Regulation of Residency Training of Foreign Nationals

1. “How can developing countries grapple successfully with health crises if they lack the very foundation of a health system: people?”

2. Regulation of Residency Training of Foreign Nationals

3. Discussion Points • Existing policies or the legal basis for allowing foreign nationals to undergo residency training in the Philippines; • Proposed ways and means of regulating foreign residents as to: • Identify the proper agency that should regulate these foreign residents based on mandate, • Propose structure and other mechanisms that will facilitate the regulation of residency training of foreign nationals • Policies needed to be in place in order to regulate these foreign residents.

4. Discussion Points • Existing policies or the legal basis for allowing foreign nationals to undergo residency training in the Philippines; • Proposed ways and means of regulating foreign residents as to: • Identify the proper agency that should regulate these foreign residents based on mandate, • Propose structure and other mechanisms that will facilitate the regulation of residency training of foreign nationals • Policies needed to be in place in order to regulate these foreign residents.

5. Introduction: The Fatal Flows • How did we get there? • Regional and international migrations are assuming new dynamics • Labor markets have become more global, and with shortages in many high-income countries, the choices available to sought-after workers are expanding • The gradient is from inferior to superior work and more stable political and economically rewarding situations

6. COMPENSATION OF RESIDENTS ( MEDICAL OFFICER III )

7. LIVING WAGES SOURCE: National Wages and Productivity Commission

8. The Fatal Flows • The Philippines, purposefully export workers, including medical personnel, to gain skills, earn foreign exchange, or fulfill humanitarian aims • The exodus is often only the beginning of a downward spiral of health system capacity

9. The Fatal Flows • In health facilities already facing shortages of staff and unfilled vacancies, the migration of existing staff adds to the workload of workers who remain, increasing their case loads and over time, leading to fatigue, a loss of motivation, and eventual burnout.

11. NUMBER OF PATIENTS Source: Hospital Statistics Report 2005

12. Health Care Provider to Patient Ratios Davao Medical Center

13. The Fatal Flows • These pressures provide an impetus for remaining workers to themselves migrate out perpetuating the vicious spiral. The loss of workers also results in leakages of public subsidies invested in educating them.

14. The Fatal Flows • Blocking worker flows violates human rights and is unenforceable. Leaving migration to labor markets turns a blind eye to “fatal flows.”

15. The Fatal Flows • Instead, strategies must be crafted to channel, balance, and manage migration to provide good and equitable global health while mitigating harm in both source and destination countries.

16. Looking for a New Perspective • Human resource development is a long-term process, requiring years of steady investment but with the potential for high yield and sustained returns.

17. National Surgical Manpower Study (The Philippine College of Surgeons )SOUTHERN MINDANAO 1: 58,369 Current General Surgeon to Population Ratio 1: 15,000-20,000 Ideal General Surgeon to Population Ratio

18. National Surgical Manpower Study(The Philippine College of Surgeons )SOUTHERN MINDANAO PROJECTED SURGEON REQUIREMENT

19. National Surgical Manpower Study (The Philippine College of Surgeons )SOUTHERN MINDANAO 1: 58,369 Current General Surgeon to Population Ratio PROJECTED SURGEON REQUIREMENT VS DMC GRADUATES

20. Looking for a New Perspective • The constant need for health workers as well as increased demands generated and new technologies often create forces that outstrip the supply of health workers. • Hence, at Davao Medical Center we had to create an innovative solutions to answer our deficient physician needs.

21. Looking for a New Perspective • The following were instituted: • Extend services of resident physicians that have graduated • Innovative retooling of some personnel with several tasks traditionally done by physicians e.g. dressing, IV insertion etc…

22. Looking for a New Perspective • Applied for subspecialty residency training programs e.g. urosurgery, neurosurgery, pediatric surgery etc.. to attract more trainees. • Created Post graduate Nurse’s Training Programs • Applied for subsidies for additional contractual personnel for nursing and physicians

23. Looking for a New Perspective • Foreign Physicians Training Program ? • Existing policies or the legal basis for allowing foreign nationals to undergo residency training in the Philippines;

