First-Generation Doctor

It was Saturday morning, and by force of habit, I woke up early even though I had nothing scheduled for the day. It was the end of my second week in private practice. Lying in bed, staring at the circular lamp set on a deep blue background which is my bedroom ceiling—meant to simulate a full moon on a starless night sky—I wondered if I had made the correct decisions thus far.

Nine years after graduating from medical school and getting my license to practice medicine, two years since I finished training to be a neurosurgeon, and yet I was, still, just at the beginning. My work as a teacher would usually keep me preoccupied, however I had only recently concluded my biochemistry review for students preparing to take the physician licensure examination. My neuroanatomy classes for first year medical students were not due to start until a couple of months later. Though I refused to admit it, anxiety was welling up.

I knew I had to temper expectations, having heard similar stories from classmates and friends. Pagalingan magbilang ng butiki sa kisame ng clinic. I should even consider myself lucky; I had one patient on my first day.

So when the demons started to creep at the fringes of my deep-blue sky, at the ready to cast frustration and doubt, I got up, took a shower, and did what any self-respecting patient-less physician would do: I cleaned my apartment. Nothing could clear my mind better than washing the dishes.

Being a first-generation doctor, I had to start from scratch. My parents are not doctors. No one among my immediate maternal and paternal relatives is a doctor. My family cannot afford to buy shares of stocks in private hospitals. After finishing specialty and subspecialty training, I did not have a clinic to take over and neither did I have practice privileges waiting to be used. As to which course my neurosurgical career would take, whether things would pan out after I obtained my diplomate certificate at the end of last year, there was no way to be certain. Where to begin? How to begin? I was on my own.

I suppose every Filipino physician goes through this stage. It is like standing on a cliff with an immeasurable vertical drop, your heart in your outstretched hand, and it’s raining hard but you cannot do anything except let the wind and water batter you as you shout, hoping the universe hears you amidst the intermittent thunder: here I am.

Was it right to stay in the Philippines to practice medicine? In my case, was it the right decision to come back? What happens if things do not work out as I had envisioned as an idealistic, young Filipino doctor?

My worth as a physician has been reduced to an envelope of photocopied diplomas, licenses, and certificates, which I carry around as I do courtesy calls to senior neurosurgeons, turn up for interviews, and apply for a consultant position at different hospitals. Residency and fellowship training open doors of opportunities, but they do not necessarily mean patients will come rushing in. That is the caveat.

I had to learn the intricacies of Philippine taxation, PhilHealth, and setting up a clinic. My secretary would teach me how to charge professional fees, something I still feel uncomfortable discussing with my patients’ families. It was a moment of triumph, holding up my completed income tax return, which I filed on my own because I wanted to save on accountant fees. I compute every single peso I shell out for my clinics.

Most work days, I spend three hours driving between hospitals and medical schools. It was one of those mornings when, stuck in traffic inside my second-hand car, I told myself that I just want to earn enough so that I would not have to worry about gasoline, toll fees, and parking.

One good thing going for me is that I have been able to save money while I was training abroad. I earn a decent income when I teach in medical schools, too. Living in laid back Melbourne for a year has taught me to enjoy the slowness of things. Everybody is in a hurry to achieve something or to become someone, that we forget to be thankful for what we have in the now.

More than ever, I would turn to my consultants for advice. I realized that although peers are conveniently available for sharing daily frustrations, it is wisdom that comes with age and experience that helps one make the right decisions.

“Just make sure that you don’t take in more than you can chew. Other opportunities will come your way as time passes. Pick the options that will make you happy. Good luck.”

I had been told this just recently, and as a first-generation doctor, it is advice like this from my mentor that provides reassurance, something I will be eternally grateful for, and hope to pay forward.

That Saturday morning, at the end of my second week in private practice, I decided to give myself a deadline before seriously considering plan B. Maybe even plan C.

While I was walking home after paying my apartment’s electricity bill, the universe responded to my cliff monologue with a text message from a senior neurologist, one of my teachers in UP College of Medicine, and also the very person who interviewed me for medical school admission 16 years earlier. I replied to her message, she called shortly after to discuss a patient.

