Philippine Diaspora and Health Care

[dseattle]

Filipino Physician Picks Life as Nurse in US

what are people's thoughts on this? moreover, what are peoples thoughts on the entire phenomena that is the Philippine Diaspora? my parents immigrated here to the us in the 80's and are both physicians (feu grads), and i have always struggled with this idea.

why as filipinos must we always sacrifice? to have to put necessity over opportunity or doing what is necessary in order to provide opportunity for future generations? is it truly in the hearts of all filipinos to return home; and as succeeding generations are born abroad, is this love being lost?

i hope that filams, filipinos internationally, and filipinos in the philippines could comment and provide some insight on this. there is no right or wrong answers, and hopefully this dialogue would provide a better understanding for all of us who are connected in the struggle.

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[chocopinipig]

what are people's thoughts on this? moreover, what are peoples thoughts on the entire phenomena that is the Philippine Diaspora?
--> most people think that doctors in the country earn a lot. In my opinion, that is only PARTLY TRUE. It takes years to build a successful practice im sure you understood that.
Ask yourself, who are the doctor population that are leaving?
most physicians that are leaving are the newly graduates, ages 25 and above. They have somehow realize they have to put up with residency training earning less than 10,000 pesos a month (AT that age!) without any benefits in terms of insurance etc and for a period of 4 years... and after graduation they have to put up a practice without any patients knowing them very well, not to mention who mostly cannot afford their PF, which is in an amount they(physicians) need to survive as a doctor with a family.

compare this with another profession in the country. Law. New law graduates only need to take the bar exam and start working as a professional. They get paid at least 30,000 pesos a month as soon as they are employed by a firm. theres no such stringent training (as is with residency) needed. 30,000 pesos is not really a lot but if resident doctors get paid the same amount im sure they would stay here.

Being a doctor is not just about helping the poor and sick. Eventually you will need to ask your patients to shell out to pay for lab exams and payment for procedures that need to be done. In a 3rd world country where patients can't afford much, this can be a frustration for some physicians. I had the opportunity to see some patients visit a small free clinic every other day. He was hypertensive, partially recovering from a stroke. He needs medications to lower his blood pressure desperately but sadly it cost a lot and he can't afford it. We offer free service but we can't offer free medication.

Government hospitals increased the salary of doctors to a minimum of 15,000 plus the added bonuses in an effort to retain the doctors. Private hospitals however even in a very large hospital only pay their residents 8,000 flat, and a doctor has to go on 35 hours duty.

A nurse working locally earns more than a resident physician with social security, night time differential, overtime pay etc.. and still want to leave for a better life abroad.

what more for the doctor who is a permanent overstayer in the hospital, but still earning less than other health care workers

you do the math, and don't ask me why they're leaving the country

 

[LocutusofBorg]

As a non-filipino, I am open to the idea of practicing in the Philippines in order bring health care where there is a shortage. I see myself, after 15 years of practice in the US (with money saved up), going to the Philippines on a long term basis to do this. Perhaps many of the filipinos who leave their country for greener pastures feel the same?

 

[pattycanuck]

My question is: why work as a nurse instead of your original profession? Is it harder to qualify in the US/Canada?

 

[WaZoBia]

My question is: why work as a nurse instead of your original profession? Is it harder to qualify in the US/Canada?

the road to residency for an IMG is long and paved with uncertainty, the exams are expensive (relatively speaking) and in the end you aren't even guaranteed a position in your desired residency. most IMGs go into residency in the states cos they want to stay here after they're done, the problem is most IMGs are on a J1 visa which means if they are unable to get a waiver post-residency then they have to return to their country of origin for at least 2 years before they can return to the states.

with nursing on the other hand you are guaranteed a position almost as soon as you're done with the required exams. you come in on an H1B visa then it's only a matter of time before you get a green card which means citizenship is only 5 or less years away.

nursing by far offers one a better chance at becoming a part of the american dream.

 

[tantrum]

It's not a big deal as diaspora is happening in many countries. The only difference today is that aside from doctors, lawyers, bankers, engineers are getting second degrees in Nursing just to get a chance to immigrate to the USA. The may factors include 1) easy way to get permanent residency or "green card" compared to J1 or H1 2) As a foreign doctor, it's harder to get matched even if you passed USMLE unless you have outstanding scores. 3) For an average Filipino (even med students) it's more expensive trying to match than finding an employer after passing the NCLEX 4) Let's face it, it's harder to get a good score in USMLE than just pass the NCLEX.
After living in the Philippines, you will realize that the situation is getting worse each year and many have given up fighting for the sake of their children. As chocopinipig said, law graduates are getting better treatment than healthcare workers (even though there is no shortage of lawyers).

 

[kittycrinkles]

i haven't even made plans to take Step 1. most of my blockmates are though.

but one thing's for sure, it would be hard for me to forgive myself i become a sellout, like that guy.

yes, gotta admit that was being judgmental.

 

[PinoyDoctor]

This may be quite relevant. What I'll paste below are the conclusions to a Developmental Studies paper I did on the topic of "Nursing Education Industry in the Philippines" just last year. If you want to view/read the whole paper, do not hesitate to write me a private message to request for it. Comments on this or on my paper are welcome as well.

In addition, you may read my take on the paradigm of health workers in the Philippines at http://forums.studentdoctor.net/showpost.php?p=4901128&postcount=1005.

The question I'd then like to ask is: If there were no such "earning" opportunities abroad, would you still want to become a doctor in the Philippines? Or would you rather do something else instead?

God bless...

---------------


The training and migration of nurses is not a phenomenon of the present. As discussed at length by Catherine Ceniza Choy, many nursing traditions in the Philippines had begun from the time when the Philippines became an American colony. The culture of migration of nurses on the other hand began during the time of Ferdinand Marcos' dictatorship when he started to promote the exportation of nurses to the United States as a response to the Philippines' waning economy. In time, the Philippines' started to see a rise in the number of nursing schools that produced first class nurses that were in demand around the world, eventually making the country the top exporter of registered nurses.

