Not so few medical schools and hospital training programs have closed because of the dramatic decrease in applicants. Only those medical schools, usually the long-established and big ones, can attain its yearly quota of enrollees. This is an indicator that a battle for survival has begun. As often the case, the strongest and the best adapted will survive. In smaller hospitals, junior consultants and “moonlighting” general practitioners go on 24-hour duties because of lack of residents-in-training. And in bigger hospitals, residents’ training year would begin with complete set of residents, only to be depleted by midyear. One by one, they were dropping out of the training program in favor of a better job offer in private clinics, locally or abroad, or even job offers not in the medical field, such as call centers. Others would rather pursue a master’s degree in a different field; others study nursing, after which they leave the country.
So, why not dwell in a career that took almost half a lifetime to build? Why rather be anything but a doctor nowadays?
Work Not Satisfactorily Compensated
First of all, people have this erroneous notion of doctors being overwhelmingly wealthy. Driving around with luxury cars, wearing designer clothes, or globetrotting. This may be true for a handful but, what most people fail (and refuse) to know is that this image of the wealthy medical doctors should be treated obsolete. Most of the few remaining doctors who may be considered rich are those who have either come from wealthy families or have acquired their wealth through long, long years of stable medical practice or through businesses.
So, what about the other doctors? Doctors that have to compete for patients with several thousand others in the cities?
To setup a practice isn’t so easy, as one would think. No doctor could just admit his patients in any hospital. He has to pay for clinic space where he wants to practice and this could amount to anywhere from P300,000-P1,000,000 (in really “high-class” hospitals). Then he has to buy medical equipment necessary for his clinic, which could be from P15,000-P100,000.
So, how can a doctor, with all these expenses, gain back his investments with only a handful of patients per day?
Most people can’t simply imagine how a doctor, with long line of patients waiting outside his clinic, be anything but out of money. What people don’t know is that most of these patients consulted either for free, because being referred by a relative or friend, or with a discount on the professional fee (most of the patients, by the way, do ask for discounts in the professional fees). What is even more troubling is that, because people think doctors are rich, they continually beg for discounts on just about everything, thinking it wouldn’t really hurt the doctor. But the cumulative effect is that it does hurt, especially when everybody else will refuse to pay the amount that is rightfully due for his services rendered. People just fail to consider that the service they’ve been given took several years of study in the hell of medical school and hospital clerkship and internship and specialty training, not to mention the several hundred thousand bucks spent by hardworking parents.
It is sometimes so disappointing and disenchanting to hear some patients haggling doctor’s fees, as if they are in the market buying vegetables and meat, that it almost leaves a bitter taste in the mouth afterwards.
Patients’ Growing Mistrust of Doctors
I’d say this is a direct consequence of ordinary people being bombarded everyday with television and printed news of “bad” doctors and “bad” hospitals, not realizing that most of these stories are either incomplete or biased (after all, journalists aren’t forced to present both sides of the issues).
Several questions run in the minds of patients whenever they consult doctors. Is he competent enough? Can he diagnose my problem? Is he going to overcharge me?
And when the doctor begins probing their schedule of medications, habits, and diet, patients suddenly turn defensive: Is he trying to pin the blame on me? Is he telling me I’m not compliant with my medications? Is he telling me I’m not eating properly? Is he telling me my vices led me to my illness? No, no, no!
And thus, the denial of one’s responsibility for one’s actions ever increases.
As the TV character, Dr. House, succinctly puts it, patients lie. And they lie to cover up details of themselves deemed too intimate or too incriminating. The doctors’ job becomes all the more difficult with this lack of cooperation, stemming from mistrust. It’s like trying to feed a stubborn, obnoxious toddler with his healthy dose of leafy greens for the day: the more you insist, the more they resist. Waiting for the patient to willingly divulge that information (or try beating around the bush for eons) or consent to a diagnostic procedure is just like waiting for the stubborn child to finally open his mouth to take in that spoonful of food. One can understand such behavior in a child, but not in the adult patient.
Another disturbing observation is that patients have developed the attitude that doctors should always be there for them, as needed and as wanted. Patients come to the emergency room to be treated as an emergency case, even if their problem isn’t an emergency at all, and then get mad if left suddenly unattended because a real emergency case arrived and needed the attention of all the doctors and E.R. staff. Patients come at the outpatient clinic during lunchbreak, demanding to be seen immediately. And if asked if they could wait for a while longer because everybody is on a lunch break, they’ll give outbursts that they couldn’t because they don’t have the “time” to wait. And then, they’ll fling obscenities at doctors in the E.R. because they think they aren’t attended to completely enough. When they find out that they’re making a fuss about nothing at all, they would defend their bad behavior by saying they got emotional, angry, and panicky, and they have the right to because they are “patients”. For them, they need not to be civil with doctors because doctors aren’t human beings, with no right to hurt feelings or suffering undue psychological and physical stress. And to top it all off, adding more insult to injury, doctors working for 24-hours (the kind of doctors who most often encounter these ungrateful patients and who suffer most from the above-mentioned assaults) get paid P100 or less per hour.
