Ranking as Medical Officer.. Does It Matter?

I graduated from a residency training where we didn't use the terms "medical officers" nor "medical specialist". They were only used in public hospitals.

I looked for job opportunities left & right, was not accepted, and only found/learned the hard way that being a resident-on-duty (ROD) all over again is the only option left. I swore to myself that after residency, I won't be agreeing to any 24hour duties again but it seemed that I had to break my own promise. In a way, it can be of very good use to me since I'm planning to take the diplomate exams of PAFP at the end of the year (as they say, experience is the best teacher). Though it may sound that I'm "moonlighting", I had no other choice. I applied for work at a nearby public hospital and was eagerly accepted. But the item being offered to me is just "Medical Officer 1". At first, I just agreed without knowing what that truly means. Then last week, a colleague told me that that rank is INappropriately low for me. According to her, her rank in a public hospital (where she is currently a resident) is "medical officer 3", and kapag diplomate status na, the rank goes up to "medical officer 4" (or some would say that it's already "medical specialist 1"). I thought twice.

I know I am after the training/experience but I have mixed feelings regarding the item/rank being given to me (as MO 1). I feel like I stooped down to GP level when in fact I'm already trained & a consultant/specialist in every way. Siyempre, CFP (Certified Family Physician) na ako. As of now, I haven't signed the contract yet (a blessing in disguise na rin siguro). Probably it's a sign that I should still look for something else &/or a better opportunity will come in my way. I'm afraid that if ever my consultants, co-residents hear about this, they might say bad things like I'm just bringing utmost injustice to my previous training.

Right now, I'm torn - should I stay for experience? Or should I leave? 

Does the rank/item as medical officer matter, in terms of my professional career, financial gains? Will it look good in my resume when I apply for future work?

What Can I Do?

For the past three years, I only knew a little about the real health economic status of my country. Most of the patients I have encountered "can afford" basic laboratories, common medications. I was fortunate that the hospital where I went at have complete (well, almost complete) facilities. They follow-up at your out-patient clinic (as instructed), and everything goes well. In the ER where most patients are HMO holders or employees of affiliate companies, requesting for laboratories and/or ordering for medications was simple - just write it on the chart, nurses either encode the lab/get the medicine from the pharmacy, and patiently wait for the outcome. Sana ganun sa lahat, pero hindi.

This month, I started to work as a medical officer in a public hospital (primary-type, based on hospital bed capacity). Since most of my duty schedule was concentrated in the emergency room, I am always faced with the concern that the relative and/or patient has little to no money. I usually encounter a dilemma on how to come up with even just an initial clinical working impression (among my differential diagnosEs) when my patient cannot afford to pay for a simple laboratory examination. I cannot treat a patient who comes at the ER because he doesn't have the means to pay for a medication. Worse, the hospital has incomplete facilities - the laboratory can only process urinalysis, fecalysis, capillary blood sugar requests; the rest have to be sent or done outside. Likewise, the pharmacy has incomplete stock of medications. As faced with this scenario, paano naman kapag emergent na or urgent yung case? I pity the patient.

Just like in 1 of my previous duties - I saw an unstable patient. We sounded the "code blue" but we were really slow and delayed with our approach because of incomplete stock of medications. The relative was out & late in buying the needed medications. We can only use whatever is available. Eventually, the patient expired. I can only shake my head in disbelief & dismay. I believe we could have saved him. If only... I wonder if the management is really concerned about their patients. Of course, probably not. Imagine if there was a customer satisfaction survey conducted, the hospital could have failed in all aspects, big time.

I know that this is not unusual. For colleagues who have trained in public hospitals, this is very common & this always happen. Kawawa naman si Juan dela Cruz kapag nagkakasakit siya. He ends up six feet under.

Occupational Medicine

The workplace is not always a safe place to work in. Just like at home, there are always structures, elements that in 1 way or another may become a hazard and may cause injury or disease to an employee - whether regular or just contractual and even to the employer. The impact will be decrease in production and/or bad image for the company. 

For example, that Eton Construction Incident which happened last January in Makati City. 10 employees dead, 1 gravely injured. They were just going to have their lunch. Unfortunately, they rode a gondola which can only carry 2-3 people. Their weight was more than what the gondola could bear. The result - fatality. Is it a case of ignorance from the management, an unsafe behavior by the employees, or both?

Occupational Medicine is a gradually booming specialty, as recognized by the Philippine Medical Association. Its specialists are likewise recognized by the PhilHealth. Some companies are gradually recognizing (& hiring) physicians which have taken the basic course (either in Occupational Medicine given by the Philippine College of Occupational Medicine, or Occupational Safety & Health by the UP College of Public Health). The training courses are all recognized and accredited by the Department of Labor and Employment Bureau of Working Conditions (DOLE-BWC). Many specialists are also gaining interest in this specialty - thus, this is not limited to general practitioners, or family physicians only.

The basic course is an 8-day course, running from thursdays to sundays for 2 consecutive weeks, starting from 8am to 5pm. You receive a handbook, and served free meals (2 snacks, 1 lunch). The venues are either in Greenhills, San Juan, or in North Avenue, QC. Attendance is very strict (checked twice a day), absences are prohibited, tardiness is a no-no. Otherwise, you get a sanction. As the course director has mentioned several times, the most important days are the first two days, and the last two days. A plant visit is conducted on the second to the last day, followed by workshops and the graduation. Examinations are conducted before and at the end of the workshop to evaluate our knowledge.

It was like going back to medical school - instead of classmates coming from different pre-med degrees and schools, I met colleagues from different specialties (general practitioners, dentists, pediatricians, internists, etc.), different locations (mostly from NCR, some came from provinces as far as Batac, Ilocos Norte, Cagayan de Oro, Cebu), different fields of work (cement factories, call centers, private clinics, etc. and yes, even those unemployed like me). If you're lucky, you get to see your batchmates (from highschool, or pre-med, or medical school) who have also enrolled in the course at the same time with you. With time, we got to know each other, be more comfortable and be friends. There was no sense of competition, prejudice.

I was included in the first batch of the workshop for the year 2011. I was part of 54 participants. As the course director said, it was the largest group. Not to forget, there were 18 applicants who were placed on the "waiting list" & was unable to join. Our resource speakers were not bored with us, said that our group was very participative in the discussions. We were able to finish the workshop panels on time, and 1 of us got the highest score in the post-workshop exam for the past 2 years.

The discussions were extensive - ranging from medical topics like Occupational Cancers and Skin Diseases, Musculoskeletal disorders just to name a few, some engineering topics like Plant Sanitation, and administrative issues like Physician as an Executive, Employees Compensation Commission (ECC), policy making, etc. On the bad side, I've observed that the discussions were congested to just 1-2 hours. Because of interests, experiences of my colleagues, some of the open forums were cut or limited. Second, the fact of taking-in too much knowledge in so little time is too much to bear. 

The basic course is just an overview of what's instore for the Advanced Course before taking the Diplomate/Specialty examinations. Sounds exciting & promising, isn't it?

Hopefully, this will be accepted and recognized not only by physicians, companies but also by the government.

All 54 participants of the first class of Basic Course in Occupational Medicine for the year 2011