Tiago Villanueva: Medical education and healthcare in the Philippines

Tiago_VillanuevaMy Filipino roots and family ties usually take me to the Philippines once a year, but this year my trip was unusual as I had the chance to make contact with the local healthcare and medical education system. This was all unplanned as a relative has been receiving hospital treatment and I ended up visiting a private hospital in the Philippine capital—Metro Manila. I also ended up unexpectedly being invited to give a presentation at one of Metro Manila’s medical schools.

The Philippines used to be a colony of Spain, and later on of the United States. The healthcare system now is similar to the American healthcare system as healthcare is delivered mostly by private institutions, and access to healthcare is chiefly based around the ability of citizens to pay for healthcare, often out-of-pocket. There are public hospitals and clinics, as well as a national social insurance scheme in place called Phil Health. This is particularly relevant to those who can’t pay for private healthcare, but Phil Health still does not reach 100% of the population and is limited in terms of what it covers. For example, hospital based cardiology procedures for patients who just had a myocardial infarction such as cardiac catheterization, are not included. Moreover, in many government hospitals, doctors often have to ask patients to pay for all the surgical equipment before they can go undergo surgery.

Like many other private hospitals in the city, the hospital that I visited in Metro Manila is considered one of the best in the country. It complies with rigorous international standards and its doctors often carry out their postgraduate training overseas, particularly in the US. Even though I was reassured to see my relative receiving clinical care of the same standard (if not better) than in the West, I was well aware that this sort of care is only at the reach of a small proportion of the population.

I ended up giving a talk on how to report research and getting it published to an auditorium of about 300 medical, nursing, pharmacy, and medical technology students and doctors, at the Our Lady of Fatima College of Medicine, as part of a cycle of “scientific lecture series.” Medical degrees in the Philippines usually emulate the North American model where students are required to have an undergraduate degree before enrolment, with the actual medical training programme lasting four years. I noticed that all of the students from the four faculties that attended my presentation wore white coats in different shapes and sizes to distinguish between study programmes.

My talk was linked to another one scheduled just before my own, and given by an American neurologist and epilepsy specialist called Andrew Wilner, who talked about the diagnosis of epilepsy and also about alternative career pathways for doctors, such as medical journalism. What stood out for me, and what seemed to be so different to what happens in Europe, was the degree of formality and enthusiasm attached to the event. The lectures were preceded by a prayer and singing the national anthem using audiovisual support, and there were giant banners posted on the street in front of the university building announcing the lectures. Moreover, both my colleague and I were introduced to the audience separately by a senior faculty member immediately before our talk, who went through our CVs in some detail.

Despite the availability of good training and healthcare organisations, retaining doctors in the country is a considerable challenge. Many Filipino doctors end up moving overseas to pursue their career ambitions, and some even retrain as nurses to make it easier to move abroad, as the nursing profession usually involves less regulation in terms of recognition of degrees between countries. Nevertheless, I found out that this year’s “top notcher” in the national physician licensure examination has said she intends to stay in the Philippines in the long run. I hope many others will follow suit as there are apparently only about 70 000 doctors in the Philippines for a population of about 100 million, with most not wishing to work in the areas where they’re most needed—rural and remote areas. The Philippine Medical Association has said that the country still needs 930 000 more doctors.

Tiago Villanueva is the BMJ editorial registrar. He paid for his own travel to the Philippines and was not paid for his talk at the Our Lady of Fatima College of Medicine. Nevertheless, he was treated to breakfast and lunch at the university’s premises and received a souvenir bag afterwards, which included university memorabilia.