Trainee stories

The Philippine medical licensure exam finished this weekend, and boards jitters are, for many new physicians, giving way to preresidency ones. In the Philippines, most residencies — training programs under specific specialties — close their application periods after boards season. What follow
are weeks, if not months, of deliberation, during which preresidents are given an (unpaid) trial period to show their skills and trainability in a “Hunger Games” like competition
for limited slots.

Those who are victorious can rest a little, knowing they’ve secured their slot. However, those who actually make it into residency know that the struggle to maintain their slot isn’t quite over. Residency will demand unprecedented levels of time, devotion and responsibility, and for many, they will have to spend this a 3- to 6-year period of their lives undercompensated.

This is what I thought of when reading through #InternshipHorrorStories, the hashtag originated by Sen. Risa Hontiveros as she invited the sharing of experiences of internship in the country. There’s the corporate intern who, instead of gaining valuable work experience, is made to brew coffee and hand out fliers. We also have postgraduate nurse trainees who pay for training, not to mention earn certificate
upon certificate to build up their credentials prior to acceptance at a regular post. There are also medical interns, some of whom also have to pay for training, and who may also need to pay for their own, or patient’s, supplies.

The Association of Philippine Medical Colleges looks out for medical interns, and following a worldwide trend of decreasing work hours to enhance productivity and learning, has set out guidelines limiting work hours for interns. Some hospitals have followed suit, and others have played deaf. The internship experience in hospitals is varied. Some hospitals limit intern duties to clerical work, operating room assists and similar tasks. Other hospitals can barely survive without interns, who handle anything from blood extractions and vital signs monitoring, to first-line care and the administration of drugs. What’s true across the board is that these groups, being the most junior in the team, are vulnerable to abuse.

What, then, of residents, who have no such groups advocating for them? Residents are a uniquely disadvantaged group. Teaching hospitals, among whom are the biggest names in local health care, are heavily reliant on them. Their licenses allow them to manage patients on a whole new level of responsibility, and some — definitely not all — hospitals might, knowingly or unknowingly, be taking advantage. They are not obliged to pay residents, particularly those in private institutions, a high hourly wage, since residents are “privileged” to be in training. So residents, licensed doctors, can be doing 90 hours a week (a conservative estimate) and receiving around P60 per hour — a computation based on a common paygrade for private institutions. Vacation and sick leaves are enforced on a variable basis. In some institutions, the release of residents’ salary is even conditional upon the completion of tasks or paperwork. Residents in government hospitals have higher pay, but may need to pay out of pocket for patient expenses and surgical supplies. Trainees value their slots and training so much that these conditions are silently accepted as par for the course. To complain is to risk a bad reputation at the least, termination at worst.

Residents make a huge impact on the health-seeking experience of many Filipinos, particularly those in the metro. One hopes that as these internship horror stories call attention to the way companies take advantage of vulnerable young graduates, we can also take a look at healthy compensation for physician trainees, who might well appreciate the opportunity to specialize, but who also have families to support and bills to pay. Residency should still be hard, as befits training in any craft, but a magna carta for medical trainees might not be a bad place to start.

kchuarivera@gmail.com