Indeed, the Philippines, with its high literacy rate and English speaking background, has always been a potential source of labor, whether for the country itself, or for other nations. For many decades, the number of Filipinos being deployed to other countries for work has been increasing steadily. In recent years however, the number of Filipino nurses working overseas saw a new surge that was hard to ignore. It became apparent that the baby boomers in many developed countries were reaching their 50s and starting to acquire health problems that demanded more and more on health care. However, precisely due to that same problem of a graying population, these countries were increasingly becoming unable to produce enough health workers, in particular nurses, to support their growing health burdens. Hence, as Filipinos became more aware of the increasing demand for nurses in many of these graying nations overseas, there was almost no hesitation on the part of Filipinos to capitalize on these opportunities. Many Filipinos saw the prospect of earning more and living a better life in working as nurses abroad. Consequently, many private entities in the Philippines and beyond saw this as a chance to cash in on the demand for nurses by educating and training more Filipinos to become full fledged Registered Nurses.

As this nursing education industry continued to develop, many corollary concerns arose. The commercialization of many nursing schools has affected the quality of education and training of nurses in the Philippines. More specifically, many nursing schools, in an aim to merely earn, have built nursing schools which are barely able to meet the requirements for a nursing school as set by CHED. In effect, the majority of nursing schools have passing rates below 50%, definitely a significant waste of resources for many who have invested on becoming nurses, and just as much a boon to the image of the Philippines as training ground for first class nurses.

The economic opportunities presented by nursing has however acted as a competition to other academic courses, more precisely, by luring students in other health related courses such as medicine, into nursing. This has resulted in a decline in the number of students studying to become doctors, since the return on investment in becoming nurses, rather than doctors, was apparently significantly faster. Moreover, the decline in the number of doctors was exacerbated by the fact that since Filipino nurses overseas can earn ten times more than doctors in the Philippines, many current physicians and specialists have also gone into nursing. This decline in health professionals in the Philippines has inevitably put a strain in the aggregate health of the people in the country.

Viewed from the Marxist perspective, these trends in the nursing education industry are more likely than not a result of the capitalist interests of people. As such, the synchronized responses in the nursing education industry and the demand for nurses, is primarily motivated by the potential to profit. Indeed the nursing industry has been profitable, especially for nursing schools which have decided to commercialize the course to attract more to enroll into their program. In the light of the rampant increase in nursing schools, and the subsequent decline of the quality of education rendered, the seeming response of the governments to eradicate poor-performing schools may be due to the demands of the nursing education capitalists as a whole, to maintain the image of the Philippine nursing education industry, in effect to keep their income-earning schools afloat. In the global scale, the comments made by ICN on the need for developed countries to be more responsible about producing their own nurses, may be in the light of the global nursing industry as a whole, which seeks to likewise maintain the stability of health within the labor-exporting countries.

As of late, where projections on the demand seems to continue to climb, and the world's sources of nurses is increasingly becoming unable to cope, policies are being drafted that would aim in finding the best compromise between the countries involved, that is, between the Philippines, and the countries it provides its nurses with. In the meantime, the nursing education industry would continue to attempt to maximize its earning capacity, taking into consideration, the interests of capitalists in the individual, national, or global level.

 

[WaZoBia]

i haven't even made plans to take Step 1. most of my blockmates are though.

but one thing's for sure, it would be hard for me to forgive myself i become a sellout, like that guy.

yes, gotta admit that was being judgmental.

wow, that's not very PC.

 

[PinoyDoctor]

As a non-filipino, I am open to the idea of practicing in the Philippines in order bring health care where there is a shortage. I see myself, after 15 years of practice in the US (with money saved up), going to the Philippines on a long term basis to do this. Perhaps many of the filipinos who leave their country for greener pastures feel the same?

I really do hope so... but i've spoken to a couple of Filipino physicians and nurses in the US, and quite a number of them would mention something along the lines of going back to the Philippines merely to retire. To this proportion of people, I hope they also meant giving back to the Philippines or the Filipino poor what excesses they might eventually have in their lifetime.

Peace be with you... You are a consolation to those who still have hope.

 

[kittycrinkles]

peace to those i may have offended.

i don't think i can ever understand why he did what he did (graduated nursing, went to med school, got top marks, then shifted to nursing in the US). why bother to go to med school?

this issue has also affected professionals i personally know. like my dentist's wife (also a dentist), she has just taken the nursing boards, after 2 years of re-entering school. now, she's processing papers for nclex.

i personally don't wanna reach that point, that point where i would have to exchange almost 10 years of studying to be a Filipino physician to achieve the American dream.

 

[dseattle]

its a tough call. every time a philippine professional leaves the philippines, that is one less filipino to directly serve the homeland. in some ways all international filipinos help out the philippines via remittances, mission trips, balikbayan boxes, etc, but too many bandaids, not enough treatment. at the same time could you call all filipinos in the diaspora "sell outs"? thats one in every ten filipinos that don't live in the philippines, which is hella people...and to answer whomever posted "its not a big deal as all countries have people immigrating". well it is a huge friggin deal when hospitals close because there are no professionals to work and when the health of a nation is suffering because the government/economy can't support it.

thus the conflict within diaspora. family vs. nationalism. do you deserve to get paid minimum wage for all the years/time/investment in a medical education? can you hold idealism so dear that you cant support your family or pay your bills? (in the us, the average medical student debt is $200,000). or do you do what you can, move to rural chatanooga, usa, or the middle east, just to get work and provide for your family at home and abroad?

but who is to blame? we all are. though there is no use in pointing fingers and crabbin' at each other. thats what they want us to do, instead of working together to create change. personally i dont know if i could move to the philippines for long term and provide medical services. maybe a few months out of the year and as much as i can, but its a really hard decision especially not growing up there. what would be nice is more of a collaboration between international filipinos, medical exchanges starting at the undergraduate level through graduate/continuing medical education. help teach filams that they could pursue medicine beyond their parent's pressures, and use what they learn in their diasporic lands to help the homeland.

and pinoydoc, i agree, its not a new phenomena, but this is the worst it has ever been. i talked to a filipino nursing recruiter whos been doing it for the past 40 years or so, and he said the major "improvement" was that the us gov't was providing more visas for nurses and also the families, so at least the immediate families aren't broken up. but what about the extended. immigration back then was a "choice", now, i'm not really sure what it is.

