Doctors appeal DOH order restricting training in US

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MANILA, Philippines — The Department of Health (DOH) said it was reviewing an order that had reduced the number of Filipino medical graduates applying for advanced residency training in the United States following an appeal by US-based Filipino doctors to revise the policy as it “narrows” opportunities that would eventually benefit the country’s health-care system.

In a Nov. 4, 2023, letter to Health Secretary Teodoro Herbosa, Dr. Henry Echiverri, president of the University of the Philippines Medical Alumni Society in America (UPMASA), called for a reconsideration of the administrative order (AO) which imposed restrictions on doctors wanting to practice or are practicing certain specialties from pursuing advanced studies under a 62-year-old US law.

These “negative” specialties — internal medicine, surgery, OB-gyn, family medicine, pediatrics, anesthesiology, pathology, and radiology — were indicated in Administrative Order No. 2022-0009, which was signed by then Health Secretary Francisco Duque on March 22, 2022. The order took effect in March last year.

Echiverri said that after the order was enforced, the need for training certificate (NTC) would no longer be issued to medical graduates “desiring to train in the listed ‘negative’ specialties.”

“UPMASA, on behalf of the medical school graduates of the Philippines that are affected by this order, would like to appeal for a reconsideration by not completely closing this pathway,” he said.

‘Valid points’

In an exchange of messages with the Inquirer last week, DOH deputy spokesperson Dr. Albert Domingo said that the “department is studying the matter, fully aware of the valid points raised by all parties.”

When asked whether the DOH was open to amending the AO in a way that would restore the specialties that were in the “negative” list back into the training program, Domingo declined to give a categorical answer.

“We will provide more information once the study progresses,” he said.

But the health official assured those concerned that the DOH “remain[s] dedicated to ensuring the well-being and professional development of Filipino physicians, in the pursuit of the highest standards of health care and public service.”

He had no figures immediately available on the number of doctors affected by the order.

‘Negative’ list

The specialties in the “negative” list are in the training programs already available in accredited hospitals in the country where licensed medical graduates could apply for residency. Therefore, the DOH said, the issuance of an NTC would only be approved when the training an applicant is applying for was not included in the “negative” list in accordance with the AO.

Applications for NTC may also be approved if there are “no available slots in all public and private teaching and training hospitals” in the Philippines, the AO said.

Licensed Filipino doctors may pursue residency training in the United States under the Exchange Visitor Program of the Philippines, which implements the 1961 US law called the Mutual Education and Cultural Exchange Act. But these doctors will have to secure an NTC first before they can obtain a J-1 visa, which is granted to those approved for visitor programs related to work and studies.

“Since the inception of this Act in 1961, many have benefited from said exchange program, and the new administrative order narrows this door significantly,” said Echiverri in his letter to Herbosa.

“We understand that this also assures an adequate health manpower in the country as stipulated by the Universal Health Care Act, but we also understand that the rationale is that there are enough training programs existing in various locations in the Philippines that are not filled in the eight ‘negative’ fields,” he added.

The restrictions are meant to ensure that the Philippines do not lose registered doctors to migration. However, Echiverri stressed that the exchange program should not be blamed over such fears.

Citing estimates from the Professional Regulation Commission (PRC), Echiverri noted that there were around 28,000 licensed physicians in the country.

“Based on these numbers, there should be no lack of physicians filling all the residency slots,” he said.

Echiverri also pointed out that the restrictions only apply to the exchange program with the US. “This results in an unequal enforcement of the rule based on a rationale that Philippine residencies are not filled,” he said.

Echiverri said the order was “troubling” because it curtailed the opportunity to acquire education in other parts of the world.

“Our Constitution specifically safeguards individual freedom and promotes human rights, one of which is the right to an education,” he said. “By keeping this door open, the government’s duty to ensure that people get the most up-to-date advances and innovations is assured.”

Filipino doctors admitted to the exchange program are required to undergo a two-year “home residency” upon the completion of their training in the US in order to “facilitate a transfer of knowledge and skills” and apply their expertise in the Philippines.

“The exchanges of ideas in an open and free society led to significant advances in science and medicine … especially where there is intercultural exposure, and opportunities to work on cutting-edge advances,” Echiverri said.