General Practice: Doctors’ Stigma?

Saturday, April 07, 2012 Stef dela Cruz 62 Comments

As a doctor, I’ve had many opportunities to ask myself, is there really a stigma in general practice? Does general practice look so unenticing among doctors and patients that it has developed a certain stigma? The answers I get from fellow doctors and from patients are not too reassuring.

General Practice: What Is It?

General practice is defined as medical practice without a specialization. Yes, you need a doctor’s license to become a general practitioner. You need to be a competent doctor who graduated from an accredited medical school. You are, in every essence of the word, a licensed physician.

General Practice and Its Stigma Among Doctors

General practice among doctors does have a certain stigma whether we want to acknowledge that fact or not. I have not yet met a doctor who wants to practice General Medicine; every fresh graduate of medical school wants to go into specialization. But what does this say about us, as patients or as doctors?

general practice stigma

Below are a few things I have learned about the stigma of general practice among doctors. I am sure you have heard of at least one of them.

  • General practitioners sometimes earn less than wage earners. I remember stories from general practitioners who get paid PhP1000 for going on duty for 24 hours in certain hospitals. They handle all departments: Emergency Room, Obstetrics, Pediatrics, Surgery, and Internal Medicine. They refer to specialists once they’ve seen patients firsthand, but they still have to manage the entire hospital for 24 hours at such meager earnings. These doctors are definitely underpaid – and definitely underappreciated.
  • Doctors who choose general practice are often seen as incompetent. Many doctors often ask their patients where they sought consult beforehand, and patients are often too embarrassed to reveal that they did so at a general practitioner’s clinic. And to add fuel to the fire, specialists sometimes say derogatory remarks about fellow physicians who never had the chance to go into specialization.
  • Health personnel often refer patients to specialists. I have yet to encounter a nurse or any other health professional referring their friends and family members to a general practitioner, even if it’s for minor signs and symptoms. This seems to come from the notion that specialists are much better than general practitioners.
  • Some feel that being a college graduate is much better than being a doctor if it means going into general practice. (This is an update.) A doctor commented on this blog post, saying that because of the stigma and the rather low salary of doctors in general practice, graduating from college alone is even much better than graduating from medicine if you don’t go into specialization.

General practitioners are looked down upon by too many people, including doctors and other health professionals. If I had a penny for every specialist who criticized general practitioners, I would probably be one hundred pesos richer. Okay, that’s not a lot, but that still speaks volumes about what doctors think of their colleagues.

What General Practitioners Had to Go Through

Graduating from medical school is no joke. You have to have the resources, the brains, the social skills, and sometimes, even the connections to get to where you need to be. Medical school is tough. After college, you need to pass another battery of tests to get into medical school. (For instance, in the university where I took my medical degree, there were thousands of applicants who wanted to get into medical school just like I did, but only about 400 made the cut.)

After that, you need to pass your subjects in medical school. Then, you go on duty everyday for a year. In our batch, only about 240 students graduated out of the original 400 medical students.

Then, you have to apply as an intern for another year – and pray that you get matched to the hospital of your choice. After that, you take the physicians’ licensure exams, where only about 30 percent pass nationwide. But even after all that hard work, a doctor does not get much of a break if he stops there and decides to go into general practice. There is definitely a stigma there.

There are many unspoken truths about the doctor’s realm, including a hierarchy that feeds off of doctors who think their specialization is much better than others’. And then there is the stigma of general practice, another unspoken reality in the world of doctors.

Stigma of General Practice: Who’s To Blame?

If you are a patient, would you trust a specialist more than a general practitioner, even if it’s just for a scratch or a cold? Do you trust all specialists in general even if you haven’t exactly researched on their credentials? Do you look down on all doctors who go into general practice even if you have never met them?

If you are a doctor who is now taking his specialization (or if you are already a specialist), I would like to know what you think. Do you feel that the stigma of general practice does exist? Do you think that general practitioners are being treated unfairly but that they somehow deserve being looked down upon? Lastly, tell me if I’m wrong, but aren’t you glad you are no longer a general practitioner?