After all those years of hardwork in medical school, the hundreds and thousands of pesos spent by parents, wishful for the day when they’d be called lucky fathers and mothers of doctors, the two-year long hell of being clerks (glorified term for the lowest form of animal in the hospital) and then interns (glorified term for the second to the lowest form of animal in the hospital) and the months of grueling study for the medical board exam, of which result will dictate the life or death of a budding career, we get paid a measly fee? And then, patients, when feeling slighted,come up threatening to take away our licenses as if they own it?
The doctor-patient relationship’s foundation, like any other professional relationships, is trust. Patients should trust that doctors will, firstly, do no harm (this is what we have sworn when we swore the Hippocratic oath) and will do his best for their greatest benefit. Doctors should be able to trust patients giving them correct information that would be a big factor in the treatment of their disease. But if patients have no trust in their doctors, then what’s the point of the whole doctor-patient relationship?
Why Should Doctors Leave
A recent eyeopener was an article I read in the Philippine Daily Inquirer last January 13. It was written by a young medical doctor who is part of DOH Doctor to the Barrios program and works in underserved areas of the country. She described the fulfillment she gets, being able to help people receive the medical attention that they need. She said that people around her have thought her crazy for not wanting to work abroad. A simple life is all she wants, it seems.
Maybe the life she has is enough for her. For now. But how about later if she decides to raise a family? Would she settle for raising her kids in the province where the nearest hospital could be miles away? Would she settle down in one area or go from barrio to barrio, her family tagging along with her?
There is no doubt that her deed is a noble act and that she renders the country great service. However, nobility do not require selflessness all the time. Noble is he who performs his work well for the sake of working and seeks his rightful fulfillment, be it monetary, in career, family, or spiritual.
But what if he cannot find fulfillment in work here? Where will he go? Obviously, the person in search for fulfillment will go somewhere where his efforts are appreciated and given worth.
The problem is, however, people here in this country expected all doctors to be sacrificial lambs to the great deity called “Patriotism”. But isn’t that behind this “deity” hides the self-righteous people who perpetually ask others to make sacrifices for them? Aren’t these the kind of people who perpetuate a justice based on mendicancy?
As a doctor, I continually ask myself the question: am I receiving my worth? For the duration of my practice, I’ve let myself work and be underpaid for it and still it’s okay. After all, it is “service”. But for how long can I stay this way? How about my parents whom I have to support? How can I support them if other people will expect me not to receive my worth for their sake? So that I could heal them and guide them to living healthy lives and then threaten to take away my right to practice if, in as much I try to defend myself from those who abuse me?
So many are clamoring for patients’ rights, claiming that doctors are out to victimize patients. But have you ever heard of anyone defending the doctors from patients who not only abuse their service, but take away their right to be humans? None. Because not everyone believes that doctors are human beings, too, and they work for survival, just like everybody else.
To my fellow doctors, my message is: Let us leave this place, if we can and while we still can. Let us not let ourselves believe that we shouldn’t receive any less than what we have earnestly worked for. Let us not let them tell us how and why to practice. Let us live for ourselves. By knowing our real worth can we all be of true service to our country. In time, when people have learned that one man do not live for the sake of another man, we could come back. Let us live by this mantra, taken from Ayn Rand’s novel, Atlas Shrugged:
“I swear by my life and my love of it that I will never live for the sake of another man, nor ask another man to live for mine.”
To the people, do not expect us doctors to bleed dry for unthankful, unappreciative fools who think we owe our lives and our licenses to them. Do not expect us to live when you are trying to kill us. Give us the worth of our work and we will live, not for you, but because it is our right as we worked hard for it. When you have learned, we will, no doubt, come back.
But for now, M.D.’s are leaving. We are on strike.
January 27th, 2007 at 12:21
points taken. i guess we cannot blame the doctors for their decision to leave the country - that is their prerogative. but please, please, for those choosing to stay, give at least the minimum for what the patient is due (pls refer to 2 of my posts, Patience Patients and “Grace” Anatomy on Christmas Day)
January 28th, 2007 at 16:37
hi doc. This is benj from the party.
im also a med student. I wanted to talk to you during the party but … I was shy. hehe
February 2nd, 2007 at 3:00
Dr.Tess,
Maraming salamat sa Blog na ito, matagal ko ng gustong isulat ang nasa Blog mo pero walang panahon. Isa lang din ang nasa pag-unawa ko sa sitwasyon bilang Doctor sa Pilipinas. Marami pa akong gustong sabihin pero hindi ipahintulot ng panahon. Hanggang sa muli. Huwag kang mag-atubiling makipag-email sa akin salamat.
