March 6, 2003 - Second of a series

Doctors bailing out

The series at a glance: 1 - It's the teachers turn 2 - Doctors bailing out 3 - Arthur's tale 4 - U.S. nursing shortage 5 - Nurses and recruiters 6 - Aries speaks up 7 - A price to pay C - The real war (and other views)

     "The future looks bleak here," wrote reader Jorge last week. "Doctors are taking up nursing. Let me say that I am one."

     Jorge is not alone and that is not news anymore. The Philippine Nurses Association says, some 2,000 physicians are taking up nursing nationwide. In June 2002, more than 100 doctors took the nursing board examinations. At the Philippine Regulations Commission, members of the board of nursing have been very busy interviewing special applicants for examination that would enable them to practice as registered nurses. Those special applicants are - you guessed it, Doctors of Medicine.

     If this happened 10 years ago, the news would have shocked everyone. Nursing used to be a stepping stone to a medical degree. The reverse route is now happening. It is expected that more and more doctors will take the nursing board examinations.

     All the doctors I have talked to in the last few weeks would leave the Philippines for the United States in a second if given the chance. Most cited one reason: the poor conditions affecting medical practice in the country. We will talk about those conditions throughout this series. A more comfortable life in the U.S. is what they expect. "Frankly," one said, "with my condition right now, how could I get any worse?"

"You probably already know that passing the U.S. medical licensure examination does not guarantee you a visa from those consular officers along Roxas Boulevard. If you are already in the U.S., it does not guarantee a spot in a residency training program, either. The bottomline is, it is tough, as tough as doing a femoral tap in total darkness. As tough as getting through a case presentation with Dr. Portigo without getting stiff in humiliation."

     Our reader Jorge, for sure, did not think about this when he decided to go to medical school. Perhaps, nobody did. Doctors turning into nurses is unheard of before, and that is not to undervalue the nursing profession at all. Who would you rather be - Dr. N doing the ex-lap or the nurse assisting - the former throwing the insults or the latter taking them?

     The distinction of being in medical school and the prestige of being a doctor supersede everything else, at first. After graduation and board examinations, however, another picture sets in - and that is the picture of reality. You talk about idealism, patriotism, and conscience but they can only take you so far. "Think about poverty. Think about corruption. Think about malnutrition, and hunger, and pollution, and traffic," reads a message on the website doktorko.com. "What about the future of the kids? Is a house, or a car, or a good school affordable?

     "Then look at New York, Chicago, San Francisco. New house, new car, good school, snow, food, and so much more," continues the message. "For a doctor, these things get considered. Coming to America has never been a more delicious alternative. Not so much with the US being attractive, but the Philippines driving them away. Most doctors think they don't deserve working in the Philippines. A million and one reasons."

     The options for Filipino doctors to work in the U.S., however, are limited. The licensure examination, administered in 3 steps, is not only tough but expensive. If you pass all 3, you have to undergo a "matching" process to determine which hospital you are going to undergo your residency training. All this while carrying a "J" visa which expires at the end of your training. Then you get a "waiver" to extend your stay, avail of a working visa as long as you are willing to work in an underserved area like in Texas, near the Mexican border, or in areas of Nebraska where you watch grass and corn grow instead of Broadway shows. If you're lucky and your employer is willing to sponsor you, you can get an immigrant visa and then move to a big city like Las Vegas, earn hundreds of dollars per hour and walk along the strip like its your neighborhood.

     I personally know a few doctors who went through the above route. But their number pales in comparison to those who took the examination and failed and those who took and passed but did not get "matched". An alumnus passed the licensure examination but failed to get a match until the examination result expired after which you have to take the 3 steps again. And you probably already know that passing the U.S. medical licensure examination does not guarantee you a visa from those consular officers along Roxas Boulevard. If you are already in the U.S., it does not guarantee a spot in a residency training program, either. I have proof but I'm keeping it to myself. The bottomline is, it is tough, as tough as doing a femoral tap in total darkness. As tough as getting through a case presentation with Dr. Portigo without getting stiff in humiliation.

