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Preparing for the Health Future for Filipino Obstetrician-Gynecologists

Jose Y. Cueto Jr., MD, MHPEd Member, Board of Medicine. Preparing for the Health Future for Filipino Obstetrician-Gynecologists. Confluence of Events. PRC Planning Workshop (Feb. 10-11) 1. Medical manpower survey 2. Predicting medical manpower needs for the next 10-15 years.

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Preparing for the Health Future for Filipino Obstetrician-Gynecologists

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  1. Jose Y. Cueto Jr., MD, MHPEd Member, Board of Medicine Preparing for the Health Future for Filipino Obstetrician-Gynecologists

  2. Confluence of Events PRC Planning Workshop (Feb. 10-11) 1. Medical manpower survey 2. Predicting medical manpower needs for the next 10-15 years

  3. Confluence of Events MRA Meeting in Thailand (Feb. 21-23) 1. Draft of core competencies 2. Template for data-gathering (ASEAN)

  4. The Future? Looking at the present Identifying the trends Predicting the possible developments Developing a plan

  5. Questions to Answer What are the key areas to consider in predicting the future? What is the present situation now? Can we identify a “trend”? What are the most possible future change or scenario? What do we need to improve on?

  6. I. Population Trends (Bureau of Census, US Dept. of Commerce, 1996)

  7. Population Trends

  8. Demographics: Age Structure

  9. Demographics

  10. Trend and Projection High growth rate High fertility rate High number of childbearing age High birth rate very busy OB practice

  11. II. Health Statistics

  12. Trend / What to do High IMR High MMR Wide discrepancy among regions Many factors involved Analysis of root causes Failure of present measures

  13. The Future Increase in population, increase in number of poor citizens Budget for health may remain the same Deterioration in medical services Increase in mortality rates

  14. III: Education and Training

  15. Education and Training Core Curriculum Duration: 4 years Modular: 6 years Consortium Accreditation Requirements Residents In-service Examinations Subspecialty Training

  16. Certifying Exams (2001-2006)

  17. Trend Total No. of Residents: 878 per year Ave. No. of examinees (WE): 239.5/year No. passed (WE): 155/year Backlog: 84.5 examinees

  18. Trend Ave. No. of examinees (OE): 218/year No. passed (OE): 146/year Backlog: 72.3 examinees

  19. Deeper Study What happened to those who failed? Did they eventually pass the exams? Did they go into practice? Did they join another organization? Are they now classified as “GP with training” by Philhealth?

  20. IV: The Practice of OB-GYN POGS Fellows: 2,029 Diplomates: 224 Distribution and place of practice: data not available

  21. Philhealth Data • Data on CS claims from July 2008 to June 2009 • Performed by Fellows/diplomates: 59.86% • GP’s with training, PAMS, DOH-certified: 29.5% • MD’s with no training: 7.4%

  22. Profile Data Needed Type of Practice Solo Group, single specialty Group, multi-specialty Salaried Salaried / Private practice Others

  23. Profile 2. Scope of Practice General OB-GYN OB only Gynecology only Perinatology Infectious Disease Gynecologic Oncology Endocrine/Infertility Uro-gynecology Ultrasonography

  24. Profile 3. Setting or place Metro areas Non-metro areas Area without diplomates and Fellows

  25. Profile 4. Experience Less than 5 years 5-10 years 11-20 years More than 20 years

  26. Questions At any given time, what is the predominant profile? How do we make projections for the future? How many training programs do we need? How many graduates do we need to produce?

  27. Questions How do we address maldistribution? What is our stand on those performing operations without credentials? What do we recommend about the GP’s with training? (products of accredited, non-accredited TP’s) What will the picture be in 2020-2030?

