Mandatory Return of Service for Professionals: Closing the Pandora’s Box?

In an unprecedented and controversial move, the UP College of Medicine (the state’s subsidized premier medical school) through its UPCM College Council,  approved overwhelmingly the proposed Return Service Mechanism for its UPCM graduates during the council’s March 11, 2008 meeting. (See the details of this new UP Medicine Admission Policy here).

 UP College of Medicine main entrance. Legacies that lived beyond hundred years..

Simply put, starting academic year 2009-2010, all freshman medical students who enter the halls of this premier medical institution, will be required a three (3) year return of service after they graduate before they will be allowed to go out of the country for training, further studies or employment. This is way ahead of that House Bill 4580 authored by Rep. Ignacio T. Arroyo (5th District, Negros Occidental)  that if approved into law, will require all Filipino professionals to render service for at least 2 years before they can go abroad.

In my previous post here, I was trying to determine if there was indeed a shortage of physicians here in the Philippines. The scary answer is yes we have communities who have not seen any physician at all. The average density estimates of 1.2 physicians per 1000 Filipinos (WHO 2002) or 1.2 physicians per 10,000 Filipinos (ADB 1998) is still among the lowest in Asia and globally.

The debate on MD brain drain and MD-RNs going abroad goes protracted and ironically, is still unresolved or acted upon by major stakeholders. Majority of the Filipinos still suffer from the lack of physicians especially in the provinces. This fact still hounds us all and especially the physicians.

Is the this move by UP College of Medicine, the government’s premier medical school and that of HB 4580 of trying to stop this “exodus” and lack of physicians by requiring doctors and professionals to render service to the countrymen a valid one?

Will the provisions of these policies offer solutions to this half a century of professionals leaving our country?

If you think so, maybe you can elucidate some more. If you think not, please say so and elaborate on your answers. In fact, you can give recommendations and suggestion to these policies and laws so your opinion(s) will be read!

That will be the topic for the 17th edition of The Blog Rounds- Mandatory Return of Service for Professionals: Closing the Pandora’s Box?

Submit your link and title to my email kokegulper(at)yahoo(dot)com or leave a link by commenting to this post!Deadline for blog articles will be on Tuesday August 26, 2008.

Diamonds in the Rough:National Search for Young Doctors in the Community Setting

It is a search for unsung heroes in the medical field today: those who choose to serve the ones who need it most, by immersing themselves in the depressed, neglected, under-served communities in the country.

Of unsung heroes we have a thousand of them…Of Filipino doctors serving the community, they are our “Diamonds in the Rough”.

Honoring these unsung heroes does not only give due credit to the “doctor behind the rough”. More importantly, it gives glory to the very essence to which these doctors chose to live their lives- serving the often neglected communities in the Philippines.

That’s why on its 75th year, the Phi Kappa Mu Fraternity, in its search for EXCELLENCE in the realm of community service launches “Diamonds in the Rough”, the national search for outstanding young community doctors in the community setting.

Here is an excerpt of the mechanics, lifted with permission from the Diamonds in the Rough National Search website. (You can view all the details of the search from this website.)

MECHANICS

Award Categories
There are three major Award Categories: Luzon, Visayas and Mindanao. These categories correspond to geographical locations of physicians who can be in communities with substandard qualities of life and very minimal resources for health care throughout the Philippines.

Eligibility
In order to be eligible for the award, the nominee must:

  1. Be a Filipino citizen 40 years old and below
  2. Be a duly licensed medical practitioner under the Professional Regulatory Commission of the Philippines
  3. Have actively served in the under-served community for which he is nominated for at least five (5) years
  4. Be currently practicing in the said community
  5. Not have been recognized by any award-giving body with similar objectives
  6. Not have been charged with any misconduct involving moral turpitude
  7. Not be related to any members of the Phi Kappa Mu or its partner agencies up to the 2nd degree

Nomination Process
Any individual, NGO, LGU or any organization based in the Philippines is eligible to nominate. Nominations may be made with or without the consent of the nominee. Requirements for nomination are as follows:

  1. Duly accomplished official application form. This form is available for download in http://diamondsintherough.ph.
  2. Pertinent documents including but not limited to testimonials, citations, commendations and other documents in support of the nominee.
  3. Written profile of the community in terms of location, demographics, and other information regarding the community.