24. Foreign Physician Training Programs Medical Act of 1959: Article III THE BOARD OF MEDICAL EXAMINERS; REGISTRATION OF PHYSICIANS • Section 11. Exemptions.- The preceding section shall not be construed to affect • any medical student duly enrolled in an approved medical college or school, or graduate under training, serving without any professional fee in any government or private hospital, provided that he renders such service under the direct supervision and control of a registered physician RA 2382,4224,5946

25. Foreign Physician Training Programs Government and Non-Government Agencies : • Department of Justice ( Bureau of Immigration) • Department of Foreign Affairs • Medical Specialty Societies • Department of Health • CHED

26. Foreign Physician Training Programs • 1. Medical Specialty Accreditation Boards • Filipinos be prioritized in the resident quota allotments per training program • Certificate of Accreditation • Reciprocity Rule • Specialty is recognized by recipient

27. Foreign Physician Training Programs 2. Bureau of Immigrations •SEC Registration /Articles of Incorporation/By-laws for Private Institution or Charter or State Universities and Colleges:•Certificate of Accreditation issued by FAAP;•CHED/DECS/TESDA Accredited courses /programs;•Bulletin of Information;•Faculty Profile;•Pictures of buildings, laboratories/libraries; and•Other credentials, as may be required by the BI Student Desk (Letter request duly notarized)

28. Foreign Physician Training Programs 2. Bureau of Immigrations The Student Desk shall Inspect the petitioner school/learning institution and verify all credentials submitted thereof. The Student Desk shall recommend to the Commissioner of Immigration appropriate courses of action to be undertaken regarding the petition for accreditation. The Commissioner grants authority to accept foreign students by signing the “ORDER” prepared for the purpose. Upon application the petitioner pays for the school accreditation fee of P10,000.00 plus a legal research fee of P10.00 & P500 express fee for a total of P10,510. The School Registrar or Person-In-Charge or Liaison officer for foreign students shall be required to attend a seminar on Special Study Permit (SSP) and Sec.9 (f) Visa for accreditation purposes.

29. Foreign Physician Training Programs • Section 9(f) Philippines Immigration Act of 1940, as amended • "A student, having means sufficient for his education and support in the Philippines, who is at least eighteen years of age and who seeks to enter the Philippines temporarily and solely for the purpose of taking up a course of study higher than high school at a university, seminary, academy college or school approved for such alien students by the Commissioner of Immigration."

30. Foreign Physician Training Programs • Section 1(a) Executive Order No. 285 • "Only aliens who seek temporary stay in the Philippines solely for the purpose of taking up a course higher than high school at a university, seminary, college academy or school authorized to admit foreign students who are at least 18 years of age at the time of enrollment and have the means sufficient for the education support of study area covered under this order

31. Foreign Physician Training Programs • Non Immigrant Students under Section 9(f) visa • is one seeking temporary stay • who is at least 18 years old • has the means sufficient for his education and support in the Philippines • who pursues a full course of study higher than high school • at a school authorized to accept foreign students by the Bureau of Immigration

32. Foreign Physician Training Programs • PROCEDURAL GUIDELINES IN THE ISSUANCE OF A STUDENT VISA ABROAD • Student communicates with the HEI authorized to accept foreign enrollees and complies with the following required documents: • Five (5) copies of the Student's Personal History Statement (PHS) duly signed by him, both in English and in his national alphabet accompanied by his personal seal, if any, and containing, among others, his left and right thumb-prints and a 2 x 2 inch photograph or plain white background taken not more than six months prior to submission • Transcript of Records/Scholastic records duly authenticated by the Philippine Foreign Service Post located in the student applicant's country of origin or legal residence. • A notarized Affidavit of Support including bank statements or notarized notice of grant for institutional scholars to cover expenses for the students accommodation and subsistence, as well as school dues and other incidental expenses. • Photocopy of data page of the student's passport showing date and place of birth, and birth certificate or its equivalent duly authenticated by the Philippine Foreign Service Post. • Upon compliance of the required documents, HEI issues Notice of Acceptance (NOA). • For those desiring to enroll in Medicine and Dentistry, their documents shall be submitted to the Office of Student Services (OSS), CHED for evaluation and if found in order, a Certificate of Eligibility for Admission (CEA) is issued to concerned foreign student. • He then submits documents including the certified true copy of the CEA of those enrolling in Medicine and Dentistry to the Department of Foreign Affairs (DFA