  28. V. Hospitals / Levels of Care • Data from PHA: • Gov’t Private • Level 4 50 77 • Level 3 41 185 • Level 2 281 425 • Level 1 338 442 • TOTAL 710 1129

  29. Hospitals / Levels of Care Different needs (competence and expertise) Different capabilities (equipment, facilities) Varying profiles of patients

  30. Senate Hearing President of PAMS Publicly complained against specialty organizations which he described as “elitist” Claimed that specialty exam questions are geared to practice in big medical centers Pointed out that diplomates and Fellows could not be found practicing in provincial, district and local hospitals

  31. Training Curriculum Primary care: 1st year Secondary care: 2nd year Tertiary care: 3rd/4th years

  32. Trend and Questions • Levels 3 and 4 constitute 29.4% • Majority belong to Levels 1 and 2 • How should training programs respond? • Are there enough diplomates and Fellows?

  33. Problem Standards for accreditation of programs and certification of graduates Rule being implemented: only one standard only one examining board for specialty Need to respond to national needs

  34. VI. The Regulatory Body The Professional Regulation Commission-Board of Medicine RA 2382 as legal basis Art. I. Sec. 1 “the supervision, control and regulation of the practice of medicine” Quasi-legislative and quasi-judicial functions

  35. Board of Medicine Drafted resolutions: 1. Practice of medicine 2. Classification of physicians (GP/specialist) 3. Declaring residency training as practice of medicine 4. Deputizing PMA to oversee residency training 5. Mediation of cases

  36. Philhealth Workshop Topic: Credentialing and Privileging BOM: GP and Specialist No “GP with training” classification If cases are filed in regular courts or PRC, the practitioner will only be classified as GP Solution: give 5 years to pass certifying when practicing in Metro areas In areas w/o diplomates and Fellows, give incentives for them to practice

  37. Pending Bills amending RA 2382 List of Sanctions Art. V. Sec. 28 (k) Performing….an area of medical specialization without fulfilling specialization requirements prescribed by the IPMA and the Board

  38. Control of Residency Training Three Institutions PRC - PMA DOH - PMAC CHED - TPME

  39. The Future What would be the best arrangement or relationship between medical specialty organizations and the regulatory body? What amendments should we recommend?

  40. VII: Continuing Professional Education In many countries, initial certification after residency training After a period of time (7-10 years), require re-certification exams Traditional: attendance in conventions Expensive, difficult to evaluate Distance from place of practice Sponsorship from drug companies

  41. CPE Non-traditional Activities / Sources of Data 1. Practice evaluation 2. Outcomes assessment 3. Self-assessment programs 4. Distance learning modules 5. Submission of list of cases, procedures 6. CME Committee bulletins, advisories, updates, CPG’s 7. Feedback from PRC, PMA, Philhealth, others

  42. PRC Longitudinal tracking of physicians Done every 3 years on renewal of PRC ID’s After licensure After residency training Additional training

  43. Future • With improvement of IT technology, there will be less need to gather all members in large-scale conventions • What will be the most effective method of disseminating new knowledge / information? • Or learning skills?

  44. VIII: The ASEAN Mutual Recognition Agreement (MRA) Exchange of professionals Licensed in home country Main problem: regulatory law limits practice of medicine to Filipino citizens Exception: reciprocity arrangement

  45. Determining Equivalence Data-gathering on: 1. MD degree program 2. Residency training: curriculum competencies certification 3. Subspecialty training 4. Competencies (GP, etc.)

  46. MRA Main concern: competence, ability to compete with graduates from other countries Communication skills Regulatory laws and policies Culture Direction of transfer

  47. Future • Completion of data from member countries • Implementing guidelines • Solving problems like legislation • Orientation and dissemination to practicing physicians • Continuing communication

  48. IX: Scientific and Technological Developments 1. Genomics 2. Stem Cell 3. Vaccines 4. Drugs

  49. Scientific and Technological Developments 5. Advances in operative procedures (lap, robotics, etc.) 6. Imaging techniques 7. Information technology 8. Changes in management (operative to non-operative)

  50. Scientific and Technological Advances • 9. Tumor markers / screening methods • 10. Transplantation

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