If you answered YES to any of these questions, then you have helped to promote the stigma of general practice one way or another. I hope that this blog post has helped open your eyes, provoking thought and evoking emotion enough for you to share this post or at least comment on it. Smile

Stef dela CruzAbout the blogger
Stef dela Cruz is a vegan doctor and writer. She received the 2013 Award for Health Media from the Department of Health. She is the editor of The Manila Bulletin's Animal Scene Magazine. Get in touch if you want to invite her as a speaker!


  1. I sympathize completely, i'm a medicine grad and i'm being paid 800 for doing checkups in a clinic 10 hours a day, it's not exactly the right compensation and i feel like others think i'm an underachiever... it's as if it's better to JUST BE A COLLEGE GRAD THAN TO BE A DOCTOR IF YOU'RE GOING TO BE A GENERAL PRACTITIONER and there's something really wrong about that...

  2. @mlopez, wow, that sounds horrible! But that's true, some of the doctors I know get paid about the same amount. I hope you get better opportunities. :)

  3. I always thought all doctors are highly paid. Sorry to hear about this. :(

  4. most general practitioners i know earn more than a specialist. People come to them because most of them charge reasonable amount. One GP I know earns 50k per day. He has his own clinic and since he's good on what he does. he usually sees 80 patients per day. diba ang galing?

  5. Mr/ Ms. Anonymous, that's wonderful to hear! But, as any doctor knows after having done the patient census at the out patient department for at least a year during training, there are holes in the story you shared with us. I've been doing the math, and here's what I see:

    80 patients per day, assuming that each clinic day follows regular hours = just 6 minutes per patient? (Too little time, in my opinion, but I guess he can take a detailed history, do his physical exam, and provide an explanation of a person's condition in that time).

    Hmmm. In any case, what is the name of this doctor who practices general medicine? I would LOVE to interview him for my website! :)

  6. True enough. Even for nurses like me encounter the same dilemma. Like being just a regular registered nurse isn't enough to be called a worthy profession if you don't settle for higher studies. Geezas, all those many years of hard work and study must have been worth nothing :|

  7. Im reading comments here, someone said 50k a day as a general practitioner? LOL that's probably Vicky Belo. Ha ha ha but I think she earns more.

  8. Jo, I guess many fields are under pressure to specialize. It would have been alright, except that without that specialization, the profession gets butchered with statements like "just a regular nurse" or "just a general practitioner".

    Mr/ Ms Anonymous, I never thought of it that way - maybe Dr. Belo was indeed the general practitioner mentioned in a previous comment. :)

  9. Based from experience being a patient, some general practitioners are left behind with the nitty-gritty of every part of the body. I once asked a gen. physician/pedia if the gut has something to do with oral problems, and he practically ruled out the gut connection when clearly alternative medicine considers other causes. Had I consulted a gastro for my chronic dental problems like ulcers and white-coating on tongue, I could have saved a hundred bucks I doled out for that BS general physician for some veggies to fix my digestive-related oral malady.

    But then again, since it's already a common knowledge that most, if not all, docs left in the Philippines are the lamest ones, we can't be sure if our specialists in the medicine are as reliable and updated as we think they should be.

    So yeah, if someone wants to take medicine, he better specialize on something unless he was born a prodigy the know-it-all type. Indeed, it pays well to know well.

  10. Hi, Itin, thanks for your detailed story. However, some of your comments are a little too prejudiced:

    "The doctors left in the Philippines are the lamest ones..."

    "Doctors better specialize unless he was born a prodigy..."

    You are entitled to your own opinions, but it is remarks like yours that make it seem so much better to just be a college graduate than a doctor, yes?

    And, contrary to your advice, doctors don't have to specialize. It's an option, not a requirement. You've had your run-in with incompetent doctors, but not all general practitioners are like that.

    In life, only the uninformed will make generalizations and hold prejudices that do not take into consideration the rest of the picture. Do not let the bad apples ruin the otherwise excellent fruit basket.