Ed
February 2nd, 2007 at 12:38
To Ed: Thanks for visiting my site. I’d like to have some email correspondence with you but you didn’t leave your email add
February 12th, 2007 at 3:39
to each his (or in this case, her) own.
i’ve chosen to stay.
i hope i don’t regret it.
March 22nd, 2007 at 9:48
[...] M.D.s on Strike: Why Doctors Are Leaving And Why They Should Be Leaving - There’s a current brain drain my country: doctors, nurses, teachers, and just almost every type of professional are leaving the country in favor of higher paying jobs overseas. Some countrymen are labelling those who leave as sellouts, as those who don’t have a sense of patriotism. But I disagree. These people care for the country as much as those who stay. But they had to leave so that the country may realize its mistakes [...]
April 6th, 2007 at 7:56
Its really sad that you say this. I was hoping that since you are working at all these hospitals that you would develop a sense of duty to serve our countrymen. I witnessed my dad start out like that too. He had offices in cavite(2 of them), roxas blvd, PGH to name a few. Ill tell you this though…there are more things to life than money. Doctors here make alot of money but many of them go to the academe to teach because its more fulfilling.
April 6th, 2007 at 22:40
to Vic: But what is wrong with money? People have been conditioned to equate money with evil. But we’ve forgotten that money represent the hard work we’ve done. Yes, there are more things to life than money: career satisfaction. It’s never been just a question of money, but rather the appreciation of the hardwork doctors do and the appreciation has been waning.
Did you really read the article? You misunderstood the entire purpose of the article by reading it as just a want for more money.
And as much as I wanted to serve solely my fellowmen, what can I do when I have hungry stomachs to feed? Yes, it is tempting to pursue my ideals. But poverty has taught me to prioritize survival first.
If you are yourself a doctor, you would understand the great inequity in the Philippine Healthcare System today. The Philippine Healthcare System and Status at the time of your dad is VERY MUCH DIFFERENT from what it is now. All of my uncles, who have practiced here in the Philippines and have eventually practiced in the US, and a great number of Filipino doctors nowadays believe so.
April 7th, 2007 at 9:12
actually I am a medical student here in the US. I saw my dad work to establish his practice and eventually he became a great success. He only died fairly recently which is why Im here. It took him 15 years to finally become stable. It would be about the same here minus about 5 years.
The situation in the US is not as good as alot of people think it is. If you are a foreign medical grad its really hard to get residency here. Especially now that there are new medical schools popping up plus US grads coming back from the caribbean. For us local medical students we have to pay our loans back and it will take me about 5-10 years to pay my loans back which small compared to my classmates who went to Ivy League schools.
What Im saying is even here we have to go through some years of being really dirt poor even with our MD’s in hand.
April 7th, 2007 at 13:06
Yes, the hard life started during medical school. I didn’t say that lives of doctors abroad are easier. I never said that. Yes, I know it is hard to get work as a doctor in the US if you’re a foreign graduate because you have to show you’re a lot better than the American graduates. I know that because almost all my uncles and cousins are in the US practicing medicine, though they finished their medical education here in the Philippines. My classmates have gone through the whole USMLE and residency matching procedure and they’ve told me how really hard it is. At the present I am also preparing for my USMLE.
My point is that doctors here are never fully appreciated for the hardwork they are doing. All their efforts of strengthening the healthcare system are ignored. Some even had the gall to say that if we don’t like what we’re earning as doctors, then we should shift to working at call centers or study nursing to go abroad. It is that bad.
It wouldn’t have been that worse if it’s just a problem of money. But it is worse because people expect that we sacrifice our lives and our pursuit for happiness for them, by staying and not going if we can and if we want to, because we OUGHT to, as duty to our country. I believe this should not be so, because I believe every man should work for the pursuit of his ideals and dreams and not because he needs to feed his fellowmen, who’d rather not do anything about their sorry state in life.
That is the thing that I rue. That for my fellowmen to actually say we OUGHT to stay because of our duty to them. The deteriorating healthcare system of our country will not improve with this kind of attitude. I know it is kind of radical to call out to my fellow doctors to leave this country. But it has to be done, because it is the only way now for the country to realize that it has to stand on its two feet and do something about it. Not just argue about it but actually take action as a whole.
April 7th, 2007 at 13:15
[...] Continue Reading This Entry [...]
