This story originally appeared in the Philippine Daily Inquirer on May 23, 2009.
I am a “moonlighter.” In medical circles, the word largely refers to a Filipino doctor practicing as a general physician (GP), one who works outside one’s specialization or without one. Some doctors choose “moonlighting” as a lifetime career; others go into it while they are still undecided on what “path” to take or while in the process of formulating their so-called “plan of life.”
In the United States, “moonlighters” would refer to doctors who take on night-duties (and, therefore, metaphorically work under the moon’s light) to sub for another physician for some extra earnings. Such a moonlighter would be a “lokun” if he were in Singapore.
Well, moonlighting in the Philippines is just one of several “paths” for doctors. A doctor could go into a field of specialization; or he could review for the United States Medical Licensure Exam (USMLE) or for the US Nursing boards. Yes, nursing!
So what’s the big deal if one is a GP, a moonlighter?
First, let’s take a look at the “ideal career trajectory” of a doctor. After earning a health- or science-related college degree, the wannabe doctor has to go through four grueling years of medical study. After which, he is academically entitled to be called a doctor. Then he must serve for a year as a medical intern in a hospital of choice—a requirement for taking the board examination.
Passing the exam would seem like the happiest point in his life. But the happiness doesn’t really last long. After a few days or weeks of partying, the “ideal” path beckons to specialization which would entail three to six more years of training, depending on the chosen field. After this, the doctor becomes a consultant, and has to pay millions of pesos for shares of stocks so that he will, at least, have a right to practice in a decent tertiary hospital. The “super ideal” scenario is to train for a subspecialty, which will require another two to three years. And we haven’t counted in the months or years of irregular semesters the medical student might have gone through before.
Finally, the subspecialist has to attend continuing education seminars to update himself on the latest in the field of medicine. This he has to do until he won’t be able to read, or hear or walk as he used to; or until he has used up all the ideas on how to spend the millions of pesos he earned from his successful medical practice.
So being a GP deviates from the ideal path?
I passed the medical board exams in August 2008 but I chose not to apply for any residency (specialization) program just yet. Since then, I have been in a number of moonlighting stints.
The doctors I’ve met in these stints come from different batches: new graduates; fiftyish—but moonlighters all, each with a unique story to tell. Stories that made them decide not to shun specialized medicine, which includes hospital work that lasts 12 hours, or even 36 hours, non-stop or alternately; with hundreds of patients per day attended to—for stipends that range from P10,000 to P15,000 a month. All this in a hospital culture of seniority, money and politics.
I know of some doctors who earn a little more than P50 an hour from moonlighting. Imagine, this, after paying approximately a hundred thousand pesos per semester. Decent? Well, others settle for this income because they can’t find better options. Better to be “productive” while waiting for “good luck” (read: opportunity) in other countries.
Why don’t the moonlighters get better opportunities, or the residents-in-training better stipends? Perhaps, because doctors don’t stand to protest the reality (or the abuse?) they are made to suffer, opting instead “to protect the dignity and nobility of their profession.”
I confess I am guilty of wanting to work as a doctor in another country. But since medicine is a “protected field,” some countries do not recognize the Philippine licensure. To go to these countries—Australia, New Zealand, Canada and the United States, to name a few—Filipino doctors will have to pass the medical licensure exams there. But years will also be used up to qualify for these examinations. Eventually, those wanting to go to other countries end up, where else, but moonlighting.
After a few months of moonlighting, I have learned many things not taught in thick medical books. And I have seen the real face of the medical profession in the country. Yes, you may recognize a doctor earning millions of pesos, the big-timers, when you see one! But they are few and far between. Most doctors in the country can’t even compare their salaries with those of call center agents! For this reason, I’m not really surprised why doctors (and other health professionals) would want to work abroad. They feel that all the years of difficulties, sacrifices they went through to become doctors are not worth the “prize.” In fact, around half of my school batch is now reviewing for a medical licensure exam of another country. They seem to have no more plans to practice medicine in the Philippines. And the brain drain—“brain hemorrhage” would be the more appropriate phrase—won’t stop until the government (oh my, our government) would institute measures that would stanch the bleeding.
But another face of the medical profession tells me that it’s not all about money. When I participate in medical missions in the provinces, I meet doctors who live simple lives. They say that it’s really one’s expectations in life that define true happiness. It won’t matter if one’s a GP or a specialist. The Filipino doctor on a ship or an oil-rig physician is a GP earning a decent wage though, being away from his family, he has to endure loneliness.
The GPs in the barrios are the true heroes. They live a life close in style to the life of the people they serve, and enjoy a most rewarding feeling in healing and saving the lives of their less fortunate countrymen.
Many young Filipinos wanting to become doctors have asked me if the medical profession would be a good choice as a career. I always tell them that if it is sincerely in their hearts to help the sick and save lives, then they should pursue their dream. And I always tell them that if money is all they want, then they should forget about Medicine. Rich doctors get rich because of hard work and because they engage in other businesses, not necessarily because they are doctors. In our country, the life of a doctor is a life of sacrifice, a life of service, a life for others. For a dedicated doctor, the monetary reward comes just as a bonus; the real reward comes from heaven.
When I was a child, people would ask me what I would want to be when I grow up. My typical response was, “Paglaki ko po, gusto kong maging doctor!”