33. Foreign Physician Training Programs • DFA indorses the documents to the Philippine Foreign Service Post (PFSP) in the student's country of origin or legal residence for the issuance of the corresponding visa. • PFSP notifies student-applicant with instruction that he appear in person before the Consular Officer for interview and submission of required documents, as follows: • Original copy of the School's Notice of Acceptance (NOA) containing a clear impression of the school's dry seal • Original copy of the Certificate of Eligibility for Admission (CEA) issued by CHED if enrolling in Medicine and Dentistry. • Police Clearance issued by the national police authorities of the student's country of origin or legal residence duly authenticated by the Philippine Foreign Service Post having consular jurisdiction over the place. • Medical Health Certificate issued by an authorized physician including but not limited to standard-size chest x-ray, HIV, hepatitis B clearance. The Consular Office shall not assume the task of determining the student's scholastic fitness for the program applied for and shall issue the student visa as soon as all the requirements are accomplished. • Foreign student reports to the BI Student desk for registration and to the accepting HEI and shall enroll in the school which issued his NOA upon arrival in the Philippines. Accepting HEI assists foreign student desk to obtain Alien Certificate of Registration (ACR) and Certificate of Residence for Temporary Student (CRTS) from the Bureau of Immigration (BI). DFA sends notice to accepting HEI on the issuance of the student visa to applicant, copy furnished CHED, BI, NICA and NBI. OSS keeps on file submitted data on foreign students.

34. Foreign Physician Training Programs • Other Prohibitions: • No alien admitted as a student shall engage in employment for hire without first having applied for and secured the consent the Commissioner of Immigration. In no instance will a student be permitted to accept employment of such nature as will interfere with the full course of studies. • Foreign student is prohibited from going out of the country during school days, except for valid reasons with the permission of the Registrar/school authorities duly noted by the Bureau of Immigration. • Note: For this purpose students are issued Single Entry SRC. Students who are holder of a Multiple SRC, is required to surrender the same to the Bureau of Immigration for replacement.

35. Foreign Physician Training Programs • Admission Requirements • Application Letter • Personal Data Sheet • Three (3) Pieces Passport Size Pictures (3.5cmx4.5cm) • Medical Certificate affixed with documentary stamp, Drug Test and Laboratory Results • Three Photocopies of Medical Board Rating or its equivalent attested by the Philippine Embassy of the country of origin or consulate or the Department of Foreign Affairs of its authenticity • Four Copies of Sworn Statement of Assets, Liabilities and Networth Disclosure of Business Interest and Financial Connections • Physician’s License or its equivalent with the authentication of the Philippine Embassy or Consulate or the Department of Foreign Affairs of its Authenticity

36. Foreign Physician Training Programs • One (1) Photocopy of NBI Clearance (for student who resided in the Philippines for more than 59 days at the time he applies for the said change/conversion of his admission status to that of a student, he shall also be required to submit the National Bureau of Investigation (NBI) clearance.). • Police, Court and Fiscal Clearances (for student who resided in the Philippines for more than 59 days at the time he applies) • Residency Training Agreement • Three Photocopies of Marriage Certificate for Married Women • One (1) Photocopy of Medical School Diploma with the authentication of the Philippine Embassy of the country of origin or Consulate or the Department of Foreign Affairs of its Authenticity • Application Fee of 200.00 Php • Psychiatric Evaluation and Psychological Exam • Notice of Acceptance By the Receiving Training Department • Proof of Payment of Tuition Fee

37. Yearly Foreign Physician Tuition Fee

38. Foreign Physician Guidelines • General Training Guidelines for Foreign Physicians under Training with Davao Medical Center • Adhere to all hospital or clinical facility policies and procedures. • Adhere to all Hospital and Departmental policies and procedures. Failure to exhibit integrity, ethical conduct, or professional standards may warrant dismissal from the Program.

39. Foreign Physician Guidelines • General Training Guidelines for Foreign Physicians under Training with Davao Medical Center • Collaborate with the HHMDTO and Department Training Officer concerning learning goals for this clinical experience. • Comply with health and other professional requirements of the clinical facility prior to the start of the clinical experience. • Be prepared to work in the clinical setting in a safe manner that demonstrates professional standards and arrive at the agreed time.

