FAMILY SPECIALTY
Becoming a family physician requires not just special training, but also a passion to serve
By Carisa A. Paraz, MD Contributing Writer
There was a time when everyone in the family from the apo to the lolo was seen by one doctor only-the general practitioner or GP. The GP was familiar with the vaccines given to bunso, with the number of pregnancies nanay has had, with lola's blood pressure fluctuations, and every other health condition of each member of the family.
Today, GPs who had further training are called family physicians, but it was not too long ago that their practice was recognized as a specialization. The umbrella organization of surgeons, the Philippine College of Surgeons, was formed as early as 1936 while the umbrella organization of internists, the Philippine College of Physicians, was formed in 1953. The Philippine Academy of Family Physicians (pafp) was founded in 1960 as the Philippine Academy of General Practitioners, but it was only in 1972 that it applied for recognition as a specialty by the Philippine Medical Association.
Despite this lag, "the Philippines is one of the most senior when it comes to family-medicine development in the region," says Dr. Zorayda Leopando, past pafp president. "We have one of the most developed [programs] in Asia."
The pafp recognizes two types of training programs: the traditional three-year hospital-based training program and an innovative program that takes four to five years. Fairly new and yet to be standardized, the innovative program has produced only one graduate to date. In the program, residents use their practice experience as training for specialization in family medicine. The experience can be in a rural health unit, district hospital, private general practice, or in a hospital as "moonlighters." They discuss the patients they see in their practice with their preceptors, who supervise the residents during weekly preceptorial sessions. One advantage of this type of program is the residents do not leave their practice and thus maintain contact with their patients, do their own work, and maintain their income.
One example of an innovative program is that of St. Jude Hospital in Manila, which now has seven residents who each go on duty one day a week at the hospital. The residents are free to moonlight on other days. The training program is preceptor-based because all the training activities are dependent on the preceptors. The residents meet once a week with preceptors in their clinical rotations and twice a week with a family-medicine mentor.
Dr. Leilani Apostol-Nicodemus, member of the board of the Foundation of Family Medicine Educators, describes the innovative training program: "The evaluation is very tedious so that you will ensure the same accomplishment of competencies with that of the traditional training program."
The residents still have to achieve certain competencies per year level, and these are measured through reports and examinations. "The difference with traditional is in its implementation, because with the traditional they are within the hospital; they are being supervised 24 hours a day, and their learning activities are done within a protected time in the hospital. In the innovative, there is learning on their own, that is, in the area of their practice. It is based on self-directed learning that's why measuring the accomplishment should be very strict also."
Graduates of any residency training program are certified family physicians provided they have also completed a research project. After one year of practice as family physicians and maintaining the required continuing-medical-education (cme) units, they may then take the diplomate exam, usually given in January each year. Successful candidates are conferred the title Diplomate in Family Medicine during the pafp's annual convention. A diplomate has to complete 180 hours of cme in three consecutive years to be considered a candidate for fellow, the highest rank a family physician can achieve. The title is given to a qualified diplomate who has achieved any of the following: research paper published in a peer-reviewed journal, a postgraduate degree (such as master in science, public health, or hospital administration), or an administrative-leadership position in a residency-training program or in a pafp chapter.
Further studies in family medicine include the graduate program offered in UP. The Master of Science in Clinical Medicine (Family and Community Medicine Track) was introduced in 1999. Leopando adds, "I'm proud to say the program is doing well because we never run out of students. We have seen how our graduates and students are able to make use of what they have learned in their institutions." Attracting both foreign and local students, the program has graduated three Filipinos and six Indonesians. "It is easier for the foreign students to graduate because they are focused. There is no competition for time. When they're here they only do the graduate program and don't leave until they are finished," she explains.
What does it take to enter a family-medicine residency training program? Nicodemus, who is also the residency-training officer (rto) at the pgh department of family and community medicine, says it is very simple. "Of course you should have an MD, and you should have an inclination toward general practice." Entering a residency training program is one thing, but being a family physician is another. Nicodemus stresses, "You have to have the passion of serving," and she is a prime example of this.
After graduating from the pgh family-medicine residency-training program where she served as chief resident in her last year, she immediately worked as a volunteer consultant. "Volunteer as in walang salary," she is quick to add. She got her income from research projects and teaching part-time in other schools. Not only did she work as a consultant for free, she also volunteered in Ospital ng Maynila as a research coordinator.
"As long as you like or love what you are doing, you can be successful. Any career path, as long as you like it. [If] you have the drive to accomplish things, you'll do great. You will be compensated in the end. Yun nga lang, hindi ganoon kabilis. You should be patient because it is not a one-shot deal that you will be able to earn [at once]. It's more of the satisfaction that you get because of the practice at first. Personal satisfaction from what you accomplish, but not monetary rewards. The monetary rewards will come after."
She is using her passion to hopefully attract other equally passionate doctors. As rto, Nicodemus is in charge of developing the curriculum for the two-track program of pgh and the UP College of Medicine, which combines both clinical and academic training. It is a four-year program composed of the three-year clinical training plus a year for academic training. It has been offered already to 13 residents, but recruitment of new residents was stopped in 2006 because the residents had difficulty completing the academic requirements. Nicodemus hopes to integrate common topics discussed in both the residency and academic courses, and hopefully relaunch the program by next year.
Despite the fertile training ground that the Philippines has to offer, family physicians are flocking elsewhere to practice. "Our graduates are leaving as doctors not as nurses because they are recruited by Singapore and Australia," complains Leopando.
"It's so frustrating," she continues, "We're training them to practice in the Philippines and then they leave. We have also family physicians migrating to Australia. It was said that by the end of this year 150 family physicians will be there.… Now we need to look into how to curb [their leaving] and how to protect them while they're there." M
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