 

[tantrum]

Since i've left the Phil., I've been regularly remitting money either to family or for some projects with groups of like-minded Filipinos (like NGO's). I also have a few business interests that employs people in my community. I agree that it is not a good idea to throw in the towel and be defeatist but you have to be realistic at times. Why do you think even some surgeons with long experience are trying to become a nurse so they can leave? These people have lost hope. Whenever I go back there, the news is actually worse than reality. Living there is not that bad but you can be turned off by the level of corruption in every level of gov't (up to the baranggay level). I have plans of coming back for good but it's not because of nationalism but rather comfort level. The medical shortage there is with the rural areas which are constantly being ignored by the gov't for several generations. There is an oversupply of doctors and nurses in the big cities like Metro Manila. Why do you think some nurses are volunteering for free just to get some experience? Redistribution has always been a problem and giving EXTRA compensation to those serving the rural areas will go a long way.

 

[kittycrinkles]

i personally believe our government is to blame. alloting 1% of the budget for health is certainly not a way of encouraging professionals to stay. our present government lives for "band aid" solutions, quick short-term fixes, and has never really worked for the long-term goal of a better Philippines.

it is very sad that many Filipinos have given up on our country, and i personally cannot blame them for their decisions. but, i do believe even one doctor or nurse that stays behind to serve his country is a step closer to healing that "hemorrhage" the country has been suffering from.

i don't know whether other med schools offer exposure to the underserved population of the country. as for me, i have seen only the "tip of the iceberg", and it is devastating to just accept the situation without even trying to fight back.

 

[Spartan Doc]

I am a Fil-Am, raised and grew up in the US, but went to medical school in the Philippines. Since graduation, I return every year to the Philippines.

The current brain drain, while robbing the country of its intellectuals in the short term. Think also of the long term effect as well. Filipinos are generally known as "family first" people. Family is of utmost importance. In the 1950-60s you had people leaving their provinces to find work and sustain their families economically. But they spent their time off traveling back to the province to be with their families.

What about now, I am sure the number of households with 2 parents has diminshed drastically. Much of the bonding and the opportunities for relationship building are now lost as fathers or mothers head abroad for economic opportunities. You then have the youth being raised by their lolas, and other relatives, but what impact will this have on their future concept as a family. Usually these relatives they are left with have other responsibilites as well. Leaving the media, and its obsession with light skinned, dramatic actors left to define morality for the youth. We will not see this impact yet for several generations.

What the Philippines truly needs first and foremost is a revamp of its educational system. A country is only as strong as its weakest link. (usually the poor) If the poor have substandard education, they will not be able to make appropriate decisions. You then get to see the continuity of the current situation. Where those in power bribe the poor with basic necessities of food, and shelter in return for their votes to maintain their very corrupt regime.

Now as far as those doctors that leave the country and become nurses... Who can blame them. Just look at the match results for this year. Nearly 1000 US grads went un matched, but nearly 5000 IMGs went un matched. Taking the USMLE is expensive, and even if you do well, it may still not be enough. Doing well on the USMLE is just one necessity to get into residency... Visa issues, cultural differences, ability to interview well, finding financial means to fly to interviews and buy a new suit etc. The cost can easily be 10,000 dollars plus... All for a position that is not guaranteed.
I personallly know 20+ graduates that have scored in the 90s on their exams, interviewed, yet still not matched.

Yet nursing is cheaper to apply to, less visa problems... in fact, they give out visas for nurses. Now you take a Filipino student with a need for money to support themselves and their families. Which road do you take. Many that come here to be nurses come with the intent to later pursue medicine. But then life happens, the more they make, the more they spend, and they lose focus, or priorties change.

It's easy to blame those "sell outs" but walk in their shoes and ask yourself this. is the gamble worth it?

I have a deep respect for the physicians that stay in the Philippines to practice. I could never do that personally. I am too selfish and have identified too many materialistic needs for me and my family to exist on just 20,000 pesos a month.

 

[kittycrinkles]

The current brain drain, while robbing the country of its intellectuals in the short term. Think also of the long term effect as well. Filipinos are generally known as "family first" people. Family is of utmost importance. In the 1950-60s you had people leaving their provinces to find work and sustain their families economically. But they spent their time off traveling back to the province to be with their families.

...

What the Philippines truly needs first and foremost is a revamp of its educational system. A country is only as strong as its weakest link. (usually the poor) If the poor have substandard education, they will not be able to make appropriate decisions. You then get to see the continuity of the current situation. Where those in power bribe the poor with basic necessities of food, and shelter in return for their votes to maintain their very corrupt regime.

what you are referring to as "a long term plan" is only that of the people who go out of the country. robbing the country of professionals is not short-term. bad effects are happening right now. and it will continue, if this brain drain problem is not addressed.

isn't it ironic that many blame the uneducated poor for "selling out" to bribes and corruption when most educated people these days "sell out" to live in greener pastures?

 

[hentaisocrnmdph]

Why does it sound to me that a doctor going to nursing is a very degrading job?

Gusto ko pong mag doktor- first love ko po sigurong masasabi

Dichotomous to poverty, the search for greener pasteur is indeed one of the major problems facing not just nurses but physicians as well here in the Philippines. I hope that one day, I become a physician probably with hopes to integrate that immense knowledge with the title MD and greatly, to heal or care for my patient in the most hollistic way I can- iba na rin yung power na nakakapagpahaba ka siguro ng buhay ng ibang tao.However, the issue of poverty is already passe. Kung US naman ang gusto nating matumbok sometime in our future, poverty itself would not view the difference between a physician turned nurse or either way- so to hell with frustration over that.

