Wednesday, April 28, 2004
Why doctors become overseas nurses
By Atenodoro R. Ruiz, M.D.
THE issue of our local doctors taking up nursing to become registered nurses abroad, specifically in the United States, has been the subject of several newspaper articles. National dailies reported that a recent medical board topnotcher, Dr. Emil Reyes Jacinto, had decided to become a nurse abroad instead of pursuing his medical career in the Philippines. One of the daily newspapers waas even quick to criticize him as a "sell-out" in their editorial.
I do not condone doctors who have decided to become nurses abroad, but I would like to offer another perspective, this time from somebody from the medical community.
As an associate editor of the Philippine Journal of Internal Medicine, I wrote the latest editorial (March/April 2004 issue) of this official publication of the Philippine College of Physicians, entitled "Why Doctors Leave Our Shores." This is a composite of various insights from several doctors in our society. Permission has been obtained in publishing excerpts from my editorial.
Interestingly, Filipino overseas contract workers in the Middle East and Hong Kong have been declared "heroes" of the Philippine economy, while doctors-turned-nurses who left our shores for better opportunities are denounced as "selfish and unpatriotic." I hope this commentary will help correct the double standard usually made by the media. This piece does not reflect the opinion of the Editorial Board nor of the Philippine College of Physicians:
"The phenomenon of Filipino physicians taking up nursing to find greener pastures in the United States, Britain and other countries has attracted media attention. Some of our colleagues have found this disturbing development to be amusing. Certainly, this is not funny to these doctors who had taken up nursing courses in their desire to go abroad. I anticipate this exodus to continue in the next few years, as the shortage of nurses overseas is projected to continue up to 2010. Surely, one can dismiss their motives as purely financial in nature and label them as devoid of nationalism, but that would be too harsh judgment on our part.
"To address the financial state of the medical profession, I went to the Bureau of Internal Revenue (BIR) to do my one-man team investigation.
Though admittedly not accurate, nevertheless, these figures will drive home the following points. Based on this information from the office of the Deputy Commissioner, the mean (average) annual gross income of self-employed physicians identified in the BIR database (excluding doctors who are employees of institutions and receiving fixed-salaries) for 2002 was P525,877.33 (P43,823.11 monthly). However, this mean average was not reflective of the real picture since the individual figures did not follow the bell-shaped pattern of distribution.
Thus, the median would be more representative. The median of the gross annual income for self-employed physicians in 2002 was P230,347.75 (P19,195.65 monthly). In layman's terms, around half of us doctors earn less than P20,000 monthly. For reference, our government estimates that a monthly income of P16,800 is needed for a family of 6 to meet the daily basic needs. This median gross annual income corresponds to $4,189, a miniscule amount in contrast to the yearly salary of a US licensed nurse that ranges between $50,000 to $100,000. These figures and analysis should serve as an eye-opener for the uninformed.
"Several teachers and educators of this country had sacrificed their profession to become domestic helpers abroad due to financial difficulties. The primary reason for this career shift from MD to RN abroad is obviously similar. However, it is not as humbling, since nursing, like medicine, is also a noble profession. Financial concerns and potential unstable future for the family are enough to drive them away to leave our shores for a better and secure future for their families. A few colleagues are very optimistic that this job will also serve as. . .a stepping stone to eventually becoming physician assistants or even licensed doctors abroad.
"There is the big issue of buying stocks in the big hospitals to obtain the privilege to practice. Lucky are those who have wealthy parents or spouses who can provide the millions of pesos to buy this privilege. How about those who are in the middle and lower income-class sector who have neither affluent parents nor spouses to shoulder the cost? Financial capability plays the major factor over good credentials and clinical skills at least in the first few years of clinical practice, though some may violently object to this statement. Is the medical community actually a microcosm of Philippine society, where wealth and influence determines a person's niche in society?
Our fortunate rich colleagues continue to get undue advantage over our "poor colleagues" because of money, influence, and nepotism.
The feeling of hopelessness in the context of the country's political uncertainty and stagnant economy is prevalent among the doctors. There are also fears of increasing malpractice suits and the need of compulsory malpractice insurance, likely consequences of the Medical Practice Bill if approved, leading to increasing costs of practice. A few doctors who had left were bold enough to cite local hospital politics, professional jealousy, the "my turf" concept, and greed as the "last straw that broke the camel's back," in defense of charges hurled at them of being unpatriotic and not nationalistic.
"The anemic economy has made the cost of a doctor's consultation or the price of the prescribed medications beyond the reach of the average Juan de la Cruz. For developing countries, the World Health Organization recommends the allotment of 5 percent of the Gross National Product (GNP) to health care programs. However, DOH sources reveal that only 3.5 percent of the GNP is budgeted by the national government for health annually. Is our government partly to blame for this exodus?
If only prevailing conditions (could) provide respectable pay, recognition of hard work, with the national government fostering assistance and support for our struggling colleagues, then we would not be pondering on this issue. Knowing why our colleagues left our shores should unite the medical profession, and for our national government to prioritize health and health professionals. Only then can we slow, if not stop, this hemorrhage and exodus of physicians to foreign shores.