That patient would become my first private case as a consultant.

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  1. This might be cliche and redundant but yes, we all go through that stage of uncertainty, finally facing up the unknown and anxieties “of that cliff”. There’s value to what our senior consultants and mentors tell us. Just do what you love most, have fun and the rest will come your way.
    Oh, if this may help calm your “financial uncertainties”, I have yet to see a physician die of hunger even while at the rock bottom of practice. Take that from someone who did…:)

    You’ll do fine. Ikaw pa.

    • Yes bai, I agree. It’s only a matter of deciding: what level of comfort would you want for yourself and your family? I wrote this so that years from now, I would not forget how it all started. 🙂

  2. I could totally relate, I am in my 3rd month of private practice. hehehe I consider myself lucky to have 4 private patients last month in my own clinic. hahaha! Congratulations to us! hahaha I still borrow money from my parents at times when it was really tough. I have not fully applied for hospital affiliations yet as I want to take the diplomate exams in my specialty.

  3. Markie dela Cruz

    I was inspired dockie To your story… But as for my experience i shifted to Plan B..
    1 year after i have my private practice as A General Pediatrician.. Maybe because of Pressure to my parents and to myself..I self pity for all those moments na nagbibilang ka ng butiki sa other says… Then at my age, ang hirap kumita for your own financial support..housing bills…house rent..foods..
    Pamasahe for my Moonlighting stints not only as Gen.Pediatrician but all pati medics sa ambulance at construction napasukan ko.. Then, all of a sudden.. Bigla ako napa isip for my Plan B?? Is it okay or better for me?? And That the Time Plan B opportunity came.which is My Stint For Abroad here in Oman.. I.was thinking walang patumpik.tumpik.single.naman ako..and 2-4 x higher ang grab the.opportunity…
    Pero Iba pa din pala dyan sa Pinas… Mas okay pa din..
    So. My thoughtss now is To finished my contract now and go.back to homeland there.. I am 3 years and half na din dito and my konting savings and investments na which will i call my own…its serve my purpose na..It is not always the money but Tne passion ,love and Patience To our craft.. Maybe I will.go.back there but merely as Businessman.Part time pediatrician ..hehehe…

  4. This is one of the reasons I chose anesthesia. No clinic=no overhead. I started as an associate and a hospitalist to have a “guaranteed income” to feed my family. My clients are not the patients really, but the surgeons and obstetricians who refer cases to me. After almost 10 long years, I finally saved enough to buy stocks in the hospital where I started my career. Iba talaga pag may stocks or pambili ng stocks ang parents. Pero ok lang, part of the journey lahat yan. Sometimes it makes it even sweeter, knowing how much you had to crawl to get there.

  5. Doc lailagwapa

    Thank u doctor ronibats. My daughter mentioned about u being their teacher in neuroana. Thank u doc for being an inspiration not only to medical students but to fellow doctors as well. I have read some of your posts esp abt healthcare n the philippines. I also worked with the govt, im a medical officer in our place. Relate much talaga ako sa mga sinabi mo doc. I am wd u in hoping that someday healthcare in the philippines will be better.

  6. Congratulations on your first private case, Dr. Ronnie! I’m sure you’ll do great as a consultant. I pray that you’ll have more opportunities to share and hone your expertise. God bless you, Sir.

    • Thank you Bobbi! 🙂

      • You’re welcome po, Dr. Ronnie. I first heard about you in KMJS’s Pamilya Valedictorian episode. Then last month (or earlier this month), your article “5 valedictorians in the family” was featured among Rappler’s Top In Mood. That was when I saw a link to your beautiful blog, and I could not stop reading since then.

        I hope you’ll have more strength and time to keep telling their (and also your) stories, Doc. Each story warms the heart, enlightens the mind, and feeds the soul.