     Which takes us to option number 2 - take up a two (maybe one) year nursing course, comply with requirements and take the nursing licensure exam, hook up with a recruiter and off you go to a U.S. Hospital. You can work as a nurse for few years, get an immigrant visa and a Ford Expedition. You also have the option of studying while working, take the medical licensure examination, leave nursing, start residency training, and get a couple more Expeditions.

     Although nurses recruitment has considerably lowered since the 80's and early 90's due to visa restrictions, there is still a big shortage of nurses in the U.S. The U.S. need for nurses was so huge in the 80's that the U.S. Senate passed an act authorizing employers to recruit directly for foreign nurses under the H1A visa. When the act expired in August 1995, the nurses exodus went to a lull a little bit. Now, there is this H1C visa where hospitals in underserved areas that desperately need nurses can apply to hire foreign nurses as long as they can prove the need to the Department of Labor. You know where they will look to recruit first. Filipino nurses are coming in droves again. And more and more doctors are taking up nursing by the day.

     The trend has already alarmed Philippine health officials. In an Inquirer news item last month, about 50 of the 300 doctors in Negros Oriental alone have enrolled in nursing. "In other provinces, I am told that the numbers are bigger," said provincial health officer Ely Villapando, who is expressing concern over the nationwide phenomenon of doctors studying to become nurses so they can find a job with better pay overseas, particularly in the United States.

     Villapando warned that Negros Oriental would suffer from a shortage of medical staff because the doctors taking up nursing "will be leaving in one-and-a-half years." He noted that all his department heads at the Negros Oriental Provincial Hospital were already nurses. Villapando said he alerted health undersecretary Mila Fernandez about the problem during a meeting in Manila late last year. "I thought we were the only province with this problem, but when I brought it up before a gathering of provincial health officers, they all said they, too were having the same problem," he told the Inquirer.

     Villapando also said that the problem started with the devolution of the Department of Health in 1992, which led to what he called the death of the hospital system. Devolution meant that provincial hospitals were left to the care of provinces while the city health offices were left to the cities. The towns took care of the municipal health offices. The Department of Health concerned itself only with specialized hospitals, according to Villapando. As a result, the salaries of doctors were the last to be standardized. "It's degrading for (government) doctors to get a lower salary than the janitor of the Government Service Insurance System, or of a Senior Police Officer 2," Villapando said, as quoted by the Inquirer.

     I know a few alumni who are currently taking up nursing courses in schools like the West Negros College and in places like Roxas City in Capiz. I will not write about them unless I have their permission or if they offer their story themselves. If they do, I won't dispute their decisions because I know they are sensible enough.

     I won't call this option number 3 because that will imply you only marry a nurse because of the trip to the U.S. Since doctors work in close proximity with nurses (sometimes very close), they sometimes end up falling in love, get married, and before you know it, the nurse gets a U.S. working visa, and it doesn't really take a lot of convincing for the doctor to follow. Dr. Consing wrote a column on this site about how he got lucky to marry a nurse. He passed the licensure examination, got matched, and is now practicing in North Carolina.

     I had no plans of going to the U.S. but fate had a different plan. I fell in love with a nurse, and ended up shoveling snow in a suburb in Chicago. I haven't taken the U.S. licensure examination and I have no plans at the moment. I am probably a bad example. I'm a twit, was a mediocre medical student, and dumber than a lamppost. But I make sense once in a while so listen up and continue reading.

     I was just lucky to learn how to use the computer keyboard from fellow alumni like Dr. de los Reyes and Dr. Alabado. I don't make hundreds of dollars an hour but I have no plans, yet, of exchanging the comfort I have now (why do you think I am able to write this column?) for a stethoscope and a scrub suit (no plans of trying, either). It pays to learn a few things like how to use the keyboard and the mouse. Coupled with hard work, the sacrifices ultimately pay off. You may not drive an Expedition but you can always sit back and relax in your Lazy Boy watching basketball games every night on your 65-inch High-Definition TV.

