Is the quality of medical education declining?

Like almost everything else in this country today, it seems the quality of medical education has declined significantly through the years. This is the conclusion I reached after an exchange of e-mails with Filipino doctors here and in the United States. An article in The Los Angeles Times about Pinoy doctors who migrated there to become nurses, sparked the e-mail exchange.

The article tells the tale of a Dr. Jose Pineda, who spent nine years training to be an obstetrician in the Philippines. But at age 41, he went back to school to be a nurse. According to the Times article, Dr. Pineda shut down his medical practice February last year and moved to the United States. Now he works as a nurse at St. Mary Medical Center in Long Beach, trading his spot atop the medical hierarchy for money and the promise of a better future for his family.

"I am not planning for myself anymore," Pineda told the LA Times. He makes $50,000 a year, four times what his physician’s salary was in the Philippines. He said he is making the sacrifice for his kids. The Times reported that thousands of Philippine doctors are making the same career switch with the intention of making a country switch too. They are willing to take orders instead of give them and to provide care instead of cures, all to live in the United States.

But why didn’t Dr. Pineda go to the States as a doctor? Thousands of Pinoy doctors have done that years ago and made the successful transition. According to the LA Times article, it is because going as a nurse is the fastest way out of the Philippines. Also, the road towards a medical license is so arduous and working as a nurse is so lucrative, many just take the path of least resistance.

But based on my e-mail exchange with Pinoy doctors who should know, there is a deeper and more troubling reason why Pinoy docs would rather be nurses in the States. Pinoy doctors today are inadequately trained. That’s easy to believe. A doctor employed by our HMO once prescribed an antibiotic to my wife and when we crosschecked with my brother-in-law (a top US-trained pediatrician) it turned out it was the wrong one. In so many words, they don’t graduate as many quality doctors like they used to, thirty or so years ago.

If that’s the case, the next question is, who is responsible for assuring quality training of doctors here? The question is important given that in recent years, medical schools started to mushroom in the country. Given the obvious lack of facilities for good training, it is easy to suspect that we have lost the high standards of the past when UP, UST, UERMMC and FEU produced world class doctors. We can tolerate diploma mills producing sub standard lawyers, accountants and mass comm graduates but not doctors, who must always be able to make split second life and death decisions.

Said one doctor in his e-mail: "In NYC, at the community hospital level, where Foreign Medical Graduates gravitate, not only do the Indians outnumber the Pinoys, they also outrank them in positions. For sure, there are still prominent Pinoy docs but they would be in their fifties. This means, they were educated and trained in a system that was compatible with international standards AT THAT TIME."

Another doctor tried to explain the situation in a less painful way for the Pinoy ego. "There are simply more Indian doctors than Filipino doctors immigrating to the United States as a percentage of population." But doctor number one does not buy the explanation. While he concedes that the population explanation may be a valid point, he insists sheer numbers do not tell the whole story. "The population differential vis a vis numbers has always been there since the 50’s and 60’s."

He does not have the data on the passing rate of Pinoy doctors in the past with regard the qualifying exam known then as the ECFMG for comparison with the current exam known as the VQE – visa qualifying exam. But he recalls that the passing rate for his class, UST ’65 was over 70 percent 1st time around and those who took it a second time – this shot up to over 80 percent. "Believe the stats for UP were about the same or maybe better – their grads were less than 1/3 of those from UST."

He debunks the argument that the VQE is more difficult than the ECFMG because this is the same exam Indian grads take. "So the operative question would then be what is the passing RATE for Indian vs Pinoy grads in the past four-five decades. l suspect, there will be crossing lines in the chart." And to think, he says, given our American orientation that includes use of American textbooks, we should have an advantage over the Indians.

The other doctor concedes that the golden age was the time when Filipino doctor-immigrants were able to merge with the mainstream of US medical practitioners after fulfilling the basic requirements of passing the ECFMG, state licensure exams or FLEX exams, and specialty boards for most. Unfortunately, he observed, "it is my impression that more Indian M.Ds go for the Boards. Our M.Ds (usually not from U.P.) stop after training, and many don’t go for any Boards. That is a self-defeating rut."

At this point, my doctor e-mail writers agree. Doctor number one thinks "it would be silly not to go for the boards (state or FLEX) and for that matter, the specialty boards as these boards would jack up the income 5-10 fold! I would therefore ask again, WHY? Is it a simple – ‘babaw kaligayahan’? Don’t think so. This inability to pass the American boards cannot be dismissed by a sheer lack of facilities and money."

They conclude that Pinoy doctors are losing ground to the Indians in the States because our medical education here has deteriorated to a degree that makes it difficult for our medical graduates to pass qualifying exams in America. If that is the case, the implications for our health care here seem dire, even if we don’t talk about the massive number of doctors leaving our shores as nurses.

Again, I ask, who is responsible for quality control of medical schools? If the doctors we have here are not good enough for the Americans, how can they be good enough for us? Think about that.

Wouldn’t it be sheer karma if the bureaucrat sleeping on this important job ends up on the operating table or the emergency room with one of these diploma mill graduates attending him/her?

Wonderful Profession

Speaking of doctors, somebody e-mailed me this one.

It must be wonderful to be a doctor. In what other job could you ask a woman to take her clothes off, look her over at your leisure, then send a bill to her husband?

Boo Chanco’s e-mail address is [email protected]