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

Photography Review: Still Life and Landscape

Next week, I'll be at Cebu for the annual convention of the Philippine Academy of Family Physicians and WONCA regional conference.. Since it's gonna be my first trip there, I have to take a lot of shots of the city, the people, the famous places. One important thing that I'm gonna surely bring is my DSLR camera. However, I've been on "hiatus" for quite a while on my once-favorite hobby.

Reviewing what I learned when I enrolled for a weekly photography class in Quezon City, here are the notes I've scribbled down during that session. I've also included some of the pictures I've taken prior to the lesson and after it. (Most can be found in my flickr account.)

Still Life Photography
- Object photography, meaningfully or artistically
- Kinds: Indoor - most common
             Floral - this is my most common subject
             Sculptural
             Food - most difficult
             Impressionistic
             Imitation - from existing art work
- Characteristics: Clear subject
                           Simple
                           Good use of colors and contrast
                           Good light
                           Unique perspective
                           Has a "personality"
- Techniques: In "M" or "Av" mode -- sorry, I'm using Canon. I don't know its equivalent to Nikon. 
                     Large aperture (F5 or larger)
                     Single drive
                     AWB, cloudy can be used for wooden subjects
                     Use telephoto lens - 50-100m
                     Zoom in
                     Single AF area mode
                     Center weighted metering

** Tips in taking pictures of flowers and plants --> I barely remember this part. Haha!
- Look for a sense of order or layers or patterns
- Understandable shapes
- Remove distractions or other elements


Landscape photography
- Pictures of an outdoor location
- Emphasizes local colors, culture of the place
- Unique man-made, or natural structures
- Subject is the back-ground
- Types: Natural
             Urban/Cityscape
             Road
             Skyscape
             Seascape
             Night
- Techniques on how to take it: 3 layers - foreground, midground, background --> 1/3 bottom, 2/3 sky --> if you want to emphasize the sky. But according to the great Mr. Scott Kelby, you can deviate from this rule. 

Bangui Windmills

                                                "M" or "Tv" priority
                                                Small aperture (F8, F9...)
                                                Dynamic shutter speed
                                                Single drive
                                                Auto white balance (AWB)
                                                Wide-angle lens (18mm, 17mm, 10mm)
                                                Dynamic AF area mode
                                                Evaluative or matrix metering mode



I am also reading photography books by Scott Kelby and watching lessons on the YouTube. I haven't joined any photowalk yet but given the opportunity, I'll gladly join one. Most importantly, I gotta have lots of practice and patience.


                                 

S2 Application & Yellow Prescription Pads

During our oath-taking last September 7, 2007, I remember what the Chair of the Medical Examiners said after we swore the Hippocratic Oath - "you can now prescribe". Well, we can but not all of 'em. There are some medications, drugs that are restricted. In order to prescribe those restricted drugs, we need to have an S2 license. It can be applied at the Philippine Drug Enforcement Agency (PDEA) office in Quezon City. The cost is Php1,500. It is valid in the same duration as the PRC license, renewable after 3 years. So if you plan to apply for one but your PRC license expires also on that same year, it's better to renew your PRC license first.

The requirements are the following:
1. PRC ID card or duly certified true copy
2. Official receipt of professional tax receipt (PTR); or latest certificate of employment for government physicians or duly certified true copy
3. Tax identification number (TIN) card or latest income tax return (ITR) or duly certified true copy
4. Drug test result (DOH-DDB IDTOMIS-generated report)
5. Two pieces of 1x1 id picture if applying for a S2 paper ID card. If you want to get the PVC ID card, submit two pieces of 2x2 id picture instead.
6. For those who will be renewing, previous S2 ID issued. For lost ID, submit proof of publication of loss
* Duly certified true copies can just be simple but clear photocopies. Bring your original documents for verification.
* Personal appearance is required to facilitate entry & capture of current photo & information into the automated system. Once entered, need not apply in person on succeeding period.
* Government physicians are exempted from payment of license fee. However must submit original duly-notarized affidavit that the S2 license shall be used exclusively in government practice only.


Drug test result - just like when applying/renewing your driving license, urine will be collected to check for presence of methamphethamines. Picture & legal signature will be taken when doing this test. Depends on the laboratory you go to, release of results maybe 1 week after. Forgot the price of this test. I personally went to Hi-Precision Diagnostic Lab. 

I filed for an income tax return the same year I applied for an S2 license, so that's what I used. I didn't had a TIN card.

Application for the S2 license was very fast since a few number of physicians were applying. Aside from me, there was also a veterinarian and another physician in queue. I applied for the PVC ID card. If I applied for the paper ID, I was scared that I might mistake it as a trash & throw it away. The card was released after 1 month from my application. But I was given a temporary ID in the meantime. When I claimed my ID, I was informed I can buy yellow prescription pads but that had to wait for half a year. Instead, I used typical prescription pads from my former institution since I was still a resident. Btw, bring another valid ID because you'll leave one at the entrance. And wear closed shoes when going there.


When I finished residency, I've decided to buy yellow prescription pads for my future practice. I inquired at two institutions - Philippine Children Medical Center and East Avenue Medical Center. After phone queries, PCMC has no available stocks of the yellow Rx pad; EAMC has. It was worth Php300 each pad, and I can buy maximum of 3 pads as first-time buyer. So I went there but I bought 2 pads instead. The pads were thick and I thought it would take awhile before I use 'em all. Up until now, I haven't used any piece coming from my yellow Rx pad.  