I am looking at this as a future nurse and a future MD. Bagaman gusto kong maging doktor, I came to love nursing as nursing itself and not just a premed course- formality na lang siguro iyon. Nagiging insulting pa nga sa mga nurses at times pag sinasabing pre nursing course ang medicine (believe me my inuedno dito). The thing is- so what kung mag nurse ang doktor- what' s with the inuendo. Hindi lang insulto primero at superficial sampal yun dun sa doktor pero insulto din yun sa nurse. Being the nurse that I am, naniniwala ako that both professions are respective in their own fields and are equal in the say about the care of their patients. Yung doctor ang responsible sa out of the bedside treatment of the disease (disease side) while the nurse deals with the patient's response to the illness (patient side). Kung wala yung isa, walang mangyayari sa pasyente. This is one reason why I opted to take both course dahil mas buo ang pag care ko sa pasyente- walang mas mataas dun sa isa. Hindi madali para sa nurse ang tagal ng taon ng pinag aralan ng doktor in terms of the pathology of the illness pero hindi rin naman madali para sa doktor ang tamang paglinis sa sensitibo at pinakatatagong parte ng katawan ng pasyente (and believe me, this is the reason why some doctors who take the NLE fail) at pagkelaman pa ang dami ng itinae at pinagreglahan nila. Anecdotally, hindi ba, pag ang mga consultants o residents ininstructan ang intern na mag wound care sa isang fresh surgical wound or mag insert ng line or heplock at walang kahit na anong gamit yung pasyente ni betadine o bulak na panlanggas, di ba ang management ng nurse ang naghahanap ng mga kailanganin nila? Sana dito na natin tinitingnan ang issue ng MD to RN. If ever man siguro akong maging doktor muna ako, kahit wala ang issue at paradigm natin ng poverty, bakit hindi ako mag nunurse samantalang kagalang galang naman yung profession na yon?

 

[chocopinipig]

nobody said it was a degrading job. The filipino doctors are just trying to survive by shifting into nursing and earning a better paying job.

a doctor is proud of his abilities. If shifting to nursing was degrading he/she would think of changing careers in the first place.

 

[kittycrinkles]

be it nurses or therapists going abroad, our country is "bleeding" from the lack of health care professionals. and that is a sad, sad truth we have to face and address.

 

[dseattle]

great discussion so far! i hope we all will learn something from our different perspectives.

i have much to reply later, but i wanted to ask if anyone had suggestions of medical related or vacation-wise places/events to check out while in the philippines. i am going there from may 7 - june 6, and will stay mostly in south luzon, though i might go up to cagayan at some point. i will check out san beda medical college (where my counsin attends), but if anyone is willing to meet up or show me any places (i'm thinking of helping out bantay bata for a bit too), send me a private message. or if you just want to start a list of medical sites to go to that would be cool to post here. ok maraming salamat in advance! ingat.

 

[AlleghenyPOD]

Filipino Physician Picks Life as Nurse in US

what are people's thoughts on this? moreover, what are peoples thoughts on the entire phenomena that is the Philippine Diaspora? my parents immigrated here to the us in the 80's and are both physicians (feu grads), and i have always struggled with this idea.

why as filipinos must we always sacrifice? to have to put necessity over opportunity or doing what is necessary in order to provide opportunity for future generations? is it truly in the hearts of all filipinos to return home; and as succeeding generations are born abroad, is this love being lost?

i hope that filams, filipinos internationally, and filipinos in the philippines could comment and provide some insight on this. there is no right or wrong answers, and hopefully this dialogue would provide a better understanding for all of us who are connected in the struggle.

I feel for you and I do recognize the situation that is affecting the Philippine Medical System. This so called 'Brain Drain' is a rather Philippine-centric phenomenon--thousands upon thousands of recently graduated Filipino nurses flee the country to look for lucrative work abroad and significant instances of Filipino doctors going back to nursing school for a chance to practice nursing abroad.

However, when one looks at this national discourse, one can't help but see two sides of this spectrum.

The negative side of this phenomenon is that the best of the best in the Philippine medical work force are leaving the country for better pay, better job security and life style, while the rest of the country is left with the 'left-overs', pardon my French. The same can also be seen about Filipino teachers, where a growing number of teachers from the Philippines are being 'imported' to the United States to address the educational problem in the states.

I truly understand the situation and the substantial effects this so called 'Brain Drain' has had on the Republic. My sister and I are citizens in the United States only because my parents came here in the early 90s. My father, who worked as a Civil Engineer in Saudi Arabia and my mum as a nurse in the Philippines were immediately changed as soon as we arrived to the 'states. Immediately, my dad took up nursing classes considering the lack of engineering positions in NYC (where we first moved to) and the fact that a nurse's salary doubled if not trippled an engineer's. This is personal example of the discourse that has shaped the lives of millions of Filipinos that come abroad for opportunity's sake.

Yet this is also a positive factor, which leads me to my second point. The so called 'Brain Drain' can also be seen as a positive light in that it has resulted in over 10 million Filipinos living and working abroad. Literally there are 90 million Filipinos in the Philippines but over 10 million Filipinos or people of Filipino ancestry are living abroad. This in its own right is a positive factor for the Philippines because it leads to annual remmittance of over $10 billion to the Philippine economy. Fil-Ams or Canadian-Ams are sending dollars back to the Philippines everytime they buy filipino goods, movies, cds, everytime they go back to the philippines or establish homes in the country. Economically speaking, has led to a global 'Filipno' awareness so to say because in the United States, Filipinos are renowned as a significant factor and contributor to the American health system. Whereever you go in the states you will see Fillipino doctors, nurses, pharmacists, nurse's aid, diagnostician, clinician etc. The birth and creation of a Filipino-American Manifesto has been achieved here in the states (i dont know about other western states) but I know that because of the brain drain to the states, the Filipinos succeed greatly here and which in turn transcends to the general impression of the 'Filipno-American'.

Im sure its rather similar for other Asian ethnics that are living in the states and giving back to their home states, such as the vietnamese, chinese, indians etc.



All in all, I would like to end this post with a saying my dad told me when I was young. "You can take the Filipino out of his country, but you can never take the Filipino out of the man"


Mabuhay,

 

[AlleghenyPOD]

be it nurses or therapists going abroad, our country is "bleeding" from the lack of health care professionals. and that is a sad, sad truth we have to face and address.

I personally think that the situation is not as bad as what others think of it. I have relatives and family members who are in Philippine politics and when asked about the status of the so called 'Philippine Brain Drain' they say that it is only a matter of time before the situation stabilizes itself. Sure some thousands of Filipino physicians, nurses, PAs, PTs etc go abroad to work, who doesnt want that? The main point of professionals is to provide health care and show the expertise one has to a host population, this is so when it comes to the Filipino medical professional (doctor, nurse, etc) when he/she provides much needed medical care in the undermanned US medical system, Canadian system, EU systems and in the Middle East.