SENDING ENTRIES
All nominations are to be submitted to the DITR Screening Committee, addressed to the DITR Secretariat. You can also submit your nominations to the Salamat Dok Current Affairs and News Office.

Alvin Anthony P. Anastacio
Unit 35 F2 One Adriatico Place
Adriatico St. Ermita, Manila
Philippines

Salamat Dok: Current Affairs and News Office, Ground Floor,
ABS-CBN Sgt. Esguerra Corner,
Mother Ignacia Avenue, Quezon City

Nominations can be directly sent to info[at]diamondsintherough[dot]ph or diamondsintheroughsearch[at]gmail[dot]com, with all pertinent documents scanned.

All entries must be received by Phi Kappa Mu in the UP College of Medicine or any of our partner agencies on or before November 15, 2008.

FINALISTS and WINNERS
Diamonds in the Rough will have 9 finalists (three each from Luzon, Visayas, and Mindanao) selected by the DITR Screening Committee. The 9 finalists will be elevated to the Final Evaluation Committee who will select three winners of the Diamonds in the Rough Search (one from Luzon, Visayas and Mindanao).

FINAL EVALUATION COMMITTEE
The DITR Final Evaluation Committee will be composed of multi-sectoral representatives selected by the Phi Kappa Mu and its partner agencies.

The finalists would be subjected to an intensive evaluation by the DITR Final Evaluation committee. This may involve on-site evaluation, gathering of testimonials, data gathering, authentication and evaluation of submitted documents. The final evaluation committee to ensure the impartial selection of the 3 Diamonds in the Rough winners.

CRITERIA
The Diamonds in the Rough criteria focuses on the doctor and his community.

I.The doctor should be a man of integrity committed to selfless service to others in need. He should have made a significant impact on his community through his passion and dedication. He should be an effective leader and community organizer.

II.The community will be evaluated based on its location, accessibility, and the availability of medical resources. The community should also have worked hand in hand with the doctor in initiating progressive change in the health and well-being of their shared community.

The DITR Final Evaluation Committee will actively interpret the principles above and determine the final criteria for the final three winners of the Diamonds in the Rough.

PRIZES and AWARDING
Each of the 3 winners will receive PhP100,000 worth of total prizes. The community of the DITR winner will also receive PhP100,000 worth of prizes, to go to projects supported by the DITR winner. Awarding will be held on December of 2008.

For Questions and Inquiries, you can contact the DITR Secretariat, Alvin Anastacio through e-mail info[at]diamondsintherough[dot]ph or through gmail[at] diamondsintheroughsearch[at]mail[dot]com or mobile phone 09162156336.

Hip or Knee surgery have excellent long term outcomes

We knew these long term symptomatic relief (quality of life) offered by total joints surgery for quite sometime already. But why isn’t it given as an option to osteoarthritic patients 65 years old and above is not clear either.

This study (” Joint Replacement Surgery in Elderly Patients With Severe Osteoarthritis of the Hip or Knee“) by doctors at Beth Israel Deaconess Medical Center in Boston, Massachusetts and published in the Archives of Internal Medicine (Vol. 168 No. 13, July 14, 2008) said so in their conclusion.

Conclusions: Elderly patients who had hip or knee replacements for severe OA took several weeks to recover but experienced excellent long-term outcomes. Physicians often do not discuss joint replacement surgery with elderly patients who might benefit.

So how many physicians actually give the option of Hip or Knee Surgery to patients with severe osteoarthritis?Or even discuss the option to their patients? Is it the cost?The knowledge about the surgery?Outcomes?

If ever you need information on this, the author will freely discuss this options with you, their physicians.

You don’t play badminton to get fit, you get fit to play badminton!

A sports physician’s pearls of preventing badminton related injuries aimed for the not-so-fit badminton newcomers!

Read them here!

Leveling the playing field on badminton courts and professional practice

I’ve been playing badminton for almost a year now but never enjoyed any other sport as much as I enjoyed whacking shuttle cocks now. I have long accepted the limits of my innate athletic ability. But when my fitness level went off scale after med school and residency, I went berserk in panic search for a sport that would trim down excess calories.

