Doctors’ exodus, exam leakage rock health care industry in 2006

Nursing is undoubtedly the fastest-growing profession in the country this decade but in 2006, it took a few twists and turns.

During the first semester of the year, the public was focused over the migration of Filipino nurses to countries like United States, Singapore and Britain.

These countries now face a dwindling health workforce because of a graying population and their nationals’ lack of interest in working as nurses. As a remedy, they opened their doors to foreign nurses, particularly Filipinos who are known for their dedication to work and caring bedside manner.

But what compounded the issue is that many doctors went back to school to study nursing so they could work in hospitals abroad where nurses are in demand.

Dr. Jaime Galvez-Tan, former executive director of the University of the Philippines’ National Institute of Health, said around 3,000 doctors are now enrolled in nursing schools.

Annually, doctors-cum-nurses account for 1,000 of the 12,000 nurses who leave the Philippines for greener pastures.

Tan noted that around 100,000 nurses have gone abroad in the past five years, with the biggest exodus occurring in 2003 when some 18,000 nurses left the country.

"But many of them have not been recorded by the POEA because they were hired directly by the hospitals. Many others left as tourists," Tan said, referring to the Philippine Overseas Employment Administration.

To address the situation, the Department of Health (DOH) held the first "Summit on Human Resources for Health in the Philippines" last March during which experts from various government and non-government agencies shared their experiences and opinions.

The DOH also introduced then the "Wanted: Pinoy MD" project that gives scholarships to aspiring doctors to be able to study in medical schools. The project was designed to fill the shortage of physicians in the country.

Health Secretary Francisco Duque III said the project is part of 25-year Human Resource Masterplan for Health intended to strengthen the country’s health workforce.

Since 2003, government-run hospitals are believed to have lost 400 to 450 doctors to foreign hospitals.

Duque added the issues on the doctors’ exodus is "complex" and requires both global and multi-sectoral actions.

"We have to recognize that there are individual rights to free movement and personal advancement. But we also have the duty to meet the rights of every Filipino to good health," he said.

The DOH also launched this year the "Philippine Medical Tourism" program that is aimed to promote the country as a destination not only for its breathtaking tourist spots but for medical treatment and wellness services as well.

DOH Undersecretary Jade del Mundo said they expect the program to bring in tourists so this could increase the demand for medical workers in the Philippines.

And with the revenues that the project can generate, the government is also hoping that the working conditions, salary and benefits given to health workers in the Philippines will improve, encouraging them to stay.

Leaked questions

But this year, the nursing profession was rocked by a controversy that the global health care industry seemed to have watched — some questions in the licensure examination conducted by the Professional Regulation Commission (PRC) last June 11 and 12 had been leaked. The irregularity was uncovered when examinees in Baguio City complained that reviewers of R.A. Gapuz Review Center had access to test questions prior to the examination.

The PRC created a fact-finding committee to look into the anomaly, which found out that some 20 percent of questions in Test 3, which covered Medical Surgical Nursing, and 90 percent questions in Test 5, which covered Psychiatric Mental Health, were leaked out.

The leaked questions were traced from the manuscripts of Anesia Dionisio and Virginia Madeja, both members of the Board of Nursing (BON) who prepared Test 3 and 5, respectively. The PRC has filed administrative charges against them.

Aside from Gapuz, two more review centers were implicated in the irregularity — the Pentagon Review Specialist Inc. and the Institute for Review and Special Studies (INRESS).

The PRC committee’s findings were corroborated by the National Bureau of Investigation.

INRESS happened to be owned by Dr. George Cordero, who was then the president of the Philippine Nurses Association (PNA), which is tasked to recommend who sits in the BON. He also owns the Philippine College of Health and Sciences at C.M. Recto Ave. in Manila, which offers nursing courses, among others.

From the testimonies of some witnesses, the committee discovered that Cordero had organized an "enhancement review class" or a "final coaching" session at a movie house of SM Manila days before the test.

The witnesses alleged that through a Powerpoint presentation, Cordero "flashed the situations, questions and answers on the screen" he claimed would appear on the test. He vehemently denied the accusation as he resigned from the PNA.

To cleanse the tests of leakage, the PRC invalidated the leaked questions and re-computed the scores. Of the 42,006 nursing graduates who took the test, the commission declared that 17,821 passed, representing a passing rate of 42.42.

But some institutions, organizations and nursing schools such as the University of the Philippines, University of the East-Ramon Magsaysay, University of Sto. Tomas (UST), the Association of Deans of Philippine Colleges of Nursing Inc. and a faction of PNA have demanded a re-take of Tests 3 and 5.

The PRC junked the proposal, earning the accolade of successful examinees who banded together under the group, Alliance of New Nurses (ANN). They wanted to move on and pursue their dreams.

The commission said it believed that the advantage of those who got access to the leaked questions had already been taken away when the questions were invalidated. The PRC also insisted that majority of the examinees are innocent so they should not be punished for others’ wrongdoing.

Life had been like a see-saw for the June examinees at the height of the controversy.

Even President Arroyo flip-flopped on the issue. In August, she initially supported calls for the re-take but back-pedaled weeks later.

The PRC, on the other hand, began administering the oath-taking of successful examinees but was stopped by a temporary restraining order (TRO) issued by the Court of Appeals in September.

The TRO stemmed from a petition filed by some students and faculty of UST’s College of Nursing. They asked the court to nullify the invalidation made by PRC and to order the re-take.

Last Oct. 27, the appellate court directed the PRC to resume the oath-taking and nullified the re-computation of grades and upheld the original scores of the examinees.

This meant that the 1,184 examinees who initially passed the test but failed after the re-computation no longer had to re-take the test while some 1,167 examinees who initially flunked were stricken out from the list of those who passed the exam.

According to Dr. Marilyn Lorenzo, executive director of UP’s Institute of Health Policies and Development Studies, the way the leakage was handled was not enough to redeem the credibility of those who passed the June exams.

Lorenzo noted that unless the examinees re-take Tests 3 and 5, they might not be hired by foreign hospitals. She warned that other Filipino nurses might also suffer the consequences of a "no-retake."

"For me, 2006 is not a good year for the nursing profession. The exodus of nurses has not been managed well and now, we have the leakage issue," she said.

As of press time, the Commission on Graduates of Foreign Nursing Schools (CGFNS) is studying if the June batch will be eligible to take its examination. CGFNS is tasked to issue visa screen certification to foreign nurses who are qualified to work in the US.

CGFNS announced in its website last Oct. 26 that it wanted to know "whether the licensure process followed in the light of the challenged results of the June 2006 exam is ‘comparable’ with that required for nurses licensed in America, as required by US law."

But out of this scandal came something good. The government realized that review centers operate with so much liberty, that except for securing a business permit from local government units, there has been no agency regulating them.

Malacañang has placed review centers under the supervision of the Commission on Education. The PRC, which used to be under the Office of the President, has been attached to the Department of Labor and Employment.

The effects of the controversy on last June’s batch of successful examinees are expected to be felt in two years, which they usually spend training in the Philippines while having their visa processed.

Whether or not the future of these examinees has been jeopardized, only time can tell.