Why do you think Filipino medical professionals are leaving the country in the first place? The lack of jobs is prevalent in our country. Ive heard stories from my father and uncles of post-collegiates with no jobs in the Philippines due to the massive competition in the engineering, medical, fields. The country is already over populated as it is, with over 90 million people and with numerous professional schools, the Philippines is graduating thousands upon thousands of doctors, nurses, teachers, engineers, Physical therapists etc; more than what our country can accomodate. Do you think the Philippines can employ all of our possible graduates year after year after year? Of course not. Its all on the basis of the market economy. There is no demand in the PHilippines because the country is saturated with professionals, however there is such an EXTENSIVE demand of well educated and brilliant Filipino professionals abroad. Why here in the United States, most hospitals are saturated with Filipino nurses, physicians, pharmacists and many American medical professionals recognize the expertise of Filipino medical workers. I know in the OR/ICU where my mom works as a nurse anesthesist, the physicians and Director of Nursing demand 'Filipino professionals' because of the level of care they give to the patients as compared to American medical professionals, who lack the 'extra touch' training Philippine traning gives.

I like to think of the situation of this so called 'B-Drain' in a good way. Thousands of Filipinos go abroad to find well paying jobs and as a response to this give back thousands of dollars to the Philippines annually and provides a steady and profitable remittance to the country. This year, the Philippine economy has been recognized by ASEAN and economic partners in the EU, US, Japan and China as one of the "ASEAN 5" ( The Philippines, Malaysia, Thailand, Vietnam and Indonesia are the region's fastest growing economies). The Philippine economy has flourished at a rate of an impressive 5.6% GDP growth this year and our foreign exports are rising at a rate of 10% a year, which indicates the level of industrialization and infrastructure growth/infrastructure stability under the current administration. Positive growth factors indicated by the IMF and foreign banking systems have indicated a growth in the service economy, growing manufacturing arm and a booming agricultural economy. Added to this, the Philippine 'Diaspora' has played an important role in our economic progress, as over $10 billion have been given back to the Philippines this year due to the OFWs. The more we send professionals abroad, the more they will give back to the Philippines, which will trickle down itself to the domestic development of the country in terms of economics, education, government and overall national stability. Plus, one has to be realistic naman. The country has over 90 million people within a land area of 300,000 km^2; and as our populaiton grows at over 1.5% a year how can we accomdate? Immigration provides a breathing space for the country and better chances of a more effective human development index.

 

[mmu addict]

I have a lot of classmates in the US now working as nurses and they were at the top of our class, were Chief Residents in their respective fields of residency but still opted to go abroad because it is so hard to start a practice here and still be able to put food on the table.

Based on my husband's experience (he's a surgeon, I finished 4 yrs surgery training), it is so frustrating when you are expecting to be paid for a certain procedure (alloted to pay tuition, or other bills) and the patient wants you to lower the PF because they can not pay or they were discharged from the hospital with the hospital bill fully paid and the doctor is left a promissory note then the patient is never heard from again. How can you save money for your family's future with these kinds of situations?

Even working for an HMO (hubby works for 2 HMOs) is hard work with very low pay. Most HMOs pay their doctors Php100 plus per hour (around 2-3 hours twice a week) only even if you get to see 5-10 pxs for that hour. It would have been worth it to be paid per patient but that is not the case.

So that is one of the reasons doctors here prefer to work as nurses abroad.

 

[kittycrinkles]

i just don't think the government is sincerely thinking that losing professionals in the country is a problem to be addressed.

if you don't think we lack professionals, i'm sure you'd change your mind once you see the sad state that most towns are in, health system-wise.

i'm not saying that we should all stay in the country and become martyrs, literally suffering for idealism. i'm just saying that it's about time the country does something about it.

probably by encouraging professionals to come back and serve the country? let's have our biggest "imported product" back in its homeland.

and please, let us not call the people who didn't choose to leave "left-overs".

i would be a hypocrite if i say i never thought of leaving for residency in other countries. my mom has countlessly asked me about applying for US MLE after med school. she also wishes for better source of income money for me and my family.

but, i honestly want to have my residency here and practice medicine HERE. i feel a bit selfish for wanting to go with my choice over hers (the person who worked for my education), but i really want to serve ONLY Filipinos and no one else.

 

[tantrum]

There's a retrogression with immigration visas (Schedule A) for nurses going to the USA. There will be a bottleneck of nurses trying to get out. UK is now open only for EU nations. The US Congress can't even pass a comprehensive immigration bill due to lumping legal with illegal immigrants.
As for training overseas like the US, it's becoming very competitive and very difficult to match as the US is the only country left open for foreigners to train.
In a way, this will keep a lot of health professionals in our country unless they want to be underemployed somewhere else.

 

[AlleghenyPOD]

i just don't think the government is sincerely thinking that losing professionals in the country is a problem to be addressed.

if you don't think we lack professionals, i'm sure you'd change your mind once you see the sad state that most towns are in, health system-wise.

i'm not saying that we should all stay in the country and become martyrs, literally suffering for idealism. i'm just saying that it's about time the country does something about it.

probably by encouraging professionals to come back and serve the country? let's have our biggest "imported product" back in its homeland.

and please, let us not call the people who didn't choose to leave "left-overs".

i would be a hypocrite if i say i never thought of leaving for residency in other countries. my mom has countlessly asked me about applying for US MLE after med school. she also wishes for better source of income money for me and my family.

but, i honestly want to have my residency here and practice medicine HERE. i feel a bit selfish for wanting to go with my choice over hers (the person who worked for my education), but i really want to serve ONLY Filipinos and no one else.

Interesting point of view and my apologies if I offended you when I referred to the medical professionals who were unable to go abroad/ chose not to go abroad as 'left overs'--please note that I indicated this clause with a "pardon my french".

I cant help but read over your post with intrigue, particularly in reference to your self claimed 'idealism'--and I do respect you for your endeavor to serve the Filipino people; to provide much needed medical care. Perhaps you will be one of the physicians who will go to the provincia and 'fill in the gaps' in what you claim as the "sad state that most towns are in".

----

Coming from my uncle who is a physician, he told me that "in the end, its all about returns. As Medicine is a service." And to be true, he is right. Capital is very incentive, kit.