40. Foreign Physician Guidelines • General Training Guidelines for Foreign Physicians under Training with Davao Medical Center • Attend all established clinical days, conferences, or notify Department Training Officer of absence. • Perform with the presence of the preceptor any specialty skills or assessment • Demonstrate safe and comprehensive care under the supervision of the preceptor.

41. Foreign Physician Guidelines • General Training Responsibilities for Preceptors of Clinical Departments that Accepts Foreign Postgraduate Physicians • Orient student to the clinical practice setting including identification of facility policies and procedures. • Serve as a role model as a practitioner, teacher, and mentor. • Assign direct patient care activities to the Trainee. • Supervise the Trainee in the clinical practice setting.

42. Foreign Physician Guidelines • General Training Responsibilities for Preceptors of Clinical Departments that Accepts Foreign Postgraduate Physicians • Critique the Trainee’s ability to provide organized and safe care. • Provide suggestions that will assist and improve Trainee performance to achieve course and clinical outcomes. • Contact HHMDTO member concerning any issues that may arise.

43. Foreign Physician Guidelines • General Training Responsibilities for Preceptors of Clinical Departments that Accepts Foreign Postgraduate Physicians • Be available to the Trainee at all times or provide for a back-up preceptor in case of absence from the clinical area. • Provide ongoing written documentation of Trainee progress in meeting designated course outcomes for the purpose of evaluation. • Assist Department Training Officer with the formal evaluation of the Trainee’s progress at the end of the clinical experience

44. Foreign Physician Guidelines • General Training Responsibilities of the Clinical Departments that Accepts Foreign Postgraduate Physician Trainees • Assume responsibility for the over-all coordination of the Trainee’s clinical experience. • Provide preceptor with course syllabus, designated course outcomes, and directions on how to assist Trainee’s in meeting these outcomes. • Establish communication between preceptor and Trainee.

45. Foreign Physician Guidelines • General Training Responsibilities of the Clinical Departments that Accepts Foreign Postgraduate Physician Trainees • Be available to preceptors to discuss any issues that may arise. • Meet with the student and preceptor to discuss Trainee’s progress and exchange ideas and/or suggestions to better achieve outcomes. • Maintain responsibility for the final evaluation.

46. Foreign Physician Guidelines • General Training Responsibilities of the Clinical Departments that Accepts Foreign Postgraduate Physician Trainees • Provide the Trainee with the opportunity to evaluate the clinical experience. • Discuss with preceptor any information from Trainee concerning ways to improve the clinical experience for future students.

47. Foreign Physician Guidelines • General Responsibilities of the MedMancom with respect to Foreign Resident Training • Establish and implement policies that affect all residency programs regarding the quality of education and the work environment for the residents in each program. • Ensure that department training officers establish and maintain proper oversight of and liaison with appropriate personnel of other institutions participating in the Foreign Residents Training (FRT). • Establish and implement institutional guidelines and policies for the selection, evaluation, promotion, and dismissal of residents.

48. Foreign Physician Guidelines • Establish and implement procedures for the regular review of all FRT programs to assess their compliance with both the Institutional Requirements and Specialty Training Program. This requirement will be met by: • Performing Internal Reviews of each residency program, as required and specified by the specialty societies. • Requiring department training officers to promptly report all communications from the specialty societies that are relevant to program accreditation. • Requiring department training officers to expeditiously address all program deficiencies identified in Internal or specialty society accreditation Reviews. • Receiving regular reports on the current status of all program deficiencies identified in Internal or specialty society accreditation Reviews.

49. Foreign Physician Guidelines • Establish and implement institutional policies and procedures for the discipline and the adjudication of resident complaints and grievances relevant to the FRT programs. • Monitor each program's establishment of appropriate work environments and resident duty hours. • Assure that the residents' curriculum provides a regular review of ethical, socioeconomic, medical/ legal, and cost-containment issues that affect FRT and medical practice.

50. Foreign Physician Guidelines • Also assure that the curriculum provides an appropriate introduction to communication skills and to research design, statistics, and critical review of the literature necessary for acquiring skills for lifelong learning. • Finally, assure that there is appropriate resident participation in departmental scholarly activity, as set forth in the applicable Program Requirements. • The Medmancom shall meet monthly or more often if needed and maintain a permanent record. The Medmancom shall report on matters of Training to the HCATS .