“I am awfully fat. Period.”

I jumped at any sport that came my way- swimming, mountain biking, marathon, volleyball and even basketball, to name a few. I dabbled at a sport for some time and then moved on to another if it bored me to death already. But when my nephews invited me to a badminton game in our backyard, my affair with rackets and shuttle cocks never stopped since then.

” I gotta have one of those “Yonex” MP racket, promise!”

I got hooked and seriously believed that being “geeky” on badminton would somehow improve my nominal athletic skills to competitive level and burn fats at the same time.

I almost thought this was “MI 4″.

I started training- albeit non formally, with the help of my nephews and friends. I read books, searched the net, watched training videos, international matches, and then applied what I saw on and off court. I stalked coaches, watched former national players’ matches, and asked endless questions to athletes often shunned as an obnoxious behavior.

“That was an awesome cross court shot don’t you think?”

Whilst a beginner, I joined matches and insisted taking on better skilled opponents. Obviously my ass got whipped left and right. I lost count of the times I was floored on court chasing shuttle cocks and losing balance. Most veteran players laugh at my mistakes. Some ridicule me at my clumsiness and shun off my competitive attitude on court.

Like Rudy in Rudy.

But I was serious not just on winning but also on improving my game and losing some extra calories. I took notes of my mistakes, applied new skills whenever possible and consistently improved tactics through drills and training. Results were barely tangible at first.

Until, I first won my class E championships.

Almost a year passed and I have improved a lot from where I started. Everyone seem to notice the “fit body” and weight loss (~30lbs) I incurred from playing this sport almost daily. Modesty aside, I learned a number of skills, improved my stamina and then pushed the limits of my athletic ability to levels I only dreamed of before. Given an equally skilled partner in a doubles match, I can deliver my previous court “tormentors” a smash past their speed limits or give them hard time winning matches against me. Interestingly, you gain more friends with more skills you learned!

At the bottom of this improvement is the commitment to learn, accept, improve, train and apply new skills to beat your handicap and win friends. Have I started this type of attitude and training 30 years ago, I would have given Lin Dan a run for his spot in badminton world rankings!

But that is purely speculative I guess. Thirty years later.

>Professional practice in the business of medicine is analogous to learning and improving in a new sport, like badminton. Like it or not, when you are a newbie entering a competitive medical or surgical practice, chances are, you’d eat dust and be shunned away by “colleagues” for dabbling at “their craft”.

Or crap.

Medical practice is basically of skills and competition. Clinical and patients skills and the competition to earn one’s practice. You gotta learn some skills and improve on it. And almost always, it’s lonely being a newbie in the business of medicine.

The field is not without “he-who-went-there-first” type of people, who have been comfortable in their share of patients’ pie, but forgot to acknowledge the need for “new blood” to be infused in the learning process. These ‘colleagues” will feel threatened by your aggressiveness and learning skills. Either they whip your ass or shun you away from “the practice”. Worst, you will be shot at first sight, and will offer you lots of excuses to do so.

In one interview I attended, an interviewer admonished a training program applicant for signifying his intention of practicing in the same place where this guru is comfortably practicing. On surface, the excuse was “it’s too crowded”. Yet, on deeper prodding you’d find no clear evidence that it is in fact the status quo. The patient to specialist ratio is still wanting and that new skills have to be learned for specific type of diseases. This is where the newbie trainee is hoping to fit in. He has new skills, an updated learning, a conscious effort to improve and a love for the community. In my opinion that’s all he need to be in this “game” of competitive medical practice.

My take on this and my advice for newbies ? Learn your craft, improve your skills, create a market for your expertise, stay on the side of the patient, and just ignore the rants thrown at you. I’m pretty sure that later, when you have grasp firmly on new found skills and niche, you’ll never be threatened by anybody on account of “overcrowding”.

And maybe shame them all by extend help to newbies entering into the practice.

Alternative “practice styles” for physicians at Physicians & Practices

I blogged about Alternative Practice Styles for Physicians- newbies and used to be newbies alike, here at Physicians & Practices.

Read and enjoy!

