. Both the more mature solutions we have are growing more than 40% a year, right? But we are also doing some homework here to capture the efficiencies opportunity we have inside in a way to pursue a better bottom line result as well.
Fred, if I can summarize that the amount of value that we are generating per physician is growing and growing very fast. I think it was the first time that we released the value that we are generating per physician in our ecosystem. As we are plugging more B2B contracts, higher value, longer contracts, we are going to multiply this amount per physician in a quarterly base. This is growing. On the side of synergies, as we are plugging this platform, we also are seeing good opportunities in terms of cost reduction, cost efficiency on the digital side. Reaching the breakeven and improving margin moving forward. That is a kind of summary from that, okay?
Perfect.
Fred, if I may add something here. A point that I mentioned before, but it is very, very important to highlight here that this year it is the year for the pharmaceutical industries that we are moving from a contract campaign base revenue stream. We are implementing new products that we can have subscription product. This will turn us to have a more stable and predictable streamline of revenues that come from the pharmaceutical industries. Lélio mentioned these two products that are amazing, RX Insights and Whitebook Insights, that will transform how we have this revenue relationship with the industry turns to be a contract that it is generating recurring revenue for us. About one point regarding the economic results of the digital segments.
One point that is important for us that brings with this new logo, with these new positions, that in the future that we expected to reduce our CAC, our customer acquisition cost with that, because we going to positions as a unique hub from that. With these positions, one of the expenses that we have most, that is marketing on the digital side. We can reduce that because we expect to reduce our customer acquisition costs regarding that.
Yeah. Thank you, Fred.
Thank you, Renata. Thank you very much.
Thank you, Fred.
Before we move on, I think that is important, sorry, Virgílio, but it is important for Stella to explain to you guys that all the strategy behind the brand, that does not mean an integrated product, right? It means an integrated brand.
Yes. It's about building integrated brands that will become to be the top of mind of everything related to physicians and to medicine. With this, we believe that we'll build a much more higher LTV, reducing our CAC, and facilitating the cross-selling and upselling between products. Each physician has the specific need in each part of their career, and when we show that we are a reference to solve or to be the partner of every need they have along the journey, we'll be able to mix the products and mix the solution regarding the needs specifically they have. We believe with this strategy, we'll be much more relevant and much more easy to understand, and they really count on us as a great partner, great ally in all the journey.
Well done.
Thank you. The next question will come from Marcelo Santos from JP Morgan.
Hi, good morning. Thanks for taking my questions, and congratulations for the event. My first question is regarding continuing education. If you could please comment and contrast this segment to the undergrad. This one segment where you don't have so many regulatory constraints. How confident you are that you'll be able to keep the solid margins you have and that competition won't erode away the profitability in this business? That's the first question. The second question is, I wanted to comment on the candidates per seat that you mentioned. I think it was seven candidates per seat, a record high for Afya. Is there a mixed effect now that maybe you have a unit in Rio de Janeiro, or is this something more broad-based we're seeing, a broad-based increase in the numbers of candidates per seat? Thank you.
Hi, Marcelo. Thanks for your question. I will start from the last one here. These increases across the board. We saw a better demand and a higher ratio in all units. Of course, in some regions, like in Rio de Janeiro, have a much higher candidate per seat. As we work together with an integrated brand, it is much easier for us to guarantee 100% of occupancy, moving the candidates from one seat to another or from campus to another, and guarantee 100% of our seats fulfilled every semester. The first question about the continuing education. First, we are seeing that the demand dynamics looking for specialization, it is booming. The volume of new physician being graduated every year is growing, and it is growing exponentially. Remember that we had around 10,000 seats back in 2012. Now, it is more than 40,000.
Still maturing, and the number of physician being graduated every year is much higher. Keeping the same number volume, at least in terms of attractive resident seats for the entire market. They are looking alternative paths, so the first choice will be, "Well, I need my continuing education. I need to look for some specialization and get the skill to improve my income and keep working in the market." We are seeing a very good trend. That is the reason why we used the pandemic times to triple the number of campus offering graduate programs. Remember that we only had five campuses back in 2020. Now we are offering our programs in 15, located in the capitals and in the most important cities in Brazil and a lso analyzing more alternatives to keep opening and have the first move on this market and keep growing with higher margins.
A very attractive market for us here in Afya. Okay.
Perfect. Thank you very much.
Thank you.
Thank you, Marcelo.