April 7th, 2007 at 13:42
M.D.’s On Strike (Why Doctors Are Leaving And Why They Should Be Leaving)…
This article is my stand on the current exodus of Filipino doctors, whether be as an overseas doctor or as a nurse. Many have said that this article does not promote a sense of duty for the country. And I believe so. But I find it more important to …
April 7th, 2007 at 16:05
you dont have to call them out to leave…they’re already leaving and its really getting bad. It sucks that you guys have to show that you are superlatively better than us. That was the same warning I got from my mom when I wanted to enter PGH. I dont want to scare you but because good jobs(engineering, software engineering, and yes tech support ie call centers) are being exported to countries like the Philippines and India, more and more people are going into healthcare. Because of this medical school here is getting more and more competitive. The class coming in this year is better than us and we were better(GPA and MCAT) than last years class. The board scores are just gonna go up. I interviewed last year and in ALL my interviews there was somebody from Stanford, Harvard, UC Berkley etc(I didnt go to a famous school by the way) I think last year…im not sure the passing score went up.
It would be a shame for the Philippines to loose a doctor such as yourself. Funny thing…I told my classmates dont be surprised if a Filipino nurse knows more than you because he/she was probably a doctor back home. Hopefully by some miracle we can stop bleeding our good professionals to other countries.
I dont know I just think that persistence and hard work despite the odds can get you out of hopelessly bad situations. I had to do this here and trust me getting into allopathic med school here is very very difficult especially if you got kicked out to live on the streets like I was(this was only 6 years ago). I dont like giving up and I hate loosing which is probably what kept me going.
April 7th, 2007 at 22:47
Yes, I know that it’s getting more competitive as years pass. The passing score for USMLE has been made higher, as of this year. And I’m working against time so that I’d be able to finish the necessary exams before the passing mark would be moved again a notch higher.
I wanted to call them out to leave because the country needs a wakeup call. And even if the number of doctors and the other professionals leaving are increasing every year, people, especially the government, still choose to ignore it. They turn a blind eye to the number of medical schools closing because there are no applicants.
It has to be done so that the country will realize it’s already bleeding dry.
April 8th, 2007 at 7:34
i think the wake up call has already been heard. The sad part is that many Filipinos are so drawn to go abroad that they never think of the “other” stuff that can go wrong. I dont think that doctors leaving would wake the government up either. They have too many problems to work on as it is. This trend has been going on for a long time and it will go on in the future. The only thing that can stop the trend is to make the compensation in the Philippines and abroad equal which is never gonna happen by the way. Living here is too expensive heck alot of my classmates who drive nice cars have their parents support and those who dont have parental support like I do drive crappy cars and live in dingy apartments. Its really the same. However the fact remains…the Philippines is still medically underserved and people still need doctors. Im sure where you practice at there is so much demand for your services and given time I bet you can establish a good practice now that most of your classmates are leaving.
April 9th, 2007 at 18:51
Again, it is not only a problem of money. It is a problem of people’s attitude toward doctors nowadays. Most people seem to think that doctors are out to get them, with all the bad media and wind-up stories of negligence and malpractice. Although some are quite true undeniably, still I see it as rather unfair. We, who have worked hard to achieve whatever we have right now and then only to be controlled by people who think they hold us at the neck?
If it would be a problem of being able to practice as a doctor in the U.S., then doctors could turn to other places where their hardwork would be better appreciated. Again, I do not mean only MONETARY appreciation. Doctors who have been practicing abroad (not just in the U.S.) did undergo difficulties establishing their practices. But the fulfillment was there. In here, it’s almost impossible to establish a practice wherein people appreciate you and what you’re doing. People here only seem to see doctors as money-grabbing professionals.
Yes I am quite aware that there are undersserved areas in this country. But I still urge my fellowmen to leave if they can. Only when the Filipinos have realized the value of their doctors will be the time the doctors will be coming back.
The exodus is unstoppable.
April 17th, 2007 at 23:29
[...] M.D.’s On Strike (Why Doctors Are Leaving and Why They Should Be Leaving) at Prudence and Madness [...]
June 25th, 2007 at 22:37
Philippines News…
Thanks for sharing this post. You can visit http://www.Artikulo.com for the latest Philippines News Headlines!…
June 25th, 2007 at 23:27
Tess,
Yours is another issue that must be addressed, too.
I suggest that you post this also at PinoyMD. It’s nice and an eyeopener. Not bad at all, Tess.
This what made me laugh out loud:
“But for now, M.D.’s are leaving. We are on strike.”
June 26th, 2007 at 0:07
to Dr. Henry: Thanks! Yeah, I posted the link at the PinoyMD mailing list. And I think the idea of a strike fits the current situation. If other kinds of employment use rallying or strikes so that the higher-ups can see their sad situation, we should be able to use it too.
June 28th, 2007 at 11:10
[...] too long ago, I wrote an article entitled, “M.D.’s on Strike: Why Doctors are Leaving and Why They Should Be Leaving”. I posted it on my multiply blog and a mailing list I’m subscribed to. Some received it [...]
