Doctors see no hope for Philippine health service

[explorer]

Doctors see no hope for Philippine health service

First posted 11:28am (Mla time) Nov 21, 2005
Agence France-Presse

DOCTOR Jose Sanchez is a leading surgeon in his field but like thousands of Filipino medics he has had enough and is leaving the country ... not as a doctor but as a nurse.

In a quiet coffee shop in Manila's Quezon City he contemplates his future with two colleagues in a country where the medical system they say is in terminal decline.

The 50-year-old surgeon with 25 years experience as a lung specialist is just marking time.

Sanchez, not his real name, and two other surgeons agreed to talk with Agence France-Presse on the condition they were not named or photographed.

Nursing a cup of black coffee Sanchez says the profession today is not the same as the one he entered in 1980.

"It was different back then. Medicine was a respected profession and money was being spent on healthcare. But what we have today is a health system in terminal decline," he says.

Of the 40 doctors he graduated with 25 years ago Sanchez says over a third have emigrated.

"I don't know of anyone who is happy. It seems like everyone is leaving and the government for it part doesn't see that it has a problem," he said. "We are just another statistic among a growing list of professionals who see no future in this country."

Sanchez says a lack of new recruits is reinforcing the problem.

"When I started it was so difficult getting into medical school. The competition was fierce and the top medical schools set very high standards. Today the standards are still high but the medical schools have difficulty filling places," he says.

"The question people ask me is: why? Why, after all the years of study and 25 years of practice am I leaving, not as a doctor but taking a step back wards and leaving as a nurse," he said.

"I honestly don't see any future in this country and it is easier to leave as a nurse than as a doctor. The demand for nurses far outweighs the demand for doctors."

He says three of his colleagues, all surgeons, are now in the US as nurses and one is now the medical director of a hospital in California.

Sanchez said his salary averages around 100,000 pesos (1,780 dollars) a month. That isn't bad by Filipino standards, but the average salary for a nurse in California is around 4,000 dollars a month.

Sanchez denies his motivation is money.

"I have just lost faith in the ability of our political elites to run the country and run it efficiently. You don't have to be a rocket scientist to see that this country is just marking time," he said.

"It's going nowhere. Look around the region and our neighbors are leaving us behind. Even Vietnam is starting to overtake us," he said.

One of Sanchez's colleagues, a 39-year-old surgeon, agrees.

Graduating in 1993 many of his classmates have left the country, some as nurses and some as doctors for international aid agencies.

"Our politicians have no interest in the plight of doctors in this country. Successive governments have become complacent to the erosion of the health system," he said.

"Working conditions in the public sector are appalling. It has reached a point where doctors, many doctors, are finding it hard to make a living in the provinces where doctors are leaving in droves because they can no longer afford to stay," he said.

"I am not talking about luxury living, fast cares and big salaries. You have to understand that most of this country's 80 million or so population is poor. I have colleagues who have left the provinces, and I must add reluctantly, as they were mostly working for free," he said. "Doctors have to eat and educate their children too."

A 35-year-old obstetrician who graduated in 1995 says about half of the 300 doctors she graduated with have left, mostly after retraining as nurses.

"Medicine is my life," she says. "I think you enter this profession wanting to make a difference. But here in the Philippines we just don't have the tools to administer quality health care," she says.

"It's pathetic. Pathetic that we have a system where hospitals are closing simply because they do not have enough doctors. I have worked in both the private and public sectors. In government hospitals a doctor can work 14 hours or more a day," she says.

"The hospital I work in has a 78-bed maternity ward but only 50 beds and it is not uncommon to see three women share one bed.

In the private sector it is an eight-hour day, one patient a bed and a room. If you have the money quality health care is not a problem even in poor countries. But having said that it is getting more and more difficult to find good specialists. Even they are leaving," she says.

[explorer]

Philippine health service in crisis as doctors leave

First posted 11:14am (Mla time) Nov 21, 2005
Agence France-Presse

THE PHILIPPINES has become one of the biggest suppliers of healthcare workers in the world but the exodus of nurses and doctors in the last five years for higher paying jobs overseas has left the country's health system in a state of near collapse.

At a summit of healthcare professionals called by the Philippine Medical Association recently delegates were told in a conference paper: "The crisis in medical human resources is now upon us. The delivery of health services is being compromised. We have to address the problem before the health system completely collapses."

Jossel Ebesate, general secretary of the Alliance of Health Workers, said the situation had become so bad that the country's healthcare system would collapse within the next two to three years.

Former health secretary Jaime Galvez Tan, who has been studying the exodus of doctors over the past five years, told Agence France-Presse: "We are facing a serious problem and we need to address it now before it is too late."