    And I would also like to correct one of your statements. You said you once asked a general physician/ pediatrician a question. Actually, a pediatrician is not a general practitioner; a pediatrician is a specialist, FYI. :)

  11. You clearly did not understand my view point. However, I never said that all doctors (whether specialist or not) in PI lack the mental prowess to treat the ailing Pinoys, especially those who volunteer for humanitarian advocacy (not for profit).

  12. Dra, Itin is right... 'MOST' daw, not 'ALL' doctors in the Philippines are the lamest ones. Facepalm!!! Ha ha

  13. Itin, we all have our own opinions - the purpose of this blog post, after all, is to raise issues and to open a dialog. I'd like to point out, however, that you did say most of the doctors in the Philippines are the lamest (as Carey pointed out). Have you experienced health service from other countries as a comparison? I feel that without such a comparison, the opinion you shared is unfounded. And how many general practitioners have you encountered in the first place? One? Ten? A hundred? :)

    Also, do not blame doctors if they do want to profit from their profession. We do not, for instance, put blame or shame on bloggers who want to profit from blogging. We all have to earn our keep - and doctors are not exempted from this. As long as we do make a living honestly - whether as doctors, teachers, or bloggers - then all is good.

    Humanitarian efforts are great as well, but let's not condemn doctors who also want to feed their families based on honest efforts.

    That's something for you to think about, dear. :) And everybody should think about all of these ideas, too.

    To everyone: what do you think? What are your thoughts? Share your opinions and make this a worthwhile discussion.

  14. mahirap magtiwala sa hindi specialist pero hindi rin ganun , naloko nako dati ng specialist , tinaga lang ako sa pakonsulta. kasi wala yan sa kung specialist o hindi , asa tao na rin yan. pero binabasa ko comment at nalilito ako , sabi ni ate itin most doctors , if not all , eh tanga daw, tapos sa huli medyo kumabig ng onti , sabi niya hindi daw niya sinabi na tanga lahat. di naman ako pumapanig sa kahit kanino pero nalilito lang ako . being honest lang mam.

  15. Hi I'm a Filipino nurse here in NJ, I can't tell you my name for obvious reasons. I get to work with many doctors here, Americans, Chinese, Filipinos. I worked in the Philippines for a few years before I migrated over to NJ, I can say with pride that the smartest doctors I've met are the ones I met back home because they don't even need the help of way too many laboratory procedures to diagnose patients. Here in NJ, most lab requests are "shotgun" and meant to hit just about any diagnosis. Proud to say that Filipino doctors do have an edge because they are better diagnosticians and are not slaves to lab results. I love accompanying doctors there during their rounds because you'll see how sharp they are at requesting for labs esp since patients there don't have insurance. Here in NJ, doctors can request for just about anything because insurance covers it. There's no way they can request for just two labs and diagnose as accurately as the doctors I've worked with back home. Sharing this story to those who don't know what actually happens on the other side of the fence.

  16. I didn't even get to think about the effect of insurance policies abroad and the availability of resources! Thanks for that story! And I'm sorry to hear that doctors use labs and ancillaries as a fall-back. We all have different assets and we learn to use them, yes? :)

  17. All specialists have to start as general practitioners. General practice is not bad; it is neither fair nor right to simply say that general practitioners suck. There is enough prejudice in this world and we do not need to add to it. It's like when people say Filipinos are dirty and poor - it may be true sometimes but it is still NOT the complete truth. Bow.

  18. I was about to applaud until I saw the word, "bow". I am smiling as I type, the "bow" just made my day! :)

  19. I don't trust doctors. I think they're witches in white coats. Only diff is they earn more money.

  20. Wait, but I don't have a voodoo doll! Although I'd like to have one, hehe. Plus, I don't earn 250k in one month, unlike other doctors I work with. Does that mean I don't fit the bill? Aw...