And I do plan in providing medical care to the Filipino people as well; perhaps in the summer as part of a free health care trip in the future. Unlike you, I dont wish to ONLY treat 'Filipinos'. As a physician is expected to treat PEOPLE--and we as professionals are not to biase against one's nationality--or favor one over the other.

Regards,

 

[kittycrinkles]

I'm quite troubled that I gave you that impression.

I never had and will never have any sort of bias against serving other nationalities. I'm currently being trained in a Filipino government-funded institution and, though many of our upperclassmen have chosen to further their studies in residency programs in other countries, I wish to stay here in the Philippines and serve the people, the Filipino taxpayers, who have indirectly contributed to my education.

Medicine is indeed a service and I choose to serve people who I believe needs that service the most.

Too much idealism ba? I'm afraid I would eventually gobble up my words.

 

[AlleghenyPOD]

Kammusta kit,

Hey no problem, we're just exchanging our ideas, diba? I like reading and getting to know other people's points of views--as it contributes to my own ideology and point of view in a topic.

You know there is nothing wrong about your idealism--if it is in your nature naman to be goal oriented in helping your fellow countrymen--then God Bless you for that and always keep that passion strong. My views are mine and so do you---etc.

Im more of a realist and a practicalist; always have been in my life. I do believe strongly in a multicultural medical work force, dahil my parents are part of a multicultura allied health system here in the states. Heres an example of me and my fellow interns:

 

[dseattle]

dopeness, i'm glad this discussion is still going. it gives me a lot of hope in medicine, the motherland, and definitely a good break from seeing the same forums over and over again about circular debates on affirmative action, do vs md, and raising/boasting numbers. but i apologize in advance for not commenting on the current discussion at hand, i'm still getting caught up on all of it. but i got to get something off my chest real quick and it seems like many of you may have been in the same situation, and/or could provide some insight.

ive been back from the philippines for about a month now after staying for a month and am still in a confused state of disillusionment.

the whole reason i decided to pursue medicine and an mph was because i convinced myself that i had a connection with all marginalized people through my cultural identity, and i could use this connection/understanding to help bring some equality (oxymoron right?) to society through health care, because i believe it is the most tragic of disparities and the most basic of human rights. in some ways i feel i have built some sort of debt by being "privileged" and that i have to pay this back to society (sounds patriarchal and pseudo-kano philanthropic huh?), but because i was not so far removed from "the people" (only one generation) that i was unique. because every generation before me has dealt with some struggle: colonizations, wars, dictators, immigration, prejudice, etc, and for me to have grown up with some sort of peacetime and escape from all of that, i still wanted to return--kinda like that quote "i am here now because i stand on the backs of many". (all of this was originally catalyzed by my first 2week stint in the philippines and developed through many orgs, books, discussions, and workshops).

but after coming back this whole idealistic structure came into question. my dad asked me when i came back what i thought. after telling him my experience he said something along the lines of, "well now you know why we left", "change is a lot harder than you thought", "things arent easy". someone mentioned on this forum about how the corruption at every level can really hurt you, change you, and in some way it has for me and i dont know if this change is for the better or worse. i wouldnt say i am part of a political dynasty or whatever but i do have relatives in the political system, from local mayor to government. during the last election all but a congreso lost. just being in the country during election season is really messed up. aside from the obvious violence there is a lot of bullsh*t everywhere. (1) the commercials that promise to bring down smokey mountain and turn it into condos, has the literally puti-washed (no offense if you are naturally puti or kayumanggi) walking among the barrios and plantations pretending to do something, all with some sad background music and dramatic effects; (2) vote buying is the norm and expected; (3) campaigning costs way more than political salaries; (4) and i could go on. fortunately my family doesn't participate in this corruption. however, seeing my uncles lose to the obviously corrupt candidates (who have proven it through past terms, and are well known for their connections with drug pushers and gangsters), theres a part of me that wants to lose hope. that democracy isnt working in the philippines or that it has been abused beyond recognition. that votes are made on whims...mostly of which are irrational, and only sometimes does it work out. i can somewhat see the justification for why people want a drastic change toward anything or even allowed marcos to become a dictator and how some still believe that he did good for the country. but there is also a part of me that cant lose hope, even though everything has become way more complex.

my confusion could be the fact that i have become hypersensitive to everything, studying a lot of political systems, histories, sociology, ideologies, contemporary issues, atbp(etc), or that i was just in the wrong places at the wrong time. but for many of you filams out there i know you always feel some sort of guilt or frustration when you come from the upfront poverty everywhere you go in the philippines, and come back to americatown, usa to eat buffets and buy whatever. you just feel bleh...i cant even write or think coherently, so i apologize if this entire post makes no sense.

i still want to believe in change and hope that there is something, some group or some movement to really make a difference but my idealism is wandering around somewhere in a sea of complexities, and hoping not to drown in nihilism, cynicism, or defeatism. can anyone offer any help? i am hoping this will all surpass in time or once i get out to serving in community health centers or start school again, but any advice would be cool and much appreciated.

also, random question to lighten things up real quick since this is all getting pretty serious, have any of you worn a barong tagalog to your white coat ceremony?

ok, thanks in advance!

 

[Saipan]

Yeah, it can be hard to put into words, but it's worth trying.

I think a lot of the frustration arises when we suddenly realize that despite all or hard work and good intentions, that we actually have very little ability to effect change in others.

The problems in the PI (political, economic...etc) you discuss are not going away and "sacrificing" your life/career whether for two months or a decade won't really change anything, although hopefully it gives you good feelings.

You can try to help people, and it's nice to help people but ultimately only the people or the "masa" can help themselves.

A trike driver is destined to remain a trike driver despite any work or intentions on my part. It's only when I see a trike driver reading a book trying to learn something in between his trips that I will feel real hope for the nation's problems. Unfortunately most trike drivers seem to spend their down times sitting on their ass smoking.

 

[AlleghenyPOD]

Yeah, it can be hard to put into words, but it's worth trying.

I think a lot of the frustration arises when we suddenly realize that despite all or hard work and good intentions, that we actually have very little ability to effect change in others.

The problems in the PI (political, economic...etc) you discuss are not going away and "sacrificing" your life/career whether for two months or a decade won't really change anything, although hopefully it gives you good feelings.

You can try to help people, and it's nice to help people but ultimately only the people or the "masa" can help themselves.