An Electronic Health Record for Philippine healthcare system

screen shot of FFEHR, an EHR for Philippine health care (photo taken from FFEHR project site)

Long overdue and much awaited, an Electronic Health Record or EHR has been released for the Philippine healthcare system. Quoting DabawGNU, the co-developer of this EHR,

The first beta release of FFEHR, an electronic health record application commissioned by the ASEAN+3 node of the International Open Source Network (IOSN), was released to the public last April 28, 2008. This release comes six months after the University of the Philippines Manila-National Telehealth Center tasked free/open source software (F/OSS) programmer Nathaniel Jayme and Davao-based F/OSS organization DabaweGNU, Inc. to jointly develop FFEHR. This release marks an important milestone as the project now opens its doors for public review.

Basically just a first step towards implementing a well designed and stable EHR for our healthcare, it will definitely fuel an onslaught of interest from the so many healthcare professionals who have wanted a robust, scalable and free EHR.

Details of this said project can be read here in FFEHR website or the DabawGNU site. A beta version for linux and windows can be downloaded here.

The Blog Rounds 7th ed:I “heart” the Philippines!


“On some point, I agree these docs did something wrong. But some unscrupulous media people are just as scandalous hyping these controversies also. And to what end?”

This was my response to a friend’s rants against physicians last night. The charade of controversies she enumerated against MDs in particular is nauseating. I couldn’t blame her, except of course when she generalizes the few scoundrels to the whole medical profession.

The issues regarding pharmaceuticals and physicians conniving against Cheaper Medicine Bill, the PhilHealth scam, the VSMH Operating Room Scandal, and now this US Health Insurance scam. At the very least, it did nothing but put the medical profession in bad light. Worst, it may just kill this noble profession.

No matter how hard we inch our way making good at doing ethical practice, the ripple effect is just darn too disturbed by the waves of infamy from scoundrels who don white blazers and stethoscopes.

That’s why at times, it’s too tempting to just “pack our things up” and leave Philippines to rot on its ballyhooed corruption. But thats probably too much generalizing of a country (and the people) we loved to nitpick. Like any other profession, there are bad apples and rotten tomatoes, but this does not necessarily mean all tomatoes and apples are rotten as well.

Why did we choose to stay here? Why do we love this place, this people so much? Why do we physicians tie our shoelaces here instead of wearing the cool and financially rewarding work abroad? Why will you endure the hardships when you can simply forget about My Philippines?

These and more, will be the topic for the seventh edition of The Blog Rounds, a weekly compilation of the best in Philippine’s medical blogosphere. Hosted by Doc Ian on his blog So Far So Good, the theme revolves around what made us “heart” or love the Philippines. A very heartwarming theme indeed in these times of Hippocratic infamy.

MD’s and paramedical bloggers who wish to join The Blog Rounds, please read this guidelines, submit your entries to Doc Ian here and join the lively discussions on tomorrow’s seventh edition of TBR to be hosted on Doc Ian’s blog!

Sixth Edition Blog Rounds: Philippine Healthcare, why is it far from the ideal?

Philippine Healthcare: Why is it Far From Ideal?

This 6th edition Blog Rounds’ theme attempts to put forward an analysis of a problematic( is it?)healthcare system that has long been tackled, but never successfully addressed. One of the biggest stakeholders in “the solution” to such problem, the doctors may offer some valuable insights in the final analysis of the root cause for such dying health scenario- here in our land!

Join the sixth edition of TBR and be part of the lively discussions surrounding this issue! Doc Che will be hosting the sixth edition of TBR in her blog Merry Cherry. Her call for articles is already posted here. Please submit your entries to Doc Che before 5:00 PM April 21, 2008.

For those unaware yet, The Blog Rounds is a weekly compilation of the best in Philippine’s medical blogosphere, written by physician bloggers (or the medically inclined bloggers) and hosted on a participating blogger’s weblog. Archives and edition schedules ( plus the host blogger) are listed here. The next edition of TBR will be up this Tuesday, April 22, 2008 7am PST.

Physicians and medically inclined bloggers interested in joining this blog carnival, please contact me through my email kokegulper[at]yahoo[dot]com or any of the participating TBR bloggers. Guidelines and updates are posted here in my website, The Orthopedic Logbook.



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