Does that mean that the continuing education brand, IPEMED, will no longer exist?
We'll do the transition from IPEMED to Afya Medical School in English and Educação Médica in Portu guese. Under this brand, we will aggregate all the brands or the services and the products that build the continuing education. Not only IPEMED, but also Além da Medicina, CardioPapers is part of this too. With this, we believe that we'll be also a single point of contact in education from hard skills to soft skills, from post-graduation to marketing or finance skills. Becoming a real partner also in the continuing education part and also in the authorization, because we will upgrade the Portal IPEMED that we have today to become the largest authorization place that in each part of the career, you can customize your profile there, and then you can have all the information you want for the specific subject that you have.
With this, we will migrate from IPEMED to Afya Medical School, then we embrace everything.
Great.
There's a huge opportunity here for us to reduce the CAC. Imagine that Whitebook that has around 300,000 physicians, most of them are potential candidates to keep studying, use a continuing education solution, a continuing education program in Afya. So Whitebook is becoming Afya Whitebook. Now everyone knows that it's part of the same group. This will be much easier in reducing the CAC and the capacity to attract new students for all products in our ecosystem.
Yes. And this cross that we bring from brands like Whitebook for Afya and the opposite also, it became very credible because we don't start Afya to the physicians from zero. When we say that Whitebook is Afya, iClinic is Afya, CardioPapers, Afya, 30 units of undergrad is Afya, it brings a lot of credibility. So a lot of physicians don't know yet Afya exists, but they know very well this product. So we'll start not from zero but far from this when we put the brands together.
Our next question will come from Lucca Marquezini from Itaú. Hi, Lucca.
Hey, good morning, everyone, and thank you for taking our question. Our question is regarding the digital services segment. The company has added several services through acquisitions in the last years. Looking forward, is there any type of services that the company believes that still needs to be added to the portfolio? What should be the timeline of this expansion? Thank you.
Thank you for the question. Right now, we see our portfolio of six pillar solutions completed. We are always aware of what is happening in the market and looking for opportunities, but we don't have any target or any need right now to pursue it. We are also working partnerships. We already brought one content creators to our ecosystem as partner. We believe also in bringing partners to ecosystems is a way to enrich what we are offering to physicians. Right now, we are working on a leverage to lever what we already acquired and combine those acquisitions in a very business sense approach.
If I can add something on that, Lélio. The point is that on the B2B, we have all the pillars completed by at least one solution. The gaps that we see on those service, we do business plans and do a business development under that. The largest case on that is the prescription that we've developed internally, and it's generating new flows on that. We have it, the six pillars, mostly covered, and we do this business development insights if we see a gap that will increase the number of physicians or increase the engagements of these physicians to our sites. Under the B2B sites, we are the first movers in these markets in Brazil. There is not much, even in small startups, service that are connecting the physicians to these pharmaceutical industry, the payers and the providers.
Under that, right now it's a pure development that we are doing our MVPs. We did that in the first 2022 with the pharmaceutical industry, and then we started campaigns and developed the recurring products right now. For 2023, we're doing that, as Lélio mentioned, for the providers with these recruitment solutions that is under MVP right now in the second semester.
If we see any opportunity to fasten the pace of increasing the market share of the data volume, we may consider. But right now we are not targeting any new asset to complete the portfolio.
That's very clear. Thank you, Lélio and Blanco.
Thank you, Lucca.
Thank you, Lucca. Okay, guys. Thank you for all the questions. I will now pass the floor to Virgílio , our CEO, for the final remarks.
We are approaching the end of this Afya day, and I would like to leave five important messages. First, Afya today became a single and integrated hub of education digital service for the physician journey, with a unique national brand that creates strong differentiators to our products and services. Second, after four years of our IPO and considering the positive trend of the year, we are confident to deliver the 2023 guidance, what represents a growth of approximately four times since our IPO. We will continue to play a highly predictable business model with a strong growth, high profitability and cash generation. Third, given the execution plan of each segment, we expect another round of strong growth ahead. By 2028, we expect to approximately triple Afya's 2022 results across our lines.
Fourth, digital services will have an important growth role by 2028, with B2B contracts improving exponentially the value generated by each physician on our ecosystem. Last but not least, on the what we stand for section, we understand why our strong social impact and purpose empowers Afya's team to keep up with the strong execution and to boost our new brand launch. I sincerely appreciate your participation and I am thrilled about what is coming. Thank you all.