Thursday, March 8, 2018

To go public, or not?

I was more than delighted to receive an email recently from one of my readers.  I am posting it here hoping to enlighten more doctors, specially the young ones who are finding themselves at a crossroad in their career path.


Good day po, doc.  I have read your blogs regarding residency and I just want to ask you questions lang sana if it's okay.  I just passed the board exam last march 2017. I've been moonlighting na ever since. I plan to go on residency by Jan2019. I'm planning sana to take IM. I wanted to try applying in private hospitals in Manila but medyo takot ako na baka di ko masustain ang mga needs ko with only limited salary. I cannot depend on my family naman. Kaya option ko n rin magpublic hospital para at least bigger ang pay. May I know what residency did you go into? And if private or public hospital ba pinili mo? I just want sana to at least have an idea. Thank you, doc! - Nicole


Hello Nicole!

Thank you for taking time to visit my blog and read my entries. At least, in my own little way, I can be of help specially to budding physicians like you.

I had my residency training in Internal Medicine in Cebu Velez General Hospital in Cebu City. It is actually the base or mother hospital of my alma later, Cebu Institute of Medicine. It is a private hospital, and I admit, the pay is a bit meager compared to that of public medical institutions, therefore I had to make a few adjustments particularly with regards to my expenses.

Actually, my pathway to residency, and to finally completing it, was quite unique in the sense that I went into residency twice.

The first time I went into residency, I was a total newbie, fresh from passing the boards, with barely any savings at all. 

The year was 2006. Still high after nailing the licensure exam and oozing with desire to be independent and to take a load off my parents’ back, I moved out of the apartment I rented when I was a medical student. I knew that my monthly salary of... (drumroll please).....
Php. 12,000.00,  would not be able to support my simple lifestyle (yes, simple, no kidding!) so I chose to avail of the free board and lodging offered by the hospital.

Free lodging meant we had our own rooms at the upper floor of the hospital, free water and electricity - not a bad offer at all, except that the upper floor above ours, was where the owners of the hospital live, and when we went down one level, it was already our workplace, our battle grounds - the wards. Still not bad. No transportation expenses at all in going to the workplace. Those were minor, almost negligible hurdles compared to the challenge called residency. 

Free board meant free food from the hospital dietary - still not bad because we would occasionally have lechon kawali, pork barbecue, freshly-squeezed kalamansi juice (yes, healthy!), and I am a fan of a number of the dishes they serve even if I have been their customer for half a decade. At least I could brag and say, there is such a thing as free lunch.

I finished the first year in residency but decided not to continue to the next level since I decided to try my luck with the USMLE. I spent four years working for my American Dream and during that span of time, I moonlighted in another private hospital in Tagbilaran City in the beautiful island of Bohol. 

It was during my moonlighting stint that I was able to get hold of a relatively large amount of money that I did not encounter in my life - not really in the million levels but pay was never better than I have known since I started my career then. I was able to afford stuff that I wanted, on top of my needs. It was also during that time when I brought for myself my very first investment, a life insurance from Sun Life. I am proud of that achievement and I consider that as one of my remembrance purchases during moonlighting - something that will outlast that gig of mine. When the time came that I had to go back to residency, I had to face the fact that adjustments had to be made once again.

Presently, I am an employee of the Philippine government, since I am affiliated with a DOH-retained hospital in Mindanao. I can say compensation is quite satisfactory.

For you, Nicole and for budding doctors like you, I have enumerated the following points, which I believe are major issues that need to be considered in choosing which hospital to train
-- private or government-owned. "To go public, or not?" -- that is the question that we all hope to answer.

1. Work load -- To establish a baseline idea,residency is like a vampire that only desires to suck out all the life and blood out of you. Do not get me wrong here. I favor residency training as long as your circumstances would allow.  I am not trying to scare you or discourage you from going into training but at least I want to give you an idea of what you will soon be getting into. In my own humble opinion, work load is a little bit - just a teeeeeeeeeeeny weeeeeeny bit - forgiving in the private hospitals. In the government hospitals, aside from your designated job description as resident, you might find yourself also doing a lot of scut work, like pushing wheelchairs, extracting blood specimens yourself, sending specimens to the laboratory, and other stuff like that. I even hear testimonies from fellow physicians that they go as far as buying stuff like IV catheters for their patients using money from their own pockets. Government hospitals, specially the referral centers, are always flooded with patients, it's like there is a party at the Emergency Room every single day. You have to prepare yourself for that reality in case you go for the government hospitals.

2. Compensation -- Dito naman bumabawi ang mga pampublikong ospital. A lot of doctors nowadays are finding themselves in government hospitals because of the very attractive compensation. The government gives 13th and 14th month pay, that's one month of your salary that is tax-free. There is what we also call Philhealth sharing among the hospital
employees, wherein we receive our share of the Philhealth earnings of the hospital. Sharing could be at least Php 5,000.00 every month, that is on top of your monthly salary, monthly laundry allowances, uniform allowances, hazard pay, and many others. I knew all about this when I started working for a government hospital. In this case, all your efforts and sleepless nights actually pay off as you find yourself laughing as you pay a visit to the ATM machine to check on your salary. In the private hospital where I trained we only had the 13th month pay
to look forward to, and a modest love gift from consultants, which both come in December, that's all.

3.  Conducive learning environment -- Now this would not depend on the hospital but this one last issue depends on you, the main player of the game. Just ask yourself, in which environment will you find yourself at the peak of your learning. In which environment would you feel more motivated to work and learn at the same time. Remember that residency is all about learning the ropes before we go into the real world. It is all about learning skills, developing good habits and clinical practices, and sharpening our clinical eye. Which environment will bring out the best in you?

To come up with a decision, consider each issue carefully and just be honest with what you feel about it. Remember, you are at the receiving end of the outcome of this major decision you are going to make. Be kind to yourself first, so that this kindness will radiate on to your patients, whether they find you in a private or a public hospital.

 I wish you all the best and I hope that somehow this has shed some light to your queries.


Keep the e-mails coming, dear readers.

Thank you.

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