Outsourcing blues

ANAHEIM, California – Outsourcing, specially the variety that exports jobs, is bad trip for a lot of ordinary Americans. One hears a lot of grumbling not just about the loss of American jobs but the quality of service being provided by foreigners who replaced them. I normally dismiss such complaints as so much sourgraping, an inability to adjust to globalization, ironically, a basically American invention.

But more and more I am starting to see that we who provide those basic outsourced services from overseas will have to listen and do something about some of the quality complaints. Eventually, companies like airlines and Internet services firms that contract their call centers and help desks to companies operating within our shores, will start re-evaluating how their own competitiveness is affected by quality concerns.

It is common enough to hear of people complaining about the inability of offshore call centers to help airline passengers rebook reservations and locate lost luggage. There are also common complaints about operators in offshore help desks to provide the technical assistance of US-based customers.

The biggest nightmare of people who call customer service here is to hear an Indian voice answer their call. This is probably why some companies here are experimenting with part timers getting airline customer calls from home-based call centers. At least customers hear an American voice, one who understands their local concerns.

But there is no turning back. The Americans will just have to adjust to the brave new world of global telecommunications and offshore customer service. We just have to get better at providing those offshore call center jobs. And better yet, move up the service value chain from mere call centers operator service to business process outsourcing jobs requiring higher technical or artistic skills. The stakes are large.

The Philippines raked in offshore service generating revenues of $2.1 billion in 2005, placing third behind India and China and slightly ahead of Malaysia. That’s up 62 percent over the $1.3 billion it gained in 2004, and a huge increase from the start of the decade when the outsourcing industry in Manila employed just 2,400 people and the industry had revenues of merely $24 million.

Businessweek reports our outsourcing sector currently employs over 200,000 people. That is still way behind India’s 750,000, but Manila is catching up fast. The Business Processing Association of Philippines estimates the industry will chalk up 57-percent growth this year with total revenues of $3.3 billion and is on track to deliver nearly 48-percent growth in 2007 to $4.9 billion.

The good news, according to Businessweek, is how our recent growth spurt has been fueled not by traditional low-value-added call centers but more higher-end outsourcing such as legal services, Web design, medical transcription, software development, animation, and shared services. We have started to leverage our creative design talent pool, our large pool of lawyers, and our professionals in accounting and finance.

Now, that’s really good news. Imagine that… who would have thought our lawyers can be productive dollar earning workers too! We all thought our large pool of lawyers were just good for creating mischief as politicians and bureaucrats and fixing cases. But then again, I suspect they are talking of topnotch lawyers who are able to think and communicate in good English.

An Indian-based firm acquired by US printing  services giant R.R.Donnelly has chosen the Philippines as the springboard for its legal services outsourcing services. An officer of the firm told Businessweek that "in Manila, every lawyer seems to know what Roe vs. Wade was about. In Chennai, they may have some of the finest legal brains in the world but not everyone has heard about Roe vs. Wade or other key cases in US Supreme Court." Most Filipino lawyers sit for US bar exams and that gives Manila a leg-up over India , China, or Malaysia.

Now, if that isn’t good news, I don’t know what is.

Local doctors

One of the things I miss after my parents died is the regular dinner table debates among all the doctors in my family. I barely understood the stuff they were talking about but I found it great to see how the discussions sharpen their minds. I guess I have been subconsciously trying to recreate that atmosphere so that I am inclined to feature emails from doctors who regularly read my column and opposing comments to those views. Here’s one from Dr. Jonathan Nolasco reacting to a comment made by a surgeon, a regular email writer to this column, last week.

Your Dec. 29 article on "Local Medicine" came to my attention only when I heard some (take note, NOT ONLY ONE!) of my colleagues from different generations talking, or rather complaining about it. Needless to say, they (count me in too) were not so happy about what they read.

I wonder what type of doctor this colonial mentality friend of yours is. God bless his patients if he is still in active practice. He sounded so layman to me, i.e. the stereotypical "ah galing sa US yan, siguradong magaling yan" type of Filipino patient. Again, correct me if I’m wrong, he obviously is not a surgeon too, or is he a "Doctor to the Barrio"?

Now let’s get down to the details:

• Regarding laparoscopic surgery, whenever a patient is scheduled for gallbladder surgery, the option of traditional open vs. laparoscopic approach is always presented, depending on the feasibility. As you would expect, the latter is more expensive, therefore thrifty Filipinos usually opt for open surgery.

Another important reason is that many insurance companies will not shoulder expenses for laparoscopy. Now you see how these insurance companies are a bane to medical practice, not to mention the extremely and demoralizingly low pay and perennially delayed (six months to forever in many cases) settlement of professional fees. Shocked? First time to hear this? Now you know how this becomes another major factor for the brain drain.

Going back to laparoscopy… the point is, it’s not the lack of expertise. As a matter of fact, laparoscopic surgery is an integral part of the training of almost every surgical residency program in the country, such that most graduates of an accredited surgery training program can perform the procedure competently as soon as they go into private practice.

• Regarding mastectomy, just like gallbladder surgery, economics is key. In case your doctor friend didn’t know, if you perform less than a mastectomy (FYI, then it’s called lumpectomy), post-operative radiation therapy is mandatory. Five to six weeks of that daily, plus the intensive monitoring, imagine how poor Maria Clara can afford that.

Believe it or not, most Filipino women would rather lose their breasts if the pros and cons are presented clearly. As a rule, even in your idolized land of the free, the patient has the right to choose. In addition, we still get a lot of tumors as big as apples here in our developing country – cases not amenable to breast conservation. By the way, nobody does radical mastectomy anymore, perhaps that’s why your uninformed friend thinks it’s banned, modified radical mastectomy is the proper term.

• Exploratory laparotomy the most popular operation in Makati Med? O’ come on, get your facts right! Non-surgical laparotomy? No point in discussing this — the term itself is grossly wrong. There are always proper indications for any form of treatment. Let those in the know talk about this, lest we take them out of context.

• Regarding Oncology, mind you, the Philippines has its own Oncology Society. So who cares who’s accredited by George Bush?! Even Europeans, Australians, Japanese, and other Asians don’t even dream about being accredited by American College of Whatever Specialty. Only stupid Filipinos want everything approved by Uncle Sam, even where to jail rapists!

"If one has a big prostate, this will be operated here for sure." Oh please prove it! That’s plain BS!

I was concerned that your friend’s letter was published in your column. The uninitiated reader who believes everything he reads may be misled. It is not even a wake up call to doctors. This is dangerous, and it certainly will not help medical tourism. Aahhh… screw medical tourism. We’re just here to do our job, help those who want help. To the non- believers, go to the US and be treated there. Like I said, the patient has the right to choose.

St. Luke’s is affiliated with Memorial Sloan Kettering Cancer Center in New York, so forget about Hopkins. After all, St. Luke’s is a private institution and has the right to protect its own, unlike our inutile politicians who signed the VFA.

I’ve had the privilege of working with different American doctors on several occasions. Honestly, I’ve seen better Filipino doctors – a lot of them.

Happy New Year!

Nagging question

Now, here’s Dr. Ernie E.

A young bride and her husband were about to consummate their marriage.

The groom asked, "Darling, am I the first?"

The bride responded, "Why does everybody ask me that question?"

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