June 28th, 2007 at 11:31
[...] too long ago, I wrote an article entitled, “M.D.’s on Strike: Why Doctors are Leaving and Why They Should Be Leaving”. I posted it on my multiply blog and a mailing list I’m subscribed to. Some received it [...]
June 28th, 2007 at 20:30
Tess,
I am so sorry that you have so much bitterness against our country and its people. But it is pathetic that you insist on dragging others with you in your journey. Just because you are unhappy doesn’t mean the rest of medical graduates are unhappy.
Just leave, for crying out loud. Why drag the others with you? You need someone to approve of what you’re doing? Nobody asked you to become a doctor. But as one you should have the sense to realize that respect and trust, those two precious things you feel you’re not getting enough of, are earned. And earned hard. A doctor in Makati Med needs them as much as a doctor in the some far-flung barrio, and both should always endeavor to earn them. And to keep them when he already has it.
If you can’t earn respect and trust here, what makes you think you can earn respect and trust in the US?
I hope you pass your exams. We don’t need your kind of attitude here.
Robbie MD
June 28th, 2007 at 20:47
to Robbie: Thanks for leaving a comment here.
First of all, yes, I am unhappy with the current health care status here in the Philippines. I think even you would say that the health care system here is dismal. Even you, I think, would say that doctors are not getting what they are worth here. Or perhaps you still don’t see the reality around you. If you would read the different mailing lists and medical blogs, you’d know what I’m trying to tell with this article. Perhaps you’re one of the fortunate ones who need not bother. Well, then good for you.
Yes, nobody asked me to become a doctor. But I’m fighting for what a doctor should be getting in this country: decent work, decent living, and respect.
No, I do not want to drag others unwillingly with me. And I do not seek approval because I will do what I meant to do. But rather, I said I encourage those who want to leave to just go. And I do feel I’m entitled to both respect and trust which I have worked hard for.
And who said that I’d be working in the U.S.? Oh well, most people do think of going to the U.S. so it’s understandable that you’d think of it easily. But wherever I may go, I’m sure I’ll be getting the respect and trust I deserve, given that the place where I’m going to are appreciative of what I do because I work hard for it
Thank you for wishing me to pass my exams. Perhaps you should also write an article of your own to show your different perspective on this. Or may be you’d rather not bother because you don’t care anymore?
July 1st, 2007 at 9:38
I don’t care anymore???. I’ve already been given an opportunity to work in Australia as a specialist several years ago. Yet I prefer to stay here. I prefer to raise my children in my homeland. I’ve been giving charity service to PGH patients for gas money for more than 10 years, and I see myself doing it til the day I retire from this planet.
I do have a private practice to feed my family and to pay for the house and car. But I’m not one of the “lucky ones.” I worked hard for the past 13 years to get where I am.
I assumed you were going to the US because after all, you are planning to take the USMLE. I forgot the exam is applicable in other countries too. In any case, you should keep in mind that wherever you may go you still have to strive for respect and trust. Don’t expect it to be given to you on a silver platter just because you feel you “deserve” it. An M.D. at the end of your name doesn’t make you deserve anything, except for that MMDA color-coding exemption. A white coat doesn’t mean you already deserve respect and trust. And don’t you ever equate “respect and trust” with “good financial returns.” If you are hoping to work abroad for the latter (which you have already implied many times), then rest assured you WILL get it. But respect and trust? — well, good luck on that. I’ve seen foreign medical graduates abroad gaining as much respect as your average office clerk here. But their laws dictate good financial remuneration, so they’re happy with that.
Good luck in your journey. May you find satisfaction wherever you go. As for me I’ve already found it here.
July 2nd, 2007 at 10:57
to Robbie: So, am I to surmise that you think doctors are getting their worth here?
I do understand your point that respect is earned. It is romantic to hear the words, “An M.D. at the end of your name doesn’t make you deserve anything”. But do you really believe that? Then if so, you do believe that you do not deserve whatever you are getting today. You have to admit that respect for a doctor is key to better doctor-patient relationship. But if one party in that relationship REFUSE to give it to the other, then what’s the point of the whole thing?
Every human being deserve respect and as doctors and human beings, we deserve respect. That’s what I’m fighting for. But mistrustful patients seem to treat their doctors as not humans. You do have a private practice, as well as I do, and you have more experience compared to me, in terms of years. But perhaps you may have already forgotten how it is to work with patients who think their doctors are things to be manipulated. Yes, there are patients like that here.
Perhaps you might say it is up to the doctors to make their patients trust them. Of course, doctors do have to make the effort to show patients their good intentions. But what is the use of good intentions if the other party are narrow-minded enough to think that all doctors meant to harm them (and nothing will convince them otherwise) and yet, will expect you to treat them ?