I have my own PRC license number, yearly PTR number, and now my own S2 license. I gotta be more careful. They're all under my name.

http://pdeapress.org/phase/ONLINE_S2_APPLICATION_PROCEDURES.htm

Deja Vu

I'm in this very familiar situation wherein I'm standing in the crossroads again. A little trip down memory lane: after I passed the PT boards way back 2001, I was a bum for 4 months because I was confused whether to apply for licensure in the US or stay here. I decided to stay & I became a PT volunteer for 5 months in 1 of my previous rotations during internship, then I went into medical school. Fast-forward to 2007 after I passed the medical boards, I was again confused & undecided whether to take local residency or USMLE. My mom insisted that I take residency locally. Ok fine! It wasn't easy as it seemed. Turned out that the first specialty training I applied for is not for me. After just 1 day of pre-residency, I decided to quit. Sadly, my parents hit the roof when I told them the bad news. I told them I wanted to go into Family Medicine and they were not initially happy with it (but eventually they had no choice but to accept it).     

And then now.. I've successfully finished my residency training. Finally, I'm out of the hospital, no more duties. I was so excited, psyched to get out again, be on my own, set my "own" rules. I've pondered on implementing what I've wanted to do before - take examinations for other countries (i.e. Australia, USA) to "seek for greener pasteurs". However the thought of asking my parents for financial support for these exams was very embarrassing for me. For the past 3 years, I seldom ask money from them; every penny I spent came from my meager salary as a resident. Instead, I wanted to have a job - as a physician, of course. Not just to earn but to use what I've learned & gained. The examinations have to be "deferred", again.

I've tried to search for jobs over the internet, asked around from colleagues for possible connections. Some have called me back for interview but no reply from them afterwards, but most did not respond. I have also taken into consideration what colleagues say as the "hospitals/institutions to avoid" before applying, because of many reasons (i.e. majority said because of low pay, unfriendly staff, etc.) In the back of my mind, I know I may not have some of their requirements at this time, like if I have attended any module in Occupational Health and/or Occupational Medicine, but I'll get into it. I am being called/informed every once in a while to hold clinic somewhere as a reliever but it's not permanent and not regular. There were mornings I asked myself "What am I going to do today?" 

My current work doesn't make me happy, fulfilled. I just think of it as something that keeps me pre-occupied in the meantime while waiting and looking for a better opportunity, and hoping to land one. I've thought of applying for jobs that a moonlighter does, but it's my pride (as a junior consultant but short of a diplomate status) that's stopping me from doing that. We never know. I maybe wrong since I haven't tried that actually.

I am not alone, I know. It's really difficult to start his/her own practice, let alone have a private clinic. But somewhere, I have to start and from there let's see what happens. If ever I land a job, I hope that it will be for the long run.

My Unhappy Work

(Again, a re-post from my Multiply account)

Last month, I looked through the google website for job searches as physician. I stumbled upon an advertisement which said "Post-FM Female Residency for hire in a private clinic in Makati blah blah blah..." It also mentioned the contact number and schedule of the clinic hours. I wrote the details down in my old Starbucks Planner. That was not the only post I jotted down. And then I forgot all about it. 

Last week (because of my desperation for job searching), I remembered about the job entries I wrote down. I prayed that the job is still open. After several inquiries by text, my prayer has been answered. High pay, good clinic location. Looks promising. Or so I thought..

When I was called in for interview last weekend, I was surprised to find several patients waiting in queue. While waiting at the holding area, most of the patients said the word "Canada". I thought if this is a clinic that screens immigrant applicants for Canada? When I was called in for interview, my thoughts were echoed out by the owner. No actual out-patient consultations; I will just be doing physican examination to applicants (for Canadian, or New Zealand visas) plus arrange/sort-out paperworks, or encode data in a computer. I got quite disappointed & I had second thoughts. For someone who graduated from an accredited residency training, I wanted to leave right then and there. I thought that the job description is fit for a GP or a moonlighter. Sadly, the owner introduced me to her staff right away after our interview. She kept on saying to them that I'll be starting on monday. I wanted to stop her from saying that. Instead, I just smiled at her. In the back of my mind, why was she looking for a graduate of a residency training kung iyan lang ang ipapagawa niya? At bakit ko naman yun kinagat? The pay is nice (clue: more than Php20K per month) but everything I've learned during residency will just be wasted & I might regret this later since I plan to take the diplomate exams at the end of the year.

Yesterday, I reported to work for the first time. I met another physician who have been working there for more than 1 year na. She introduced me again to the other clinic staff, gave me a thorough orientation of the clinic & learned some rules, including the fact that we don't start screening applicants until the owner arrives. I was also surprised when I saw the mountains of papers piled in different areas of the clinic. So is that what I'm going to sort? Am I going to encode? When we started seeing applicants, I was observant on how the other physician briefly examines an applicant. When I had the initiative to examine an applicant on my own, the owner scolded me. Probably, she doesn't trust my PE findings for now since I'm just a "newbie". I assumed she's defensive about everything that's put into writing in the documents because her name is at stake. But I'm so dismayed & defeated. For the past two days, all I've ever done was take the anthropometric measurements, visual acuity of the applicants. I suddenly remembered 1 of my rotations during residency, but this was worse. I always tag along (like a dog) with the other examining physician.

My searching doesn't stop here. I'm determined to find & pray for a better work, something that will help me professionally. Financial gain will always follow suit.