In Brazil, graduated doctors are automatically allowed to get a medical licence and start practising. After 2002, the number of schools tripled (from 113 to 390), and the number of graduates more than quadrupled (10,000 to 42,000). Regulation and quality assurance of medical education in Brazil did not follow the significant increase and diversity of medical schools. This situation may threaten patient safety and the sustainability of the National Health System (SUS) itself and puts enormous pressure on the quality assurance process of medical education, which urgently needs to be addressed in Brazil. Moving forward requires strong faculty development and collaboration initiatives between government, institutions and Brazilian medical educators.