I do not mind being treated with respect as an average office clerk, as long as I’m treated as human.
It’s not only that certain group of patients bring the problem. It’s the government itself. If only perhaps they would consider that doctors and the health care system need the government’s good financial support, then perhaps it will be better for all of us. But, instead, all appropriations are concentrated on the more obvious aspects of the society, like infrastructure. If only by leaving this country will the government start noticing that it has been neglecting the health sector, then perhaps it would be better to do it.
Good for you that you found your career satisfaction here because it is not so for others. I still stand by my choice to leave and encourage others to do so, if they can. But I’m not a fundamentalist. If there will be reasons to stay, if there realizations will start to sink in the key sectors of the society, then I’d like to be present to help rebuilding the health sector of this country. But, no, I do not see the dawning of the understanding in any of those. In the minds of the people, it will always be the “selfish doctor wanting to go abroad for more money”.
July 3rd, 2007 at 8:15
Tess,
Let me quote you: “I do understand your point that respect is earned. It is romantic to hear the words, “An M.D. at the end of your name doesn’t make you deserve anything”. But do you really believe that? Then if so, you do believe that you do not deserve whatever you are getting today. You have to admit that respect for a doctor is key to better doctor-patient relationship. But if one party in that relationship REFUSE to give it to the other, then what’s the point of the whole thing?”
It is not romantic– it is the truth. And I sincerely believe it. Five years of med school only puts you at the bottom of the a bigger totem pole. And patients know that. If I were a patient why would I go to a less experienced doctor if I can afford to see a more experienced one? And that is the challenge for the young graduate: to establish his or her presence in the field and gain the trust of patients. And more, to gain the trust and respect of peers.
You are putting words in my mouth when you assume I think I don’t deserve what I am getting today. You are wrong. I am grateful for what I have today. My practice is doing well and I am looking forward to even brighter years. Patients come mostly from referrals from other doctors and from former patients. What other form of trust could I ask for?
Too bad you seem to have had too many manipulative patients or those who would think you would mean them harm. (Their opinions count, mind you.) Why in the world would anyone think that this respectable doctor wants to harm someone? Maybe the doctor did or said something that gave them that idea. By the way, I never had that problem.
So go on ahead. Leave this place. Solve this country’s health problems by taking away more of its health professionals. Hide behind the guise of wanting to uplift the country’s health condition or its doctors’ welfares. That “patriotism doesn’t feed a family” explanation was already enough. Call a spade a spade.
Maybe you’re right. And maybe I’m stupid in having served charity patients for more than a decade, and still planning to do so in the next two. Maybe it doesn’t do much for the society.
But then again, look who’s more satisfied.
I’ve said my piece. Got to go back to work now.
July 3rd, 2007 at 9:56
to Robbie: Then you are the fortunate ones whom haven’t encountered these kind of manipulative patients.
The problem is not the why patients would go to a specialist rathen than the GP or the other way around.
You misunderstand the part that I think you believe you’re not getting what you deserve today. Let me tell it one other way. I think you belong to that group of people who believe that being in the lowest end of the big totem pole deserve the lowest kind of respect, and maybe none at all (something that a fellow doctor has also blogged about. And no he isn’t a young doctor). Being a specialist or a general practitioner of medicine doesn’t matter. Both should be accorded respect because they are both doctors.
I do believe that having an M.D. at the end of your name deserves the kind of respect as those graduates went through hell just to be able to be worthy of using that suffix to their name. I do not look down at the new graduates of medicine today just because I’ve got more experience compared to them. I accord them respect as proper to someone who’s a doctor. This is what most of the older doctors forget. Though, I will have to mention that there are lots of older doctors who are more enlightened and do not think this way.
I didn’t say that I discourage doctors from serving charity to those who need it. Rather, I want to make them realize it’s not a duty they OUGHT to do. They shouldn’t be looked down to if they prefer not to. Same as if the doctor chooses to leave this country and be “unpatriotic” in the eyes of those who think sacrifices should be imposed. Personal choices should be respected.
July 24th, 2007 at 14:52
I totally agree with you… same sentiments exactly. I considered staying and I tried residency too. Aside from poor compensation and lack of respect for doctors, there’s just too much sacrifice that it isn’t worth it anymore. Hospital heirarchy sucks as well. Going abroad won’t be easy but at least somehow compensation and working hours are more humane. I have colleagues working abroad. They say it isn’t easy but at least they get what they deserve and they don’t ask money from their parents anymore.
