What are the hospitals suited for residency training program?

[archangel]

I have friends who arre residents of the Santo Tomas University Hospital. They said that STUH is ideal for training coz it's a teaching hospital. But the problem is they got a measly allowance much much lower than undergrads receive in a month.

What hospital do you think is the best in a certain field? For example: Communicable Diseases- of course San Lazaro.

[batang uliran]

I completed my 3 years of residency and 3 years of fellowship abroad but if I stayed in the Philippines, I would have stayed at PGH. The allowance is measly but you get a lot of experience, work with some of the best people around and the hospital offers a wide range of services. One key drawback though is exposure to private patients which I think is important in terms of being able to relate to this group.

[Ira]

The problem with staying in a hospital where you graduated in is that you don't get exposed to ideas different from yours. Teaching hospitals like UST, because of lack of funding, limit their diagnostics and, occassionally, therapeutics. You can't do that to a private patient. You also do not get exposed to the way private practices should be run. Best residency training program? Whatever offers a large enough charity hospital, with good funding, and good roster of physicians. Of course, your friends will say that UST is best, since chances are they are UST graduates and have never been given the chance to expose themselves to other hospitals. But I think, all in all, it depends on the resident whether he's going to make the most out of his training or not. Training programs can only do so much; it's up to the doctor to study each and every case, plus more, that he gets exposed to. HOWEVER...in surgical fields, PGH is tops, no question about it. Pero surgical fields lang. :)

San Lazaro Hospital, btw, does not have a residency training program. Doctors there are under the leadership of DOH, and they are GP's. The best exposure to infectious diseases I guess would be PGH, too, but training-wise, I don't know...

[This message has been edited by Ira (edited 12-09-1999).]

[batang uliran]

I don't disagree at all that for surgical training, PGH is the best in the country - tons of cases, killer workload but nothing else offers that level and extent of experience. If I ever wanted to be a surgeon (which I don't), the best case scenario would be to train in PGH and then refine your technique abroad. I can testify though that for medicine, training in a good US University program is better than anything locally and I've always thought that training abroad, you go by what the medical literature has shown to be beneficial and you are taught to think critically and not just mouth what your consultants tell you as frequently happens in the Philippines, even in PGH.

[mylene]

ira and batang uliran...why is it that almost all (almost, okay) pinoys na nagreresidency here sa states eh sa internal medicine napupunta? i thought wala masyadong patients sa area na yan...

[batang uliran]

They go to IM because that's the field which was open to foreign medical graduates. However at the present time, it is already very tough for a Philippine grad to get a residency training position in the US in any specialty.

[Ira]

Ditto what BU said. Surgical fields are more financially lucrative, so the positions are more in demand with American medical graduates. They severely limit acceptance of foreign (usually Asian) medical graduates in such positions so that Americans will be able to get the slots. Otherwise, if they level the playing fields, puro Asians na lang ang matatanggap since Asians have better grades and complain less about working hard. On the rare occassion that an Asian is able to get a slot, there is still a good chance that he will get kicked out of the program, because the surgical pyramidal scheme they have there is also very "political".

[archangel]

doctors, pls clarify some things:

residency is a 3-4 year training after boards, right? What is fellowhip? Is it another training for sub-specialty as in plastic surgery, neuro-surgery, plumonary medicine, etc? What/who is a diplomate?

[batang uliran]

Residency duration varies depending on your field. For Internal Medicine and Pediatrics it is 3 years, for General Surgery it is 5 years, and so forth. You are a diplomate if you are board certified in your particular field whether or not it is a subspecialty.

A fellowship is further training after your residency and the time frame for this varies from 1 to 3 years.

In my specific case, I did 3 years of Internal Medicine and another 3 years in Pulmonary/Critical Care/Sleep Medicine.

[Ira]

Neurosurgery is not a subspecialty, rather, it's just a specialty. It also has its corresponding subspecialties, like seizure surgery, cerebrovascular neurosurgery, neuro-oncology, skullbase, etc. It needs 1 year of general surgery, followed by 4-6 years of neurosurgery residency.

[Ira]

Regarding Makati Medical Center--it's VERY hard to get into that hospital, because the biggest requirement here is a strong backer. I work in this hospital twice a week, and I get to interact with the residents there as well as hear stories about how this guy got in, how this guy didn't, etc etc., and to be frank with you, grades don't matter. Patient exposure-wise, orthopedic surgery there is only so-so. The best orthopedic surgery residencies would still be NOH, PGH, East Avenue Medical Center, and Jose Reyes. In MMC, they don't really get a lot of varied cases, only a lot of casting and fractures. While it is great to have time to study, in specialty boards, there are two parts to be accredited: the theoretical and the PRACTICAL (skills) exams. And take those comments about having time to study with a grain of salt. After you graduate residency, you have a few months to study anyway--they're not going to give you the specialty exam right off the bat. And as you probably know, it's easier to remember when you actually know, understand and seen what you're studying.

I have several friends in orthopedic surgery there, and they don't make a lot of effort to study, their inservice exam results are not at par with other hospitals, and all they do is fill out paperwork for pay patients. You basically get through 5 years of training without much skills regarding patient decision making, because in that 5 years, you only have 1-2 years where you are solely responsible for and actually operate on a major case.

With regards to having a general surgery rotation in orthopedics...depends on where you take your training, I think. You have to do at least a quarter of GS rotation, but that's really no problem, since you get into orthopedics first, then your department makes arrangements with your hospital's general surgery program for you to rotate with them for a period of time.

Regarding the surgery program of UP-PGH: If you're a non-PGH graduate, the chances of getting in their program is very small. Before you are even qualified to take the written exam (that's just the 1st step, ha?), you have to be in the upper 5% of your graduating class, and yes, where you graduate DOES matter. They usually prefer to get people from the other top hospitals: UE, UST, and FEU. The present chief resident of PGH surgery, Leoncio *** M.D., is a graduate of UERM, but then, this guy's #2 in his batch.

Rule of thumb: the best place to take your residency is in a government/teaching hospital. If you opt to train in a private hospital, go to one with a big charity base. The bigger the charity department, the more patients for residents, the better training you get. And don't believe in the b.s. about private hospitals having more time to study. On the contrary, I find that residents from the less glamorous (government, or teaching) hospitals study more, since they are forced to read due to the numerous cases they're handling, and their almost daily conferences.

[Dr. Evil]

I have a friend that wants to take his residency in Makati Med because he said they give you ample time to study for boards. dat true? How hard is it to get a residency slot there? politics? How hard is it to get into a General Surgery residency in PGH if you're coming from another school? Is it also true that if you go into Orthopedic Surgery, you don't have to go through General Surgery? Am I asking too many questions? :)

[batang uliran]

Makati Med probably not too hard to get into. Far cry from PGH though in terms of training and patient exposure.

I believe it's extremely difficult to get into the UP-PGH General Surgery training program coming from another med school.

You don't have to do a full general surgery program to get into orthopedic surgery but you do have to do I think a year of general surgery.