  21. Ma. Cindy EsguerraApril 3, 2012 at 10:28 PM

    Ang ganda ng sinabi niyo, doktora! Napaisip ako dun. Your right we do have a tendency not to trust general practitioners even if we don't even know if their good or not. Magaling lang tayo humusga pero wala namang pruweba.

    Pano ba ko napunta dito? I was just reading your post on NMAT but this title made me click. Hahaha.

  22. I'm now a cardiologist. For those who aren't doctors, I want you to know that ALL specialists MUST become a doctor of general medicine before they can get into specialization. The moment a medical graduate gets his license, he becomes a doctor of general medicine. People can't just expect new doctors to be ASHAMED of this fact because it will take time before they get into specialization if they want to! It just DOES NOT MAKE SENSE to be ashamed of being a doctor, general practitioner or otherwise! Shame goes to the people who feel that practicing general medicine is worth criticizing. YOU PEOPLE DON'T KNOW HOW TO LOOK BACK AT WHERE YOU CAME FROM.

  23. Josephine Elaine CruzApril 4, 2012 at 6:52 PM

    Agree, doc! "Judge the person, not the profession." Anyone who judges the profession in general is not doing it right. It's like racism except that your judging a profession instead of a race. But um, saying Filipino doctors suck is actually racist.

  24. Anonymous, couldn't have said it better.
    JE, wow, that's one way to look at it! I'll be using your comments on my Facebook page, definitely!

  25. I'm a General Practitioner in a city here in Manila. So far I'm the happiest and most contented person I know :)
    I tried getting into residency after I passed the Physician Licensure Exam 6 years ago. But I wasn't happy with hospital work anymore (duty everyday including weekend and holidays, no time for family) plus I need to earn more because I got hitch soon after I graduated medical school.
    I'm guilty that I also belittle general Practitioners when I was in medical school, But now I'm in a field of general medicine I can honestly say that General practitioners also deserve respect from fellow doctors who had the chance to specialize in their chosen fields. Sometimes I ask God why he put me in this practice considering that I know I can do so much more. I know I'm diligent, very persevering and patient with any task I am given. I can study some more and pass diplomate exams. But, I realized I also have a role to fulfill. In my practice I had a chance to talk to patients not only about their illness but also a little bit about their lives. They open up to me. They trust me. I only charge reasonable consultation fee which patients can easily afford. Most of my patients, specially those coming from low income family are very appreciative and grateful for my service. I experienced receiving pasalubong from patients who just returned from their provinces. I received baptismal invitation to be the godmother of their child. I also received birthday party invitation because their child/ my patient just turned 1 year old. My medical practice as a General Practitioner is rewarding and I expect more growth in it. Compassion isn't just the key in a fulfilling general practice. A General Practitioner or any Doctor should also be COMPETENT. I read. I try to update myself. I attend seminars, workshops, launching of new medicines/ vaccines. It's my responsibility to my patients to be the best doctor I can be. Without me doing General Practice who would offer my patients good quality care at a reasonable cost? who would call them to remind them about their follow-up and scheduled blood exam ( my-so-called extra mile service). Who would bother to ask medical representative for free medicines/ starter dose and discount cards for them? (another extra mile service).
    I do all of these for my patients because I genuinely care for them and they trust me.
    For a year after I passed the board exam. I worked in a private clinic owned by a general practitioner. I see maximum 80 patients in a 24 hour duty. I deliver babies via NSD, I do general consultation for children and adult, I vaccinate children and adults, I do suturing, I also circumcized during summer. I learned a lot. The clinic is open 24/7. It's a lying in clinic. He also have his own x-ray machine, ECG, fetal monitoring device, and laboratory equipment for routine test ( cbc, plt count, urinalysis, and blood chemistry). During peak seasons his clinic earns almost 50K a day.
    After a year from moonlighting, I started my own clinic that has been operating for 4 years now. So far I'm proud for what I have achieved and I'm happy :)
    For people who have complains with GPs, well you just have to choose your doctor well.