He said the demand for nurses, especially in the United States, is outpacing supply.

"Doctors are leaving for a variety of reasons: political instability, low pay, corruption, poor working conditions and the threat of malpractice. But above all they don't see much hope for the future and the future of their children," he said.

Tan said the fact that doctors were leaving the Philippines was not a new trend.

"Since the 1970s the Philippines has been a major source for health professionals for many countries," he said. "The only difference today is that doctors are retraining as nurses. For many doctors it is the easiest and quickest way out."

Many developed countries have less stringent conditions for accepting Filipino nurses than they do for doctors.

This year the government set aside just 1.1 percent of its national budget on health. The World Health Organization's advised minimum is five percent.

By comparison Vietnam spent 4.5 percent of its national budget on health in 2002, the last year for which figures are available, while Thailand spent 7.6 percent last year.

Tan's study on the health system, 'The Brain Drain Phenomenon and its Implications to Health', estimated that some 100,000 nurses have left the Philippines to work abroad since 1994.

Some 50,000 left in the last five years, but nursing schools, which have mushroomed in recent years, have only managed to produce 33,370 nurses over the same period.

The study found Britain and the United States offered the best working conditions for Filipino nurses with visas for spouses and children and in some cases subsidized housing.

But above all, the study found, salaries were a major factor averaging between 3,000-4,000 dollars a month compared with 180 to 220 dollars a month in the Philippines.

"While Filipino doctors have been migrating to the United States since the 1960s and to the Middle East countries since the 1970s in steady flows, the more recent outflows is more disturbing because they are no longer migrating as medical doctors but as nurses,"
the study said.

More than 3,500 doctors have left the country as nurses since 2000, Tan said. Between 2002 and 2003 some 1,500 doctors passed the nursing licensing examination and this year some 4,000 doctors are enrolled in nursing schools.

He said it was worrying that those leaving to become nurses came from all medical professionals across the board with the hardest hit sector being anesthesiology.

"What is more disturbing, however, is that the number of students enrolling in medical school has been down on average by 14 percent a year from 2002," he said.

"As a result medical schools are now closing down because they don't have the students. Also the pass rate has fallen dramatically over the last 10 years from 86 percent in 1994 to 52.9 percent in 2004."

Tan said salaries were another problem with public health doctors earning an average of 300 to 350 dollars a month, private sector doctors earning 800 to 3,000 a month and "super specialists" like neurosurgeons and heart surgeons being paid 18,000 dollars plus for one operation.

"But even the specialists are looking elsewhere," he said.

According to Tan roughly 80 percent of the estimated 70,000 doctors working in the Philippines today are in the private sector.

"Working conditions in hospitals have deteriorated where it is almost impossible to administer the basics of health care in some provincial hospitals," he said.

"The ratio of nurses to patients in the Philippines should be 1:6. The reality is more like 1:50 in rural areas and 1:20 in the urban area. In Europe and the United States it is about 1:4," he said.

"How can you expect doctors and nurses to work in an environment like this? It's like the fingers on your hand starting to rot. If you don't treat them they will eventually fall off ... that's what is happening to our health system," he said.

The health secretary Francisco Duque, while acknowledging a problem, told Agence France-Presse that the government still "appeals to the doctors' sense of patriotism."

Although he would not go into specifics he said the problem was mainly with the number of specialists leaving rather than with any other sector.

Dr. Armando Crisostomo, of the Philippine College of Surgeons, told Agence France-Presse the flight of the country's doctors "poses a potentially serious problem for the country's health system.

"There is a school of thought which says doctors are not at the center of the health care system in this country because the front line, if you go to the provinces, are the nurses and midwives. Doctors are more at the municipal level," he said.

"The other school of thought says for primary preventable diseases we can probably manage with midwives and nurses. But in secondary care we will need doctors. And there we have the problem ... we are losing so many and from all fields," he said.

A member of the Philippine Medical Association's steering committee to examine the flight of doctors, Crisostomo said the problem facing many doctors was not purely economic.

"Other countries in the region notably India, Sri Lanka and Bangladesh have a fairly good health workforce that speaks English but their doctors are not leaving as nurses," Crisostomo said.

"One of the main reasons forcing doctors to leave is a general sense of hopelessness in the country. There is no long term government planning. All they see is a government planning to survive. How can you make plans for the next 5-10 years if you are just planning to survive in government?" he said.

He said that while the Department of Health appealed to the doctors' sense of nationalism other departments saw the country's overseas workers as national heroes keeping the economy afloat with their remittances.

