A doctor shortage

If having good intentions was good enough to make our lives better, we would be a First World country by now. We have a lot of people who are very good in drafting and articulating worthy policies, but we are notoriously bad in implementing anything. The budgets of the various departments are inadequate for the tasks that confronts them, but a good portion still remains unspent.

That’s the thing too with health. PIDS, the government economic think tank, says that while the country’s policies on health service coverage articulate progressive goals, there is a paradox in the policy articulation and the actual performance of the Philippine healthcare system.

“Looking at our health policies, the Philippines is the most progressive among our Asian neighbors. Many articulations of our laws are investments for the poor,” PIDS senior research fellow Valerie Gilbert T. Ulep said at a recent webinar. But Ulep sees the Philippines as a “microcosm of global health inequalities”.

Disparities in hospital bed density reveal accessibility issues, particularly in Mindanao, with many provinces having less than one bed per 1,000 population. Inequitable health service access is also seen across locations and hospitals.

There is the big problem of not having enough doctors. A 2019 study by the UP Center for Integrative and Development Studies found out that “for the last five years, all medical schools across the country only graduated an average of about 3,000 students annually.

“About 80 percent of these graduates will eventually pass the medical board exam. However, further attrition is expected between passing the boards and practicing as a doctor in the country. A significant portion of qualified doctors will leave for overseas work.”

The study cited the prohibitive cost of medical education in the country, ranging from a low of P44,000 per year in the most heavily subsidized public university to a high of around P300,000 in a private one. On average, it will take about P2 million to put a student through medical school.

The passage of the Doktor para sa Bayan Law or Republic Act No. 11509 made it possible for 17 state universities and colleges (SUCs) in 13 regions to now offer medical education. The law aims to produce more physicians by offering students free tuition, book, living and other allowances.

But what kind of doctors will the law produce? Do we have enough good medical educators in all those SUCs? Perhaps, we need a shift to a basic and shortened medical curriculum that emphasizes primary healthcare in local communities over specializations. We need to solve the immediate problem of unstaffed health centers. Doctors with specializations tend to choose to practice in urban areas, but the greater need is for rural doctors.

A shortage of doctors in the rural areas is also a big problem in the United States. In an article in The Economist, the Association of American Medical Colleges estimated a shortage of 124,000 doctors. This makes no sense, The Economist observed.

“The profession is lavishly paid: $350,000 is the average salary according to a recent paper by Joshua Gottlieb, an economist at the University of Chicago, and colleagues. Lots of people want to train as doctors: over 85,000 people take the medical-college admission test each year, and more than half of all medical-school applicants are rejected. And yet there is a shortage of doctors. What is going on?”

The Economist reports that more than 100 million people today live in an area without enough primary-care doctors. With less than three physicians for every 1,000 people, America is behind most other wealthy countries, despite spending vastly more on healthcare.

Apparently, the US Department of Health and Human Services warned of a troubling surplus of 70,000 physicians in most specialties. It recommended reducing the numbers entering medical school and suggested that foreign medical-school graduates be restricted from entering the country.

Medical colleges listened, and matriculation flatlined for 25 years, despite applications rising and the population growing by 70 million over the same period. “Not everyone who would be willing to go through that training and could do it successfully is being allowed to,” says Professor Gottlieb, the economist.

In reaction to this artificial doctor shortage, a new type of medical degree gained popularity: DOs (doctors of osteopathic medicine). In most countries, an osteopath is someone who manipulates middle-aged spines. In America DOs are fully-licensed doctors. They represent about 11 percent of the physician workforce and 25 percent of medical-school students.

Nurse practitioners and physician assistants have been given responsibilities typically reserved for doctors, such as writing prescriptions. Foreign-trained doctors have filled some of the gap too. Yet, the shortage persists, The Economist reports.

For us, our problem probably is also because our medical system is a clone of the American pay-as-you-go and for-profit type of healthcare system. At least the Americans have health insurance, and even the poor have Obamacare. It seems from the Filipino patient’s POV, a socialized healthcare system like in Canada and in many European countries is more responsive to our needs.

Because our government’s healthcare budget is so limited, the out-of-pocket expenses of patients, even the poor ones, are significant. They end up running to their congressmen who then dole out assistance from their pork barrel funds… and that strengthens the hold of politicians over constituents.

Many private hospitals have serious financial problems. Before MVP rescued Makati Medical Center, it was on the verge of going under. Running it like a proper business under MetroPacific’s hospital arm gave Makati Med a second life. The same can be said of Cardinal Santos Hospital in San Juan.

Running hospitals are expensive propositions, both in terms of staff compensation and capital investments. They are losing nurses because they can’t pay decent salaries. This is why many private hospitals allowed themselves to be bought by large conglomerates or foreign investors. The for-profit system, however, guarantees that we will always feel insecure about our ability to pay sizable hospital bills when accidents or catastrophic diseases strike.

Our upper class routinely go to Singapore or the US for their medical needs. So, it is the middle class and the poor who need an affordable healthcare system. That’s another one on our dream list.

Boo Chanco’s email address is [email protected]. Follow him on X or Twitter @boochanco