  26. Wonderful story! And I'm glad that general practitioners are thriving everywhere. It just goes to show that a doctor's specialization or lack thereof is no indication of his competence. Thanks for sharing, anonymous!

  27. thanks for letting us know just q little bit about thw whol delema. people think they deserve more for less. i aprove of and support GP. the whole medical establishment was founded on GP nos specialization. although there are some GP's that need to get their act together and start practicing medicine so people can be healed when the conditions present and not wait for specialty care. oh well life goes on and we have to live with what we have. thanks!

  28. Yes, doctors used to be general practitioners who catered to entire families. The advent of specializations came about later. Both specialists and general practitioners MUST be strong doctors - and both have the right to say they're good at what they do if they are indeed! :)

  29. GPs are doctor who are too stupid or too lazy to specialize.

  30. Anonymous, that's exactly what I'd say about people who don't bother to type in their name when they leave a comment. Hehehe. :)

    Kidding aside, let's not generalize - it reveals our naivete and lack of compassion. Those are not good qualities in a person.

  31. hi stef,

    i am suraj ( indian), doing GP in Qatar. My collegue is from manila..From my friend, I came to know that the situation in philippines and in India are similar, if not worse. Still I love General practice, and plan to continue the same.
    I enjoyed reading your comments, and well " you are a damn good writer".

  32. Hi Suraj, thank you for that. So very few people even understand what general practice is. And those who do often don't appreciate it. But it's good to hear from someone who loves the roots of his profession!

    Thanks, Suraj, and I hope to hear from you soon in my next articles on medicine! :)

  33. Having read those comments, a second year premed student like me starts to think if I am really into the profession or just into the

    Useful blogs by the way, they do not just bombard ideas, instead they input realities that an aspiring/accomplished doctor has to face. More power!

  34. Thank you, anonymous! I hope the posts here continued to inspire you to do what you feel is right for you, not what others do. We have our entire lives ahead of us, and choosing a path we don't really like is like setting ourselves up for failure - even if we don't fail in terms of achievement, we fail in terms of fulfillment.

    I know it is never black and white. I hope you make a choice you'll stand behind, a choice you'll be happy you made. Good luck on your career journey!

  35. I'm not tech savvy so I am posting as anonymous . Not to hide. My patients call me doc Frankie. A GP in Manila. I don't earn 50k a month but its enough to send two kids to private school. I end up saving in gifts from my patients, things from their heart; half kilo of tocino, embutido, bananas, eggs, cakes, leche flan, discount at the hardware store and paint store (with volunteers to do the painting). I get an extra half serving of vegetables at the carinderia every lunch when I go ther just because I manage her mom's BP.
    It's not cash but I save a lot! So what money I earn goes a lot farther.
    I got more to say but for my next post nalang.

  36. Bago pa man nag-usbungan ang mga ibat't ibang specializations, ang doctor ay marunong gumamot ng lahat ng mga karaniwang karamdaman. A general practitioner should be competent, if not adept, in the basic scopes of all the fields of medicine, may it be internal medicine, pediatrics, obstetrics and gynecology, radiology, general surgery, or family and preventive medicine and at the same time acknowledge that he/she has his/her own limits and know when to refer. A specialist on the other hand, trained for more advanced skills and knowledge in his/her own respective field of expertise should not take their basic med skills for granted and should be humble enough to accept the fact that they may sometimes forget some of them. In other countries, a patient cannot see a specialist without going thru a consult with a GP. Here in our country, even in the provinces now, people would ask you first what specialization you have as a doctor and you are shunned when you say that you dont have any. To make it worst, your supposedly colleagues that have undergone specialty training(may or may not have passed their diplomate training) looks down on you.(the sad reality that political hierarchy exists in any form of jobs) To set the records straight though, not all, but most of the specialists think that they are above a GP. They forget that they were once GPs and that their specialization should not be the defining factor to them as doctors, or better yet as human beings. They should even be greatful that there are GPs that refer to them adding to their pool of patients and GPs go on 24hr duty to take care of their patients after all :)) Patients should also be aware that GPs are competent enough to manage diseases and that they are the ones they see in the hospitals most of the time. The dilemma here is that there exist a problem because there's a lack of humility and discipline in one's practice and there's a lack of information dissemination of the importance of one's own practice. Hindi naman magkakaroon ng problema kapag mapagpakumbaba at nagbibigayan ang mga tao.

