They need doctors here, too

ANAHEIM, California – Not only do they need thousands of nurses here, a physician shortage also looms as demand for health care explodes. An article in the Los Angeles Times last week, warned "an aging America needs more doctors, but supply isn’t keeping up. Experts fear worsening quality and dangerously long waits for appointments."

Twelve states – including California, Texas and Florida – have some physician shortages now or expect them within a few years, the Los Angeles Times reports. "Across the country, patients are experiencing or soon will face shortages in at least a dozen physician specialties, including cardiology and radiology and several pediatric and surgical subspecialties."

How are the Americans coping with the problem? Well... there is political pressure to lawmakers to allot more funds to boost physician training and "to ease limits on immigration of foreign physicians, who already constitute 25 percent of the white-coated workforce." But it may be too late to head off havoc for at least the next decade, experts interviewed by the LA Times say, given the long lead time to train surgeons and other specialists.

In the meantime, "people are waiting weeks for appointments; emergency departments have lines out the door," a spokesman for Merritt, Hawkins & Associates, a national physician search firm told the LA Times. "Doctors are working longer hours than they want. They are having a hard time taking vacations, a hard time getting their patients into specialists."

The report about a physician shortage is news to most people. For a long while, the concern voiced by medical associations is that America is producing too many doctors, specially for the type of HMO driven medical care that has come in vogue. Doctors joke that they may soon be driving taxis. This is probably why medical schools has limited enrollment, and as a result, the number of medical school graduates has remained virtually flat for a quarter century.

But now they predict "aging baby boomers will push urologists, geriatricians and other physicians into overdrive." As it happens, a large number of the nation’s physicians are baby boomers themselves. As much as a third of this nation’s 750,000 active, post-residency physicians are older than 55. By 2020, the Times reports, "physicians are expected to hang up their stethoscopes at a rate of 22,000 a year, up from 9,000 in 2000. That is only slightly less than the number of doctors who completed their training last year."

How bad is the situation? The Times report "the wait to see a dermatologist for a routine skin cancer examination in 15 big cities including Los Angeles averaged 24 days, according to a 2004 survey by Merritt Hawkins. For a routine gynecological checkup, women faced an average wait of 23 days, the survey showed. To see a cardiologist for a heart checkup, the wait was 19 days. And to have an orthopedic surgeon check out a knee injury, the average wait was 17 days.

Does this mean Filipino doctors no longer need to study nursing to get a visa to migrate to America? I emailed a physician friend who is familiar with the situation here and at home for a reaction. He thinks the deterioration in the quality of training in Philippine medical schools would most likely still keep Pinoy doctors out of American hospitals despite the physician shortage problem.

He wrote that there is "the inexplicable acceptance even by the media, for doctors turning to nursing as their only way out. But no one is asking, why not travel as doctors? Up till the 70’s, our medical graduates did. As you can see the REAL reason why Pinoy doctors have to leave as nurses is probably too difficult for the country to accept. Our medical graduates do not pass the entry exams for doctors as they did a couple of decades ago."

My doctor friend explained why our new generation of doctors aren’t good enough anymore. "The educational crisis, you wrote about recently, INCLUDES medical education. The time will soon come when all our doctors will only be locally educated and trained. At that time, not only the poor, who have no real choice in health matters, but the middle and the upper class will be in a health crisis. Even now, l keep reminding the rich and powerful, that one day (God help!), they will be under the tender mercies of these purely locally trained doctors when they are unable to travel for their needs."

In addition to inadequate training, my doctor friend also pointed out another problem... the way we regulate medical practice. "We regulate practice and vicariously the training, which in economic terms amount to protectionism of the ugliest sort. It takes 12-15 years to produce a doctor. Is that doctor good enough for our families without foreign training? Think about it."

There was a time up to the 70s, my doctor friend recalled, when most of the leading hospitals in America had Filipino doctors among their most prominent staff members. Now, he said, there are more Indian doctors, who more often than not, also have a PhD in addition to their MD credentials.

So it would seem that the shortage of physicians here is not about to result in any further drain of medical personnel from back home... not as physicians anyway. Our niche, it would seem, is the nursing profession... but only so long as we do the right things in training our nurses according to world class standards. We would still have a crisis in our health care system as a result of inadequate number and quality of doctors but we can’t blame that on a brain drain to America.

Quality care

Speaking of our nurses and doctors, I got this email from a classmate at UP Prep who is a UP-trained doctor, married to another doctor who had to undergo cancer treatment recently. She was commenting on a column we had that covered nursing education.

I can understand why US hospitals would rather hire nurses from China and India. I had the chance to observe China-educated nurses last year when my husband was confined in Hong Kong. I found them very professional, efficient and even passionate about their work.

They are able to make intelligent assessments about the patient’s condition and make referrals directly to the attending physician, unlike the practice here where resident physicians (there were none in the two hospitals where my husband was admitted to) are the ones expected to do that. There was none of that vintage friendly smile Filipinos are known for but they didn’t come across as arrogant or uncaring. Somehow you just know you can trust them.

Your reader is right. Our nursing education needs to be more focused on things that matter. Cut down on the time spent for less important things like folding bed sheets and changing linens. (No joke – they do learn that too.)

And while we’re on the subject of health care we might as well look into the training of our doctors so we could be at par with our Asian neighbors. (Ouch to that). I’ve seen the enviable results of treatment at Singapore and Hong Kong among patients who went there after our doctors here practically gave up on them and told them they were hopeless.

Telecom tax perks

It is just as well that Trade and Industry Secretary Peter Favila got the Board of Investments to refrain from throwing away such perks as income tax holidays to just anyone who applies for them.

If this administration wishes to be credible to the overburdened taxpayers, BOI should recall its earlier approval of tax perks for the 3G upgrade of the telecom companies. Rep. Joseph Santiago, a former NTC Chairman, also joined Rep. Danny Suarez in protesting the incentives granted to the telecom companies.

"It is bad enough that telecommunication providers are already among the least taxed entities," the lawmaker from Catanduanes said. He cited a congressional study showing that telecommunication firms have been paying an effective value-added tax of less than one percent – 0.86 percent – on sales since 1999.

PLDT, Smart’s parent, and Globe, "have been operating very profitably and do not need pampering" through more incentives, Santiago pointed out. Santiago pointed out that "owing largely to Smart’s robust earnings, PLDT’s net profit surged by 22 percent last year to P34.1 billion. Globe reported P10.3 billion in net profits last year. In the first quarter, PLDT and Globe netted P8.6 billion and P3.5 billion in profits, respectively.

The combined incentives granted Smart and Globe – income tax holidays for six years and duty-free importation of capital goods – are worth at least P5 billion, Santiago estimated. Surely, the telecom giants do not seem like they need the investment incentives the BOI carelessly gave them.

Applicants

PhilStar reader Bobby Tordesillas sent this Pinoy joke.

Two girls nag-aaply ng work. One matalino, one bobo.

Matalino: Buti ka pa natanggap. Ano ba’ng ginawa mo?

Bobo: Wala. Nung nag-fill up me ng form, nilagay ko sa Sex, sure.

Boo Chanco’s e-mail address is [email protected]