A trike driver is destined to remain a trike driver despite any work or intentions on my part. It's only when I see a trike driver reading a book trying to learn something in between his trips that I will feel real hope for the nation's problems. Unfortunately most trike drivers seem to spend their down times sitting on their ass smoking.

Couldnt have said it better myself.

 

[tantrum]

I go home a lot but I always try not to be negative. It will be very frustrating if you think about the politics too seriously. You can only do a little bit as an individual. I tend to join groups like NGO's ( even health groups) that tend to be service-oriented. It might take generations to see some improvement but there is still hope as long as it does not become a failed state. Healthcare is not a priority of politicians and unless they see a strong group of advocates or it will affect their votes, I don't see them changing.

 

[kittycrinkles]

Learned helplessness --- that's what I think most Filipinos below the poverty line have come to inculcate in their minds. They know they can be better, but since the odds seem to be against them, they just adapt... they settle for what is currently theirs.

It is sad to go to a remote place in the country and learn that someone died from a sickness that could have been easily treated had proper medical facilities been available.

But, I'm very hopeful that all this can still change. That our country could have a better health care delivery system than it has now.

And, one way of starting such a change is by electing leaders who are aware of this problem and are willing to address it.

It's just too bad that most politicians are keen on giving out promises that sectors wanna hear, and not really act on it when they're in their positions of power.



EDIT: Oh wait, I think this "rant" doesn't belong here. Sorry!

 

[kittycrinkles]

i got these alarming data from an email:

Health Budget:

1. Budget for health is only 2% of the GNP, a far cry from the WHO recommendation of at least 5% for a health care system to thrive
2. The budget translates to Php 0.43 ( US$0.0086 ) per Filipino per day
3. Most of our health expenses are out-of-pocket (One of the Highest in Asia)

Diaspora:

1. We produce 2,000 doctors a year, but 3,000 leave the country every year
2. Before 2001, around 6,800 student take the Medical Entrance Exam (NMAT), but now only 2,500 took the exam

Impact:

1. Doctor-patient ration is 1:26,000 (ideal is 1:6,000)
2. Majority of doctors in urban areas
3. 80% of doctors in community hospitals are taking nursing and will be leaving the country soon
4. 200 hospitals have recently closed down, 800 hospitals are considered partially closed down because of lack of doctors

this is how the phenomenon has affected the country. a very sad reality.

 

[tantrum]

i got these alarming data from an email:



this is how the phenomenon has affected the country. a very sad reality.

I agree that the general trend is bad. Just a few points.

1. As poor as the health budget is, a portion of it goes to waste due to corruption.
2. We are still producing 3,000 doctors a year (they give 2 exams each year and the latest passers number in the 1700's X 2 will still exceed 3,000) BUT...
If the NMAT applicant continues, there will be less doctors in the future as doctors WILL continue to leave.
3. The main problem is not just the actual doctor: patient ratio but distribution. Very few wants to practice in the rural areas where there is nothing in terms of support or infrastructure. This is a perennial problem even in developed countries.

 

[kittycrinkles]

AND the health insurance system in this country still doesn't cover majority of the Filipinos. that is why many Filipinos literally die without ever seeing a doctor.

 

[AlleghenyPOD]

AND the health insurance system in this country still doesn't cover majority of the Filipinos. that is why many Filipinos literally die without ever seeing a doctor.

That is so sad to hear this, yet it does fit in with the Malthusian concept...

 

[buckley]

Hmmm...interesting thread...I will answer back with what a teacher of mine told me..." If you think you can leave and find greener pastures elsewhere, go. You can help this country more if you help yourself more."
That being said, the road to finding that greener pasture is really tough. And there's not a day that goes by if you wonder if it really is greener...I'm sure my classmates who stay feel the same way. I don't think anyone really ought to compare med grads who stay, leave as doctors or leave as nurses. It's all about CHOICE. Everybody makes sacrifices.
DO I hate the fact that I have to swallow everything Uncle Sam's system throws my way to be the kind of doctor I want? (Again I am speaking personally, I don't mean to imply that those who stay or become nurses are not decent doctors)...Sure there are days. But what do I do? I\I certainly did not embark on my own version of the American dream thinking it would be easy...And no, it's not about colonial mentality either. For me, it really is about LIVABLE residency training. Again, Im sure there are those who find Phil residencies livable to their own standards...
Kittycrinkles...hahaha...I swallowed my own words when I said I wouldn't take the MLE. Like you, I was taught/conditioned to think of MLE as a sell out. My advice--talk to people who've gone that way. I think you will find that the so-called sell-out-brain-drain-riders are actually pouring mega support to the medical education in the country. I hope I can be one of them. Be idealistic, yes, but I caution you in being judgmental.

 

[kittycrinkles]

i'm not really judging people who have gone to take residency programs in other countries. it's really a matter of what you prioritize. it isn't wrong to choose to work and to live comfortably.

i was saying at the earlier part of this thread that i feel disappointed that other medical students/doctors would choose to leave their medical profession to pursue a life working a different job in other countries. i understand they do it for a more comfortable lifestyle. but, i would personally find it difficult to give up a medical practice for a different job (e.g., nursing, teaching, etc.) in another part of the world.

i love medicine that much. i don't ever want to expect a different life for myself. i may be taking back these same words some day (with parents who keep on insisting that i take the US MLE), but i truly truly wish i wouldn't.

i don't fault others for doing what they do or plan to do, in the same way that i shouldn't be faulted for choosing this path that i want to take (a fool's errand it may be).

 

[Saipan]

i love medicine that much. i don't ever want to expect a different life for myself. i may be taking back these same words some day (with parents who keep on insisting that i take the US MLE), but i truly truly wish i wouldn't.

[/I].

It's great that you have such enthuasiasm and optimism, but aren't you still a medical student. Practicing medicine and balancing that with trying to have a life (for twenty, thirty, or even forty years), is a lot different than anything you can actually envision at your stage in life.

I could ask you a hundred questions. Will you get married or have children? Will they go to a public school or a private school? How will you pay for that private school? The tutors? The music lessons? Are you going to commute to work on the jeepney, or will you drive a nice car. How will you pay for that nice car. Car loans in the Philippines are easy to get now (for people like doctors).

