Closing the Pandora’s Box: Mandatory Return of Service, A better solution?

in Blog Rounds/Medicine by

According to ancient Greek mythology, Pandora opened the “box” (actually a jar which Zeus entrusted but forebode her to open) because of one uncontrollable urge-curiosity. The opening of Pandora’s box released all “human evils” kept inside the jar by Zeus, except one human trait.

(Pandora’s Box Painting by JW Waterhouse)

In one striking parallelism, the current brain drain of professionals is rooted in one analogous reason. Better financial and professional opportunities abroad fueled the curiosity of homegrown professionals to go on an exodus and opened the lid of our Pandora’s box.

No other profession suffered more scrutinizing eyes than what physicians received in this brain drain phenomenon . Believing that this mandatory return of service will close the exodus of professionals from the country, a congressman filed HB 4580 requiring all professionals to a mandatory return of service after training here in the Philippines. Ironically, while the government is drum rolling OFWs as the nation’s new heroes (cultivating the exodus of skilled workers in exchange for dollar remittances) it is quick to criticize physicians who thread the same path of seeking better opportunities abroad. Worse, labeling these physicians as unpatriotic offers the most hideous method of enticing them to come back, and appeal to their nationalistic pride. Why is the government capitalizing on the OFW phenomenon but openly shun doctors planning going out?

Some medical training institutions have tried to close this Pandora’s box with a “lid” of their own. The UP College of Medicine, a government subsidized university, has approved a three year mandatory return of service for its medical graduates. Other government funded medical training institutions have their own return of service program in place as part of a medical training contract for years already. The penultimate questions still remain.

Was it successful in preventing the brain drain of physicians?

Was it able to solve the worsening physician -patient service ratio?

Is this a a wise move to close our Pandora’s box?

Doc Mel ( Philippine Daily Idiot) didn’t think so. Here’s his egg laying bird nest appraisal of this move:

Straight to the point: forcing our dear motherland’s brightest med future (naks, UP med students) after graduation to serve three years in the country smacks of a short-term Band Aid in one thickening subplot of the Philippine Zombie Healthcare System.

and some more egg laying truth..

A short-term Band Aid is maybe ok NOT because it is cheap and high-impact. It is ok if only because it is one prong in an all-out multi-pronged approach to a problem. To be charitable about it, give it to the government that it is tinkering with every way possible to do it.

Most of us in the industry feel this move is a good start, but should be part of wider and broader long term solution to the brain drain and dwindling patient to physician ratio in the health care system.

Prudence MD lauds this UPCM move (Is Hb4580 the solution to Philippine’s brain drain?):

I find it fair enough that medical students whose education have been subsidized using taxpayer’s money should be required to render a certain amount of time for medical service to the country. Also, I believe this should be applied to graduates of any other courses in all state universities.

So does Pinay Megamom here (Starting somewhere):

I laud UP for making this move. However, its effectiveness to try and address the bigger issues remain to be seen. If other measures are taken to address the other contributing factors to brain-drain (compensation, professional satisfaction, work conditions, etc…), in conjunction with this move, we may actually see some changes for the better. It’s a start.

and Joey MD here (Solution to healthcare?)

I do not think that this will ultimately result in better health care, but it’s a good start. At least, this program will try to ensure that there will be enough MDs, hopefully, to serve the people’s health care needs, assuming that the enrollment in UP Medicine is about the same every year.

But weather it will end up in a better health care system on its own, we all sing a united “I doubt it this is a long term solution on its own.”

Several issues and potential caveats where raised by blogger MDs themselves that needs to be addressed if this mandatory return of service will make its impact on our zombie health care industry. Cautioning the government that even HB4580 is not the only solution to this current brain drain, it also has to make appropriations and just compensation for those who choose to work here.

  • Prudence MD cautions that it is unjust to impose this rule on privately trained professionals.
  • Mel B warned that this band aid approach is a single pronged approached to a otherwise multi pronged problem. And he espoused a “global” caffeine injected solution to a zombie, global capitalist health care system.
  • Joey MD echoed the same sentiments of strengthening other aspects of the health care industry (e.g. budget, facilities, health care education)
  • Pinay Megamom insists that provisions for adequately compensating those who are forced to work here.

Unaddressed, these issues are the same reason why most professionals leave the country. This is what JA (Ripples from the river of my thought) put forth in her blog (Here, there or Anywhere)

I don’t think that creating laws to keep people from leaving are going to be helpful in the long run though. What is necessary is for young doctors to feel that they are justly compensated during training and actual clinical practice in our country. That way, they will have more reasons to stay than a feeling of obligation to serve the country.

And if we are threading in to the realm of cutting liberties and human rights of physicians in the name of public service, them we might have missed the root cause of this problem. Just like what Anakat ( The Saga Continues) in “Exodus part 2” is saying.

I am not an expert on human rights or related laws but there has to be a breach of this in the government’s decision to pass this house bill. UP used to be a staunch protector of these rights and freedom. My alma mater has let me down by devising this return service mechanism.

In a democratic institution, where does the freedom of a professional ( to choose where to practice) ends and that of public service starts??Or does it end at all? These lines simply put a good thinking salvo on this issue.

In an attempt to close this Pandora box, the various stakeholders tried but failed to understand why the lid was opened in the first place. And while starting a band aid solution to the brain drain problem seem laudable, it has yet to prove its impact on the health care system fraught with vulnerabilities.

Sadly, we fail to discern the reason(s) why our box was opened in the first place. Knowing these reasons and addressing them primarily, maybe we will have a better shot in closing this Pandora’s box. Hope is only what’s left inside this box.

(To the MD bloggers who contributed to this edition of TBR, thank you all! Prudence MD will be hosting TBR 18, for another interestingly relevant topic of our times, The State of Reproductive Health Care in the Philippines)

Dr. Remo-tito Aguilar co-founded #HealthXPh. A board certified orthopedic surgeon, he is Chief of Clinics at General Santos Medical Center and Medical Specialist II Orthopedics at the Southern Philippines Medical Center in Davao City. Dr. Aguilar is a healthcare social media evangelist and writes his medical musings at The Cast & Curious (