I find it frustrating during my duties at charity hospitals how despite of me wanting to help a patient so much, I still cannot do so because they can’t buy medications anyway. They can’t continue with their maintenance medications, they follow-up without taking meds and are not able to get their labs done… useless isn’t it? I’m tired of watching patients die because they couldn’t afford the medications needed even if I have them admitted. I can’t pay for them since I don’t earn enough too. Much as I want to stay and help, there isn’t much that I can do.
I plan to leave to but for Australia instead. Maybe someday we can help our countrymen but right now, we have to help ourselves first.
July 24th, 2007 at 22:50
to rogue: Glad you understand what I’ve been trying to say. If you noticed, some simply just refuse to understand that we don’t have to apologize for being selfish. What I observed is that most of the doctors who’re saying that doctors ought to stay for patriotism’s sake are those who are in the middle or upper part of the hospital hierarchy and who have forgotten the hell that was medical school. These are the people who think that just because you are in the lowest end of the big totem pole it means you don’t deserve any respect. Didn’t they realize that the totem pole is standing because of us who’re near the lower end? And they even deny that patients do have a growing general mistrust of doctors and rather blames those doctors who experience those as the culprits. Ah yes, they claim to see everything and yet refuse to see that colleagues may see differently but it doesn’t mean that they’re entirely wrong.
Yes, let us live for ourselves first. It isn’t the exodus of doctors that is causing that poor healthcare in this country. It is the loss of respect and priority for healthcare that is driving the healthcare professionals away.
July 25th, 2007 at 16:17
Our situation right now is simply frustrating. Never mind what other people/doctors say… some of them just tend to rationalize/justify their decision to stay… some indeed are happy about staying and so be it. Let them have their way if it works for them. Right now, it’s just too frustrating much as I try to deny it to myself… i just feel the need to get out of the country in any way I can. I wish to be independent and I hate having to ask money from my parents and definitely, I cannot do that here.
August 7th, 2007 at 22:29
Great Blog.
I read most of it but not in great detail except for the first parts. First of all, i just happened to find this website from a search I did on google regarding Dr. Jacinto ( the board topnotcher turned nurse in the u.s.- he is doing fine according to USA today.) Anyway, I graduated in the Philippines in 1999, then intership, and then took the USMLE and I just finished Internal Medicine here in the U.S. Having experienced both practices here in the U.S. and in the Phil. Here are my comments.
To Vic (the U.S. med student) - I think your observations are based mostly of what your Father did back then. Definitely not true anymore at this time in the Philippines. Most changes happened the the past 7-8 years. Just because there is an imbalance in the cost and earnings. More so than here in the U.S. I am earning close to $10,000 a month here (my first job) - so don’t worry about your not being able to pay for your student loans. A lot of areas in the U.S. would even pay up to $60,000 for your student loan. So far i have not met a U.S. Grad with loans have a hard time after residency. Also, you have not experience the Philippine style of Med. School. Very different from the U.S. Here at least you are respected. In our school (Phil), we are the Doctor and the Nurses ( we collect urine, vitals, stool, blood draws, etc) then 36 hour duties every other day for 6 months. No way they do that to the U.S. students (hospital can get sued) Plus you get yelled at, bossed around by your senior Residents (Hierarchy is the Rule in the Phil - complain and you be kicked out or further duty hours - I do not expect that you would understand this and why medical students in the Phil don’t complaint, it just doesn’t happen). Hence the need for respect after finishing is important and yearning for the newly graduates. I am a new Doc in our Hospital, And I like the Respect I get form the older docs. In the Philippines the Residents are Treated like S-H-I-T (Pardon my language But I just remembered those days). Anyway, be grateful you are in the U.S. school. I have a daughter and if she wants She will also go to a U.S. school ( ever wondered why your father did not send you to the Philippines to Study? Low tuition, No student loan - aint that a deal!) - or maybe it was your choice…
To the Doctors who want to stay in the Philippines. - Again, as Tess Said, fortunate for you that you have found your niche. Fortunate for you that you’ve done hard work to stay in our motherland. Fortunate for the motherland. (my parent’s are still in the Phil - so good that they have doctors there still. - by the way may parents are well to do and actually stayed in the U.S. for 2 years but just got too bored…They love our country hence they returned and are helping our folks over there. My only comment, please do not lambaste the Doctos who want to leave, or are encouraging others to leave. They will have a hard time anyways doing the exams, earning money for the boards, living frugally while waiting for residency. (mind you most foreign grad MDs, including myself worked odd jobs just to support a family while waiting and studying. Anyway, whichever path you take. hard work, and sacrifice will always be there, does not mean we do not love our country ( by the way, number one gross product of the Philippines now I think are the OCWs which is supporting our economy (or else Our country would be further in debt - hence your patients are able to pay you (indirectly with the help of the OCW’s). Although, I see that the Brain drain will have consequences in our country, but this will not be helped unless the goverment helps itself first. Doctors in the Philippines have suffered for such a long time - hence its the goverments turn now.