  7. Relate much ako sayo sir. I am currently in my 5th month of practice as a gastroenterologist, after graduating last year I took a part-time med specialist job at our politically-challenged provincial hospital which pays 15k/mos for 20h/wk work. Not so much but it got me through those first few mos of practice na talagang walang-wala. No choice kasi may asawa’t anak na rin ako, kahit pang-gatas lng ok na. Like you I am lucky to have supportive mentors, to talk to and seek counsel especially kung may problema. Somehow, nakakara-os na din. Gud luck sir, I wish the best for you and all those physicians who starting their own practice.

    • I hope you get your PhilHealth payout too, Lupin. Dun lang din nakakabawi yung mga kaibigan ko who got government positions. I’ve got an appointment with UP, so that’s also steady income kahit paano. All the best to you din. We just keep are fingers crossed. 😉

  8. First Gen Pedia

    Wow. Thank you for this. I’ve read your post and the comments too. It’s nice knowing there are other doctors going through the same thing as I am. We’re in that career limbo of fulfilling the dream of helping others but you have to help yourself too.
    After graduating med school, I’ve already realized that I cannot stand a career of just being a clinician. I just graduated from my training so I’m still in the midst of vacation/planning my life. I’m thinking of applying as a teacher in a med school too (to give back) and getting some consultancy public health work. It’s really frustrating when you have to start every thing from scratch. Here’s to our transition year!

    • Markie dela Cruz

      Same same That Feeling dockie.. Im also Gen Peds but not yet diplomate kasi mas pinili ko mag Ofw for the mean time….. :,)

    • Great to hear from you, First Gen Pedia! When I wrote this, I didn’t realize that the article would resonate so well with many physicians. I guess it’s just one of those mutual experiences that bind us. Yes, cheers to our transition year, and I wish you all the best!

  9. I was a medical doctor in the Philippines but I migrated to New Zealand after I finished my Master in Public Health in UP Manila. I was a medical board topnotcher. And just like every doctor is, I was very idealistic. I went into medicine because I wanted to save the world. But up to this very day I regretted my decision to have chosen medicine as my profession. My two sisters chose engineering. Immediately after graduation they got high paying jobs and their profession is recognized all over the world without having to take registration exams in developed countries. And how many years did they have to study? Only 5 years. What is the point of becoming a doctor if you can’t support yourself financially? Because you want to save people’s lives. It’s bullshit. You have to save yourself first. Just like you I was a first generation doctor and it was so difficult because I didn’t inherit any practice and nobody was there to advice me what to do. I had a mental breakdown because of residency training because I was bullied. There was so much going against me as doctor. And what’s worse was I was still asking money from my parents after more than 10 years of study while my sisters were buying lands of their own. Now I’m happier. I’m not working as a doctor but as a lecturer in a university in New Zealand and on my way to studying PhD with so.much less stress and more money in the bank. The best part I am really enjoying my job.

  10. Oh my. I still remember your blog back when you were in med school. Look at you now. Gah! I feel so old. Don’t forget to read back your blogs from before. It might help you connect with your students. Remember, you were them not so many years ago. Good luck on your journey from one alumni to another. I’m sure you will be just fine.

  11. Thank you for this.

    I just graduated from pediatrics residency and yes — the dilemma of being a first gen doctor, from a middle income family, solo upbringing a child and desire to pursue fellowship.

    I’m out of training for now hoping to save enough even just to pay for my child’s tuition fee prior to applying for my fellowship. Initially, I tried the 80hr work/wk but being fresh from residency, I think I almost burned out. It’s hard because I did take more than I can chew and I went on despite not being happy anymore. I wish I also heard from that wise prof who reminded you about that.

    I’m still finding my own balance. I am thankful for knowing in my heart that this is what I would like to do until I grow old but I still worry everyday (since I don’t have personal connections) that there may come a time that I won’t have patients to work with.

  12. Anna Lynn A. Matignas

    Thanks for sharing your insights Dr! Physicians ought to learn the value of delayed gratification. Success will come eventually after we have sincerely helped a lot of people and if we truly love what we are doing.

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Names, dates, and events may have been changed to protect the identity of patients. The stories are not meant to provide medical advice for specific illnesses. The author neither accepts online consults nor gives medical advice online. Please consult your trusted physician.