     I talked to an old acquaintance over the weekend at a party of a mutual friend. He is a pediatrician, a PPS fellow who left his clinic in an Iloilo town to be with his wife. His goal in life, he said, is for his family to have a comfortable life, whether he works as a doctor or as a pharmacy technician. That is not unusual. There are specialists who have practiced for quite sometime in Iloilo who chose to migrate to the U.S. and then do something else. They are either married to an immigrant or they became immigrant themselves as a result of long-standing family petitions. Is the situation in the Philippines that bad?

     "Yes," wrote Rey, in response to my column last week. "About just anybody I have asked have plans of leaving. The feeling of despondency is pervading all over the country that no matter what one does - work hard, honestly and decently - life will never get better. The government is inutile to all the graft and corruption and the deteriorated peace and order situation. I don't have the stomach anymore to see on national television the politicians debating something ad nauseum or endlessly questioning every act of the President. Doctors are wary of the malpractice bill and the soon to be imposed VAT. All these, plus the added spectre of a Bush-led war, makes me think of what's the future of my kids?"

     "It's getting very difficult to maintain one's idealism in the face of all these events happening around us, continued Rey. ""Everyday the temptation of hanging up my stethoscope and jumping ship to a less demanding job but a more lucrative one gets stronger and stronger. As of now I am a BSN (Bana Sang Nurse) but if things don't get better, I will most likely join the long line of doctor's taking up nursing and anybody can have my department chairmanships and other positions as well. I fervently pray that day won't come."

     There is a sense of desperation in Rey's voice. I can't blame him. There are a lot of doctors who feel the same way, neglected and abandoned. A urologist spent two and a half years of training in Michigan, a year in France, and two years in the Philippines preparing for the diplomate examinations. Guess where he is now. He is one of at least 32 doctors enrolled in one nursing school in Laguna.

     Government officials came up with a proposal aimed at addressing the impending crisis in the government's health service because doctors continue to go overseas to work as nurses. The proposal, which is to be submitted to President Gloria Macapagal-Arroyo, seeks to bar doctors and nurses from working overseas until they have served for at least two years in the country. A health official even submitted the ridiculous notion of training "hilots" (traditional healers) to take the place of doctors.

     I have a suggestion: How about increasing the salary of government doctors first?

     Even a lamppost could have thought of that.

     Here's an e-mail worth sharing:

     "I agree with you 1,000% that teaching is a "noble" profession. There will be no doctors, lawyers, etc... without teachers. To teach is to touch lives forever! As an educator, I have my story to tell, too. I graduated at Iloilo State College of Fisheries, Barotac Nuevo,Iloilo with the degree of Bachelor of Science in Fisheries Education. I took and passed the National Teachers Board. When I applied in one of the local school districts, the district supervisor did not hire me simply because of my alma mater. He told me to go back to school to take some educational units. I was so disappointed that I went overseas to search for greener pasture. God BLESSED me with an opportunity to go to America and able to practice my teaching profession. It was not easy, but I've reached my goal. I am currently teaching Kindergarten in North Carolina and still going. I just started my MAED program at CMU and looking forward to teach adult education in the near future. To my fellow educators, don't let any bad situation discourage you! We do not teach to become rich but the dignity and respect that we gain from our students and parents are lifelong! We can make a difference in a child's life! All we have to have is a loving and genuine heart."

     This week's FINAL WORD comes from Joshua T. Duites:

     "I am looking for Sheryl Blanco Daliva, last I heard she was with the Psychology Department. I have been looking for her for the past year, I miss her so much. I'm so sorry for using your site to find her - but I have no other way. She studies at West Visayas State University, would please anyone help me look for her? Just tell her I tried looking all over for her. Please. "

     The Psychology Department of the West Visayas State University is a very good place to start looking. What do you think?

Comments regarding this week's column are welcome. Please fill up the fields below and click Send to Author. Suggestions for future column topics are also encouraged. Your comments may be quoted in future columns.

     The author's e-mail address is at drgarcia@wvsumedaa.com

     Views expressed on this column and any other by-lined articles on this site are the authors' own and do not necessarily reflect the views of the organization or its members. For comments, please e-mail the author.