[scarab]

...hehehe, kanina pa-check up misis ko sa immunologist sa asian. baliktad naman siya. kakarelocate lang dito from the US. malungkot daw sa US kaya umuwi na lang at dito na siya magpa-practice.

[OTEP]

There are always two sides to the story. May mga umuuwi din ulit dito sa Pinas to practice. Yung isang E.R. officer namin dati galing U.S. and bumalik dito to practice. May mga kakilala din akong tinatapos lang ang training sa U.S. then balik na dito ulit.

[speedy]

Is there such a thing as a govt. funded health care in the philippines? I know the country is strapped with a huge defecit as well as an over-abundance of crooks in office, but does the philippines have an equivalent of medicare/medicaid?

[speedy]

I think all physicians want to do whats best for the patients under their care and having the support, either financially or technologically, makes a big difference in what a physician can do for their patients. It's like performing surgery with all the necessary tools. Its hard to do your best work when you have to worry about what tools are available and what your budget can afford.

[retinasurgeon]

Is there such a thing as a govt. funded health care in the philippines? I know the country is strapped with a huge defecit as well as an over-abundance of crooks in office, but does the philippines have an equivalent of medicare/medicaid?

Yes, we have a government funded health care program,called Philhealth, but unlike Medicaid (or OHIP, where I trained in), it only shoulders part of the medical expenses, with the rest, to be shouldered by the patient.

[speedy]

Yes, we have a government funded health care program,called Philhealth, but unlike Medicaid (or OHIP, where I trained in), it only shoulders part of the medical expenses, with the rest, to be shouldered by the patient.

So how often do practitioners do more than what the patient could afford? Or is the budget a limiting factor in the extent of the care provided?

[van_wilder]

"I honestly don't see any future in this country and it is easier to leave as a nurse than as a doctor. The demand for nurses far outweighs the demand for doctors."

i dunno if its just me... pero when i have a faith... faith talaga, na no matter what... you can't rock it... you can always question it and im open naman to everything but... my faith is strong... and I have a faith in this country... if he doesnt see future in this country maybe it is he who doesnt have a future... and not this country... it is very true that when you look around you it would be very frustrating but present is not the future... there is always light at the end of every tunnel... we are on a very looonnnnggg tunnel, others give up... me? i would go on... i would finish this tunnel or i would die tryin...

Sanchez said his salary averages around 100,000 pesos (1,780 dollars) a month. That isn't bad by Filipino standards, but the average salary for a nurse in California is around 4,000 dollars a month.

Sanchez denies his motivation is money.

hahahaha! denial... tsk tsk... sure ba siya na the grass is greener on the other side? 100,000? thats good enough... dito natin nakikita ang ano ang masimportante sa tao... he is earning more than most filipinos and may gana pa sha magreklamo... ano ba inaakala niya pag nagdoctor siya? sobrang yayaman ka? mabubuhay ang mga tao kahit wala siya...

no offense sa mga doctors and lawyers or any professional people...

when you do your work do it for the sake of love of your work...

if you do it half-assed or with other intentions (money) then do everybody a favor… quit your job…

when i was a kid, i want to be a doctor... why? because i used to believe that being a doctor lawyer or a politician would make you rich... i have 3 uncles na doctor they are rich... and my grandma is a doctor... she is not just rich... she is wealthy... diba they say before na kung gusto mo yumaman mag doctor ka...

but one december night, my grandma asked me what are my plans... i told her na my plans for myself are the same plans they all have for me... take biology here in ateneo or ust or there sa stanford... she told me thats nice to hear... then she asked me why i want to be a doctor... i told her na i want to be rich when i grow up and i want to help the filipinos by curing them.. then she told she got the shock of her life... she told me na when you do your work, wag mo iisipin yun kikitain... imagine that you are doing it for free if you can take that then do it, otherwise don’t do it… then she told me na she became rich not because of her profession but because of businesses and from her roots... then the bubble suddenly popped... she told me na i should rather be a businessman just like my dad, it would be a very stressful and hard task but i would be able to generate jobs that would be more helpful for my country men...

if you want to be rich... be a money maker...

oh... bakit hindi siya magdoctor sa states na lang at hindi nurse? as far as i know masmalaki pa rin sweldo ng doctor sa nurse kahit indemand ang nurse diba? bakit? hindi siya ganoon kagaling? kung hindi siya ganoon kagaling eh maswerte na siya at may 100,000 siya dito di naman siya magaling eh...

[mbt]

why crucify the doctor for his decision or opinion? what's the point of trying to sling ad hominems on his love for his craft or what you perceive to be hypocrisy?

he has his reasons, just as much as you have yours for staying.