Good Blog.
Dante
August 7th, 2007 at 23:06
To Dante:
Thanks so much for commenting. Yeah, I do piss off a lot of people because of what I wrote (I think, even the newspaper doesn’t want to publish it because of its rather unpopular content).
Another doctor also commented in my other site (where I also posted this article) and shared similar views such as yours. Many people here in the country do have a narrow view of those doctors leaving the country. And yes, they may have difficulty understanding it because they may have forgotten how hard it has been from medical school and then establishing a practice. They may say that they do remember, but not really. Because if they do, I think they’d stop treating those in the “lower end of the big totem pole” like s-h-i-t. These are the older doctors who thrive on power-tripping. Just because they’re already on top, they look down on those whom actually are helping them in their practice.
My cousin also shared to me that the treatment of resident physicans-in-training in the U.S. are very much different from how residents are treated here in the country. He is in his second year of residency-in-training in a hospital in Maryland. So, people shouldn’t accuse me of just dreaming the American dream that’s why I want to go to the U.S. (or in any other country). Though the medical system in the U.S. is far from perfect, at least, the treatment of doctors are far better compared to the treatment doctors here in the Philippines get. And at least, something is being done to improve the system, which is not what is being done here.
Actually, the government is even thinking of closing the exit doors on the migrating doctors. Read my reaction to it here.
If I’ll be successful in leaving this country, I will continue to blog about my experiences as a doctor overseas, hoping that it will show the people the huge difference between the local medical system and those that they have in other countries.
August 8th, 2007 at 0:56
thanks for the reply.
I forgot to mention why I left the Philippines. Actually, I wanted to stay in the Phil. since My parent’s bought me a practice already in a hospital in Muntinlupa. However, as faith had it, My wife (who was also my classmate was an american citizen.) wanted to go back to the U.S. Although I was afraid of going, I wanted to try If we can make it here as well. Political instability, lack of security (carnap, kidnap, etc.) made me think otherwise. My family was my first priority. Since I had a chance I took the opportunity. It was difficult at first, working as a medical assistant for a year an a half. before I got into residency. Leaving frugally, in a small apartment. (by the way, I did not ask for help or money from my parent…even if they wanted too, We wanted to succeed on our own, since they helped us enough going getting us thru medicine.
although our country needs us doctors, charity or pay patients, I did want something better as well for my family. Only a few doctors succeed (like the earlier responder) in our current time. Most have money already from their parents, only a few are so lucky.
Now, looking back…i have no regrets…Life is much better here. I would never go into residency in the Philippines…it is do degrading how they treat residents. If the Senior doctors (especially the power tripper) truly want residents to occupy hte now empty slots of their program, they should pay up, also they should look at the way they treat their residents…they have only themselves to blame why doctors opt to become nurses rather than be subservient to them with minimal pay. I wouldn’t say that during residency here in the U.S. there is probably 1 or 2 power trippers, but they do not compare to the ones in the Philippines. I don’t remember any of the attending doctors in the Philippines thank me for the work I did. Here, as a resident, they know how valuable the residents are and the amount of work that saves them. They thank me everytime Just for this reason alone, would make me leave the Philippines. even after the Philippine board I see my classmates still cower to he Senior staff. I do not have respect for these abusive attendings.
Regarding the patients respect, I do not see any difference here in the U.S. compared to the Philippines. You will have the unrespectful as well, and the appreciative ones. So no comment there.
Lastly, charity care is still done here in the U.S. where a lot of my patients do not have insurance, hence rely on medicare who pays minimally (almost nothing). Hence I still do my part for mankind. I would love to help my fellow Filipinos who are in need as well, but I’d rather do that monetarily, where I think I can do more, and attending medical mission in the future (like most of my fraternity brothers have been doing). I still applaude the Doctors who are left behind, and those who did finish residency. But this is personal choice. Being Patriotic has many forms. You just have to know where you lie.
Dante
August 8th, 2007 at 1:54
Also, reading the whole blog, regarding the Doctor who said he had no patients think that he is doing harm to them. My response to that….you must be an outlier or refused to acknowledge this fact. A patient who thinks negligence occured is an example of thinking harm was done. I myself have had an occasional patient like this, even though I am very respectful, knowledgeable, nice, thorough, and take the time to listen to patients…Even the best doctor in our group (excellent ratings from the patients, he would even pass on some of the patients to me, who are not on the same wavelenght as his. You must have had no borderline personality patients or you may have turfed this to some other doctor. 10 years??? what kind of specialist are you? Judging from your response to this blog - very aggressive - I cannot imagine that someone could not disagree with you. Unless you scared them.
September 6th, 2007 at 11:55
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