Posted 01:57am (Mla time) May 15, 2005
By Jun R. Ruiz, M.D.
Inquirer News Service
Editor's Note: Published on page A15 of the May 15, 2005 issue of
the Philippine Daily Inquirer
MEDICINE is now becoming a pre-nursing course, giving rise to a new
hybrid of professionals—the "M.D.-R.N." However, this is old news,
in the headlines for years.
What's new for Filipino doctors? Are the present circumstances in
our country make it justifiable for some of our colleagues to switch
to the nursing profession? The financial factor continues to be the
primary reason for the so-called "M.D.-R.N." phenomenon. Data from
the Bureau of Internal Revenue reveal that the average Filipino
physician earns only an annual income of P230,347.75 (P19,195.65
monthly). This means that doctors are also going through hard times
in these days of crisis. The government's own economic office
estimates that a monthly income of P19,890 is needed to meet the
daily basic needs for a family of six in Metro Manila.
Although society view doctors as a group that makes money easily,
reality proves otherwise. Health card-dictated consultation fees,
the one-year wait for paychecks, local hospital politics, professional jealousy,
costly buy-in stocks in major hospitals, and the looming threat of a
malpractice law perpetuate the disenchantment among Filipino doctors.
It is frustrating to see that one needs to spend a fortune just to become an active
consultant in major hospitals. A new young doctor cannot afford this
unless he was born to wealthy parents or married to a rich spouse.
And this is unfortunate because the youth is touted as the "nation's
future."
The rapid decline in the number of medical school applicants and the
shortage of training residents in hospitals are testaments to the
youth's dwindling confidence in our profession. Malpractice bills
filed in the Senate, if approved, would further erode the
credibility of the profession with the potential for nuisance suits.
SB 1720 (filed by Sen. Serge Osmeña III) and SB 743 (filed by Sen.
Manuel Villar) aim to criminalize medical malpractice, including
minor, unintentional injuries committed by physicians. Both bills
intend to punish erring doctors with prision mayor (a prison term of
six to 12 years), cancellation of the medical license, and excessive
fines ranging from P100,000 to 1,000,000.
Surprisingly, the proposed penalties are harsher than those
prescribed for criminals guilty of treason, rebellion, and direct
assault. Moreover, the proposed prison term is equivalent to the
punishment imposed on criminals guilty of frustrated homicide. The
passage of the malpractice law would put doctors convicted of
malpractice in the same league as criminals, terrorists and
murderers.
If enacted into a law, doctors would resort to the practice
of "defensive medicine," which could result in the skyrocketing of
medical care costs. Physicians would be required to obtain medical
malpractice insurance of no less than P50,000, which most likely
would just be passed on to patients.
On the other hand, patients and their families would be encouraged
to file suits against doctors for possible quick financial gains in
case a complication arises, even though no wrongdoing has been
committed by the physician. Furthermore, a pardon explicitly granted
by the patient or his family would not be a legal impediment to the
prosecution of the "crime." In the end, insurance companies would be
the biggest beneficiaries of a malpractice law.
Even without the malpractice law, doctors already face another kind
of threat in the form of lifestyle checks and tax evasion cases. The
Bureau of Internal Revenue is under tremendous pressure to collect
more taxes because of the government's fiscal problems. The BIR
announced in February that it would conduct lifestyle checks on
doctors because its study revealed a high level of tax delinquency
among physicians. Former Health Secretary and Senate Pro Tempore
Juan Flavier supports such a move and thinks it's long overdue.
Ironically, he finds himself on the other side of the fence. In this
BIR protocol, doctors would be investigated concerning their assets
and net worth, in terms of vehicles, real estate, their trips
abroad, memberships in sports clubs, and the schools where their
children study.
But why are doctors singled out before lawyers, accountants, and
most actors? With a few exceptions, doctors as a sector are known to
be passive, non-confrontational, and even apathetic to national
issues. This is the type of personality that thrives and survives in
medical school and residency training. Unfortunately, it is this
same attitude that makes doctors perfect targets for the BIR.
At a higher level, the financial situation of physicians is
intricately associated with the political stability and economy of
our nation. Is our country in better shape compared to two years
ago? The recent elections did not achieve the stability and unity
that we had hoped for. According to a SWS survey conducted last
year, 56 percent of Filipinos believed that the rightful winner was
not proclaimed. High unemployment rate, low salaries, and corruption
in the government continue to plague Philippine society. The country
is bankrupt and is in a fiscal crisis-as a result of excessive
spending during the election campaign, many believe. In response to
the fiscal crisis, the government passed a new VAT law, hoping to
raise P80 billion in additional revenues.Though there is a looming
shortage of health professionals due to outmigration, the government
seems not to be worried about the resultant "brain drain"; after
all, it has some beneficial returns. Health professionals to foreign
lands are contributing to high dollar remittances. Outmigrating
doctors would only be joining the ranks of overseas contract
workers, our so-called "heroes of the economy." In fact, the Bangko
Sentral ng Pilipinas has reported that overseas workers sent home
$8.5 billion last year, the highest level of remittances recorded
since 1970. Were it not for the overseas workers, our economy would
be in much worse shape than it is now.
While the influx of dollars helps to prop up our economy, the
depletion of our workforce, which is already severely affecting the
quality of our health services may could very well jeopardize our
economic development.
We should investigate whether opportunities for professional
satisfaction have been thwarted by hierarchy, conservatism, and
cronyism. Our nation's health programs and the professional
atmosphere are dependent on the national policies and economy. The
issue of exploring the job market overseas is ultimately rooted in
our national economy. As long as the economy remains weak and the
government fails to create jobs locally or guarantee just
compensation, Filipino workers, doctors and nurses included, will
continue to search for a better life overseas. This M.D.-R.N.
phenomenon is a symptom of a societal disease. And it would not be
easy to cure it.
