Steps of becoming a Doctor in the Philippines

Whenever we ask children what do they want to become when they grow up, and they answers,"I want to become a successful doctor someday" most often we replied "Oh that’s really nice, that's a very noble profession indeed" or this "I know you can do it, just continue believing in yourself and in your dreams"

It is indeed a noble profession a lot of people dream of becoming. But for some people, like me, who doesn't have anyone in the family who is a doctor, we don't know how long would it take us to become a successful doctor someday.  

Here I want to share something I learned from going through this same journey as yours which I honestly didn't know upon entering medical school but wish I knew, not that it would change my course but somehow you know would've totally prepare me holistically :) 

This timeline of your journey starts after graduating from senior high school since this where you and your classmates take different baby steps in achieving each of your dreams. 

Timeline of becoming a successful Doctor:

• 4-5 years of pre-med degree 
• 4 years of medicine proper
• 6-7 years straight program (UP INTARMED/La Salle Human Bio)
• 1 year post graduate internship
• 2 months of board exam preparation 
• 3-6 years of residency training
• 1-3 years fellowship training

You can take any pre-med degree, even non-medical related ones, however, some medical schools would require units of some science courses such as physics etc. Though, I can say it is more advantageous to take health-related degree if you already knew you wanted to pursue the field of medicine after graduating from high school. I took BS in Nursing which only took 4 years unlike others such as BS in Physical Therapy which takes 5 years. Of course, not only you consider the length of years studying, but more importantly your passion. If you are passionate of becoming a physical therapist or pharmacist or med tech, regardless how long it takes, you should pursue them. Your passion is what makes your journey more enjoyable.

There are few medical schools which offers straight program for medicine, such as the 7-year program of UP INTARMED, 6-year program of La Salle BS Human Bio and recently, UST released an article that they will be accepting the 1st batch of their 6-year Innovative Doctor of Medicine program for the academic year 2019-2020. You may click the links I provided, to visit their website. This is one fact I didn't know before entering medical school. I hope a lot of medical schools in the Philippines or more so, all medical schools in the Philippines will offer straight program for medicine. Since being in this field really takes a toll of our lifetime, it's one way of shortening it but still providing quality education producing best doctors. 

Every medical student should undergo 1-year post grad internship in their matched hospital. I'm not sure with med students from UPCM if they are allowed to have their internship done outside PGH. You may refer to my post about internship for more info :)

And for you, who, like me, wants to pursue residency training in your chosen field of specialty, it is important to know that not only they differ in specialization but also in their length of years of training. And another 1-3 years, depending on what sub-specialization you wish to pursue. More or less, hospitals offers the same length of training for these different programs. There are a lot of students who take into consideration the length of residency training in choosing their field of specialty, that's why I included the common field of specialty in this post. 

Below are the accredited residency program and its equivalent of years of training offered in Perpetual Help Medical Center-Las Pinas as of December 2018.

RESIDENCY PROGRAM	YEARS OF TRAINING
Internal Medicine	3
Pediatrics	3
Obstetrician & Gynecology	4
General Surgery	5
Emergency Medicine	4
Radiology	4
Radiologic Oncology	4

There are now straight program offered for various specialty as well, where you don't have to undergo the previous required residency training. For example, before you need to take residency for IM before going to Neurology but now there's a straight program for Neurology, others are Dermatology, TCVS, Orthosurgery, Neurosurgery and etc. PGH offers a lot of accredited residency and fellowship training. Don't worry my dear, along your journey to MD, you'll gain a lot of information from your mentors regarding the field of specialty you're planning to take. Don't be shy to ask and they'll willingly help and guide you :)

It's honestly exhausting just thinking about how many years still ahead should I go before I can say "I am now a successful doctor". Each of us has our own definition of being a successful doctor. Some feels it's already enough to be a general physician once they achieved getting that MD attached after their name and a license to heal. It won't make any person less of a doctor if he/she did not pursue further training in a specialized field. What matters is how he/she was able to help other people with the knowledge, skills, & attitude he/she gain from all those years of studying.

Each of our journey differs from one another, and we should not compare our success with that of others. Taking further training in these fields are not the only way to serve as a doctor and be successful. May we all discover our passion and pursue them with an earnest heart, all for the greater purpose of serving those who are in need. May we all be blessed. To God be the Glory!

Post Grad Internship Matching: Things to consider before clicking your hospital of choice

'Tis the season to be jolly, falalala lalala. LOL.

Indeed guys it's the season to be jolly because it's already Christmas season and at the same time, it's the APMC Matching season for all medical students in their clerkship year for the upcoming post graduate internship July 2019 - June 2020.

For those who are still kind of confused as to how does APMC matching works and why is it important for medical students to engage in it, I'll quickly give a brief overview and some links to help you in your application which was well written by APMC-SN

All clinical clerks who want to do their internship after right after finishing clerkship, are required to register in E-NIPS in order to be included in the scheduled online matching process to be match in their respective hospital of choice. It's not mandatory for every medical student to participate in it, such as for those who are not planning to do their internship here in the Philippines and for those who wish to delay their internship for the time being.

APMC-SN already posted the schedule of matching for the Regular National Internship program  which will be running from July 2019 - June 2020. The 1st round of matching already started last November 05, 2018. You may click this link APMC National Internship Program Primer if you wish to know more of the step-by-step process created by APMC-SN as a guide for the online matching process. Below are pictures posted by APMC-SN in their facebook page for your guidance of the  July 2019-June 2020 Internship Program.

