The "M.D.-R.N. phenomenon"

by: Jun R. Ruiz, M.D.

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 nuisane 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.