While scrolling through my social media feed a couple of weeks ago, I saw some younger friends posting about the United States Residency Match results. The Residency Match is a process, which the US and foreign medical graduates (FMGs) use to find a spot at a US hospital for training in their field specialization. A medical resident in the US is still technically a trainee but makes a decent amount of money, enough to cover living expenses. More important, it is the ticket to a good paying job as a specialist doctor in the US. Participating in the Match is a harrowing and expensive experience. It entails passing a series of two (or three, depending on visa type) licensure examinations. Until recently, one of these exams, Step 2 CS, required traveling to the US for FMGs before it was discontinued due to the pandemic.
After passing these exams, the applicants then have to apply to numerous residency programs and travel for interviews (if they are good enough to be invited) before finally ranking their choices. On Match Day sometime in March, a computer algorithm “matches” the different applicants based on their ranking with the programs that also rank the applicants. Nearly 70 percent of US medical students find a match, and about 60 percent of FMGs also find a match. For those who do not match, they can try to “scramble” for any unfilled positions, which entails a frantic period of calling programs and asking to be considered for their unfilled positions. Otherwise, they will need to wait another year and another cycle of interviews and try their luck anew.
My wife and I went through all that back in 2001. Luckily, we were able to find an internal medicine residency program that took both of us in Wisconsin. Many FMGs fail to match, some of them many times over. I personally know people who went at least three times and never matched, and they were pretty good candidates in my opinion. When someone finally does get into a program, it is a cause for celebration and a life-changing occasion. Many doctors from all over the world try their luck at the Match even if they are already specialists and subspecialists back home since they want to have better prospects in life. This is a major cause of brain drain, when poor countries that can ill-afford to lose their doctors lose them in large numbers. The ones who already have advanced training have been trained with the time, funds, and facilities of their home countries.
Having gone through all that and succeeding in this harrowing process, when we (I, my wife, and our six-month-old son) chose to go home in 2008, more than a few people were puzzled. Most thought we were crazy to give up the opportunities many Filipinos only dreamed of. We had job offers to stay, and there were visa waiver spots that were open since we were on exchange visitor visas that otherwise required us to go home. It would have been the easiest thing to say good riddance to the Philippines and its broken and corrupt government.
Occasionally, I do think about what might have been if we had chosen not to go back to the Philippines. We would have had a good life in the US, enjoying a rewarding clinical practice and academic career. It would have been a decent existence with a good salary and meaningful employment.
I believe going home, however, has been the better choice for me and my family. Aside from the initial uncertainty, I don't think I lost money by staying in the Philippines. I earn a decent living as a doctor and I have other professional engagements that supplement my income. I personally know people who came home and just do private practice, who make a lot more money than they would have made in the US. This does vary from person to person, but it's not always a pay cut when you come home. US training is seen as a very desirable asset in the best hospitals in Metro Manila and so those who trained abroad are always in demand.
I joined the National Institutes of Health at the University of the Philippines Manila to do research and I rose through the ranks very quickly, getting tenure in two and a half years and achieving full professor in 13 years. I’ve done groundbreaking research in HIV that has guided policy locally and developed innovations that have the potential for global impact. The opportunity to provide input and have that input translated into policy that impacts millions of Filipinos is incredibly gratifying.
In addition, I'm an adjunct professor at the University of Pittsburgh so I still teach in the US and we host rotating trainees locally. We have joint conferences between the Philippine General Hospital and the University of Pittsburgh Medical Center and so we get the best of both worlds. In a way, I get to have my cake and eat it too.
But best of all, I get to take care of my countrymen and make the Philippines a healthier nation. If you love your country, you want it to become a better place. The best way to do that is to do it right here, at home. Many people do help from abroad by sending money and visiting from time to time and that is good. But personally, just like some prefer not to do virtual medicine, I wanted to be where things are happening. I wanted to see the problems front and center and get dirty tackling them head on. In the over 15 years I have been back, I have not regretted my decision and I can say that I have given my country the best of what I learned abroad and what I could offer.
It isn't for everyone though. I recognize we have been extremely blessed to have had the choice to return and stay. I fully respect people who have had enough with the hardships at home and are looking out for themselves and their families. It is not just doctors. Nurses, seafarers, engineers, physical therapists, and many other professions have to go through similar hurdles in order to work in the US and other richer countries. I wish them well.
It is disappointing, however, when some people say that they are leaving because they think it is hopeless and that it is the country's fault that they couldn’t stay. The choice to leave is completely voluntary, and people should acknowledge that it is what they wanted to do for whatever valid reason. There is absolutely nothing wrong with that, but I wish they wouldn’t bash the Philippines on their way out. Some of us choose to keep fighting. There are many of us who stay because this is where we belong.