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Plight of Doctors After Medical School
July 26, 2005
First of two parts
Graduates of medicine are faced with a dilemma nowadays. Most would think that there are not that many options after medical school. The usual step after the board examinations would be to go into residency training. Then perhaps have a fellowship afterwards. However, compensation-wise, some would not consider that a wise choice. Others would prefer taking the USMLE and have their training in the US. But then, it is not easy getting a visa to the US either. A faster way would be to go there as a nurse. During our time, a number of us already did not consider residency training as an option. And there was already the growing trend of doctors going into nursing school. A number of my classmates did take up nursing. I did not. But I decided to work. And it was difficult finding a job because I knew at first that there were not that many options.
Aside from hospitals, one may opt to apply as a physician for a company, a school or a vessel but most of these either would prefer those who have undergone training or would not even need a doctor at all. So some would say that it would be better to take such courses as accounting or psychology because all companies would require finance and human resource staff. These leave fresh medical graduates fewer options because they need to be competitive in this competitive world.
During that time I was looking for a job, the so-called medical transcription industry was growing. Medical transcription companies serve US clients. Documentation of medical transactions in the US is required by law because this would be necessary in such cases as disability claims. Doctors record these documents as voice files and send them over the internet for transcription by Filipinos. After the reports are transcribed, these are uploaded in the internet as well. Turnaround time is usually within 24 hours. I joined one company that was into this type of business. I had to undergo training, which I finished in just two weeks instead of the usual two to three months. The medical transcription team is usually composed of transcriptionists, editors and QA people who do the quality check of the finished product. I was promoted to QA team leader right after my training. Not bad. From then, I have done various types of documents from admitting notes to history and physical examination to operative reports to discharge summaries. There is much to learn from this type of work. One gets to see the manner of clinical management in the US. And all you need are listening skills, typing skills, computer skills and a good grasp of medical terminology and English grammar. In just a few months, I already had the opportunity of working as Medical Transcription Manager in another company. The business continues to grow at present. More than 20 companies are now engaged in this business. And some universities have already incorporated medical transcription as one of their courses.
I continued to explore the other opportunities for doctors. Early part of 2003, an outbreak of the Severe Acute Respiratory Syndrome (SARS) broke the news. A task force was formed. I was lucky to be part of it because I wanted to be involved anyway. The task force was based at the Ninoy Aquino International Airport. We had to check the temperatures of all departing and arriving passengers during that time and we are talking about more than 5000 persons everyday. If a passenger was found to have fever, we need to do history and physical examination and at the same time, we place our lives at risk of contacting the virus if indeed the passenger is positive. Some doctors who applied for the job backed out after the interview. We all got scared but a few decided to go on. At first I did not know what I got into. Friends would not go near me. I cannot blame them. I might already be carrying the virus. One of us even decided not to go out on a date for a while. We felt the discrimination because of the job we got into.
Anyway, our efforts were recognized in a formal ceremony by the Manila International Airport Authority and the Department of Health Bureau of Quarantine last June 2004 because our “selfless dedication and hard work became major factors in preventing the SARS virus from spreading in the Philippines while it was raging in epidemic proportions across neighboring countries” and because we are “among the courageous men and women who risked their own lives by facing the day-to-day perils of contamination, so that their countrymen may remain safe form the deadly clutches of the unseen enemy.”
SARS got under control. Then came the avian flu and meningococcemia but they were both controlled as well. We continued our duties at NAIA and we started to enjoy our work. It is a prestigious job after all. Health Secretary Manuel Dayrit would always appreciate our efforts (He almost caught me sleeping during one of my duties.). The workplace is a venue where you get to meet a lot of people from all walks of life including politicians, actors, actresses and not to mention the pretty flight attendants from the different airlines. And just recently I got to shake the hand of the President, Gloria Macapagal-Arroyo. That could be just a once-in-a-lifetime privilege.
We worked at NAIA under the supervision of the DOH Bureau of Quarantine, which is another option if one prefers to work in the government. The bureau deals with international health surveillance, isolation, immunization, yellow fever, plague, inter-island vessel monitoring and fumigation among others. At the airport we were given the opportunity to clear departing aircrafts and passengers and arriving human remains, which are also the responsibility of the bureau. At some instances, we also had to deal with arriving AIDS patients. After all, we need to do international health surveillance.
I did not end my exploration of opportunities. A multinational healthcare company was doing a clinical research on cervical cancer. I learned in pharmacology that there are four phases in drug development. Phases I thru III involve clinical trials. Phase IV is post-marketing surveillance (They still ask that in the exams.). I decided to assist in the clinical research on oncology. They were doing Phase II then. I have done a Phase IV before with another drug company involving an oral hypoglycemic agent. So I thought I can manage doing a Phase II, even though it would be more difficult. Anyway, there are gynecologic oncology fellows at PGH who will manage the patients. As I have mentioned, the subjects were cervical cancer patients. They have to undergo both chemotherapy and radiotherapy. They will go through two types of radiation therapy: external beam radiotherapy and brachytherapy (two medical terms I only learned at work). I thought things would be easy. One time, a patient developed FN (febrile neutropenia). I had to go to PGH at 10:00 PM together with the fellows to evaluate the patient. Patient was given antibiotics and G-CSF. She developed renal failure and worsened during the next three days. She expired on the fourth day. Being a doctor entails a certain degree of responsibility, which is called for anytime and in whichever job you take.
There are still plenty of other opportunities for doctors here. We just need to keep searching. There is always the option of pursuing higher studies like taking up a Masters in Public Health or Epidemiology or even just postgraduate courses like occupational health and safety or emergency medicine. This can help you land a better job. Certifications in first aid, basic life support and advanced cardiac life support are good credentials. A colleague decided to have an OJT at the Crime Laboratory of the Philippine National Police, which I used to consider myself. If you like to be in the military service itself, you are a Captain at entry level. If you have a love for writing just like me, you can contemplate on joining such publishing companies that do health magazines like Health Today. And there are those who might have a passion for teaching and sharing their knowledge. If you are not prepared to do it in the College of Medicine, you can start with medical subjects of undergraduate courses. And you can also apply in review centers and in medical transcription academies. They do welcome doctors.
Currently, I am still going on duty at the Ninoy Aquino International Airport, also still doing monitoring visits of our cervical cancer patients, and planning to set up a medical transcription company on my own. The opportunities do not end there as long as you continue to keep searching. With the Divine Guidance, you can get to where you want to go. And let us always remember that being a doctor entails responsibility wherever we go and most of the time we are able to apply whatever we learned in medical school.
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Views expressed on this column and any other by-lined articles on this site are the authors' own and do not necessarily reflect the views of the organization or its members.
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