But if u take out that car loan, have you thought about how you will meet the monthly payments. How will you balance your practice so that you will have enought to pay the bills, and to buy the nice things that most people inevitable want when they get older and have families. What will be your priorites once you have tied yourself to a four or five year car loan?

Maybe you have thought of all of this and have answers to all these questions. If so, then you are to be congratuled on your foresight and maturity.

But my thought here is simply to suggest that life rarely turns out the way people plan it. Life throws curveballs at everybody, and that's before we consider things like hormones and neurotransmitters... which basically turn everybody into a different person than the one they were at age 20 something.

Enthuasiasm is a wonderful thing, but the bottom line is that you are a person distinct from "medicine", so don't be surprised if life has something else in store for you.

 

[bleudsky]

i'm not really judging people who have gone to take residency programs in other countries. it's really a matter of what you prioritize. it isn't wrong to choose to work and to live comfortably.

i was saying at the earlier part of this thread that i feel disappointed that other medical students/doctors would choose to leave their medical profession to pursue a life working a different job in other countries. i understand they do it for a more comfortable lifestyle. but, i would personally find it difficult to give up a medical practice for a different job (e.g., nursing, teaching, etc.) in another part of the world....

i don't fault others for doing what they do or plan to do, in the same way that i shouldn't be faulted for choosing this path that i want to take (a fool's errand it may be).

well, some left for good reason/s. not entirely to live comfortably.

i have a friend who unexpectedly quit medical school during her 2nd yr because of family problems. she had no choice but to be the breadwinner since she is the eldest child. thankfully, her pre-med was PT so finding a job overseas was advantageous for her. and yes, God has been kind to her after these years.

i asked her when did she feel the rewards of her work. she said that it was just this year and she paid for it with a high price (i knew what she meant & it was very personal). she also said that given the chance to go back, she'll always choose to be a doctor. nevertheless, she's still happy with what she's done, proud of what she's been through, and what she has become.

i guess we all have our own fate, each path to take. What matters is that we're happy, whether as doctors or other health care professionals.

 

[bleudsky]

It's great that you have such enthuasiasm and optimism, but aren't you still a medical student. Practicing medicine and balancing that with trying to have a life (for twenty, thirty, or even forty years), is a lot different than anything you can actually envision at your stage in life.

I could ask you a hundred questions. Will you get married or have children? Will they go to a public school or a private school? How will you pay for that private school? The tutors? The music lessons? Are you going to commute to work on the jeepney, or will you drive a nice car. How will you pay for that nice car. Car loans in the Philippines are easy to get now (for people like doctors).

But if u take out that car loan, have you thought about how you will meet the monthly payments. How will you balance your practice so that you will have enought to pay the bills, and to buy the nice things that most people inevitable want when they get older and have families. What will be your priorites once you have tied yourself to a four or five year car loan?

Maybe you have thought of all of this and have answers to all these questions. If so, then you are to be congratuled on your foresight and maturity.

But my thought here is simply to suggest that life rarely turns out the way people plan it. Life throws curveballs at everybody, and that's before we consider things like hormones and neurotransmitters... which basically turn everybody into a different person than the one they were at age 20 something.

Enthuasiasm is a wonderful thing, but the bottom line is that you are a person distinct from "medicine", so don't be surprised if life has something else in store for you.

now i know what u mean. now, i understand why other doctors (in pinoymd) are telling me "welcome to the real world". definitely, it's so tough, more challenging compared to being students.

"with great power comes great responsibility."

 

[kittycrinkles]

i have dozens of things troubling me right now, but one thing is clear... i wanna stay in the country. i am not entirely closing the door to a change in plans, but i do hope it would not come to that, however grave or personal that reason may be.

my mentors in medschool are both GP and tireless community physicians. i guess their stories have somehow influenced me to build this strong perception of what i would ideally want for my future life as a Philippine-licensed physician.

 

[buckley]

I agree...there is definitely more to me than medicine. Should I end up practicing a different profession, I am still me. I AM A PHYSICIAN, BUT THE PHYSICIAN IS NOT ME. Med School has a way of eating you up and medicine becomes the center of your universe. Love your job, but remember there's so much more to you. It's only now that Im out that I realize how boring my ife has been being centered in medicine. Now I am rediscovering the wonder of riding a skateboard and walking down the beach.
Some of my classmates have excellent physicians as parents, but they'll tell you they paid the price. While Mommy and Daddy was serving the patients, and looking shiny as hell to any NGO/Academe/Charitable/Philippine Devt setting, they had no one.
And I know of at least one valedictorian of the UP College of Medicine who, after internship, decided to be a full-time housewife. I respect her choice. Some people say, it's a pity so much money was wasted on her...I say: Just because she was smart enough to get your free education doesn't mean you own her life...

 

[bleudsky]

read this guys:

http://www.gmanews.tv/story/64210/New-doctors-nurses-should-work-2-yrs-in-RP---PMA

 

[kittycrinkles]

forgive me if i go technical. i hate a piece of writing that doesn't even seem researched.

the article didn't even include what the bill was all about. such crappy piece of journalism if you ask me.

ON TOPIC: a survey has been done in my school regarding requiring our graduates to serve the government for at least 2 years. surprisingly, the overall response was positive.

 

[bleudsky]

total BS, if you ask me. tsk tsk!

 

[WaZoBia]

Gotta agree with bleudsky

 

[chatu11]

it's for the financial security, luxury, and convenience, and the healthcare industry has the open door for these. Casual survey tells that almost no nursing students (or grads) at least for this generation's really enthused doing the healthcare in it's bona fide essence. I view the diaspora as the getaway to an apparent, convenient , and luxurious living, and future.

Plus, the social security system elsewhere(where most Filipinos go to) is way better, ours here's not even close, i think it's even way down, because of insufficiency that it's almost not actually social security.

There's basically no money here in the Philippines. Without money, people can't have TOurs to Europe, top-of-the-line cars, high end gadgets, fund for good investments, and all the stuff that can make life "feel good", and with all these things, the yearning for something "better" if not the best is kind of what's happening.

But without money good medical missions and campaigns are almost not viable.

We offer free service but we can't offer free medication.

i rather stay home

 

[dseattle]

http://www.facebook.com/group.php?gid=4812052884#/group.php?gid=4812052884