Now let's go to the heart of this entire post, which I hope will guide you as to which hospital is best to have your internship done cuz during my time I didn't know what things should I consider in choosing the hospital. I was looking for some tips from various blogger, I'm not sure if I was able to find one but that's the reason why I wrote this blog, to help future medical students who'll be undergoing the same process in time. 

In contemplating your hospital of choice, there are a few questions to ponder on about yourself such as; What type of active learner are you?What is your priority during internship, to learn more theoretically or clinically? Where are you planning to take your residency, if there's any? Do you want to experience less or more toxic duties than your clerkship rotation? Do you want to go where there is a higher monthly allowance? These are just some of those things which I'll quickly tackle. 

Each and every student's learning ability are different from one another. Some says they learn best when they are expose to various cases rather than simply reading it from our books. So in turn they chose government hospitals where there are a lot of rare cases such as PGH, Jose Reyes, Ospital ng Maynila, DOH and etc. Some students, especially those who came from private institution, wants to learn more clinically and be able to perform a lot of various clinical procedures that they weren't able to perform frequently or not at all during clerkship such as doing thoracentesis, closed tube thoracostomy, spinal tap, intubation, epidural anesthesia, minor surgeries such as wound debridement, I & D, excision biopsy and a lot more. You can do a lot more of these in public hospitals due to a lot of cases and fewer manpower to do all these procedures. 

A lot of my senior interns, residents and consultants personally advised me stay in our school's own hospital institution because it has a balance experience in terms of being exposed to a lot of cases and having that benignity to study them since our institution only has 12 hours max during duty status. After which we have a lot more time to study & prepare for the board exam. As they said, learning to confidently perform various clinical procedures shouldn't be my priority at all as I will be able to learn them when I proceed to residency. However, some seniors and mentors also told me that having their internship in public hospital prepared them to confidently managed cases on their own which helped them during their moonlighting. So this is something you need to answer within you regarding as to what is your main objective in your internship.

You also need to consider the field you want to pursue and where you are planning to pursue it. They said it'll help you during your residency application if you had your internship in that said hospital also because you were able to form a close bond with the residents and consultants. Though at the end of the day, residency application is still a competition especially in institution where there are a lot of applicants. Another advantage is you are able to witness how the residency training is in that institution. Is it still something you want to get into? If not, then maybe you can start reconsidering other institution for your residency after internship.

Some students felt like they were too benign during their clerkship and felt as if they learn only a few than what they were expecting, so they decided to pursue internship in hospitals where they see fit they'll learn a lot more. Some however, felt like they got really burnt out from all the clerkship toxicities they had, that they considered to lay low and have their internship in private hospitals, thought not all, mostly are benign compared to public hospitals. Some highly took into consideration the monthly stipend they'll get from an institution regardless its toxicity. 

For my experience, I chose to have my internship in PHMC-Las Pinas, it is our school's owner hospital situated behind our school building, the Tamayo Tower. Originally I was matched in a different institution because PHMC was honestly not in my top 3 choices in the online matching. I was originally planning to have my internship done outside to get a different clinical experience than I once had during my clerkship. However, due to practical reasons, since it's nearby our house, about 5 minutes away from home and also because I actually plan to have my residency in this institution. So why not stay instead. I wrote a separate blog regarding the process we went through in order to be un-matched from our previously matched hospital and be rematched to another.  Since it's a private institution, we only get to perform fewer clinical procedures compared to what other interns does in other public hospital. But honestly, our residents and consultants are really kind enough to let us do the clinical procedures when we ask permission from them. If you are confident enough to do it after reading and watching how the procedure is done, take the initiative to volunteer. It's a very effective learning process. 

May be you are wondering, how did my internship went? Do I have any regrets staying in the same institution? Honestly, I thank God we made the right decision. I don't have any regrets. I am on my 3rd rotation already (Internal Medicine). Major rotations came first. We only have 12-hour duty on our duty status. On that 12 hours, I maximized my time to learn the best I can from the cases I see clinically. I'm not too tired after duty compared during clerkship when we had a minimum of 30 hours straight. I have the balance of seeing a lot of different cases and being able to study in preparation for the boards when I get home. Our institution is supportive enough as well to help us when we organized for review classes every Saturday. May be in the near future I'm gonna write on how I study and prepare for the boards during my internship period. :) Lastly, we get a small amount of stipend each month. 

My message is that, wherever you may go into for your internship, make the best out of it. It's upon us if we will take the initiative to learn. If it's toxic make the most out of that toxicity, read on all the cases you see in the wards, ER, OPD. If you are lucky enough to have a benign duty, study on your free time and read on the clinical cases you see. It's easier than done, but let's develop in ourselves the discipline to study not just for the board exam but as what most med student's favorite quote says (my personal favorite as well)

"Student, you do not study to pass the test. You study to prepare for the day when you are the only thing between a patient and the grave"

- Mark Reid

Disclaimer: This is just my personal opinion or realization that I've come up with from my experience as an intern and from the advised I got from my seniors/mentors before. Probably not everyone will agree with me as each of us has our own experiences. If you have other suggestions/comments/advise please comment down below. I'll gladly appreciate it a lot. Thank you :)