  37. That's right, Anonymous. Humility and ignorance are the core problems that lead to this stigma. Sadly, I think it will take many, many more years before there is any paradigm shift. In the meantime, let's hope that dealing with the ignorance problem can help alleviate some of the humility problem. :)

  38. I suppose you know about the Physicians Act of 2012. anti GP talaga and it should not be passed. It is now in the senate's in the 3rd and final reading na. Our dear senator Miriam santiago is tha one opposing to this.

  39. I'm not sure if it's anti-GP. May you educate us on why it is? :)

  40. One provision in the bill states that "any physician who practices inthe field of specialization not within the scope of his/her training(for specialists) may face life imprisonment w/ fine ranging from 500,000 to 2M".Specialist na yan, eh yun pa kayang GP that did'nt even undergo residency training., If you are a GP,you cannot just perform any medical procedure that is supposedly w/in the scope of practice of a specialist.Ex: circumcision,dapat board certified(diplomate) surgeon lang,NSD cases,dapat diplomate OB-Gyne lang (eh GPs & midwives kayang kaya to eh!!),surjical procedures in ER like simple suturing trauma cases must be done only by surgeons(kayang kaya rin ng GP ito),derma cases like acne surgery is reserved only for dermas, and many more..GP practice will only be limted to drug prescription & PE exam na lang kasi refer ka na lang ng refer sa "specialist"at dapat diplomate pa kasi non-board certified specialists are also classified as GP!!.Sayang naman kung kaya mong gawin on your own as a GP at added income di sayo yun.If you are classified as GP &w/o training,you will be given a much lower compensation in philhealth & from what I've heard,the PMA board proposes that philhealth should not anymore compensate for services given by GPs.

  41. "NSD cases, dapat diplomate OB-Gyne lang (eh GPs & midwives kayang kaya to eh!!)"

    WEIRD. You're right, midwives have 2 years of training. Doctors have five (med school + internship), and even more, if they have Nursing as a pre-med course. Very, very weird.

  42. Not just weird, also UNFAIR!! The bill also wants that only one medical organization(or mother organization) will control all medical organizations in the Philippines and that is the PMA like IBP(Integrated Bar of the Philippines)sa mga laywers.and we all have to be members of PMA.Not all doctors are members of PMA.As of present,PMA has no full control.Basically, wala naman problema sa provision na ito, but when that organization controls your practice unfairly and for the wrong reasons as what I mentioned above,jan may problema. Discriminating GPs is the main problem.PMA only wants to recognize the 8 specialty societies(you can research on this in case you don't know).Eh meron pang mga AFFILIATE medical societies under PMA(research mo rin). If a specialist is not a member of one of the 8 specialty societies,you are not considered as "specialist" even if you are.GP pa rin ang tingin sayo ng PMA.Ex:an ENT.specialist who is a diplomate member of PAMS(Philippine Academy of Medical Specialists),an affiliate medical society of PMA,but NOT a diplomate of Philippine College of Surgeons(PCS)-one of the 8 recognized specialty societies of PMA,that ENT is still considered GP sa mata ng PMA and philhealth which is also being controled by PMA!!!. Ang reason daw kung bakit kelangan gawin ito is to uplift the quality of medical service of doctors in our country.Ano pa bang quality ang gusto nila!!Kakulangan nga ng doctor ang problema ng bansa eh, tsaka affordabiltilty ng medical service at gamot.Itong mga problemang ito ang dapat nating pansinin says senator santiago.If that is what PMA wants, then sa PRC medical board exam nila higpitan!!,or kung di pa sila masaya,higpitan pa nila ang pag accept ng mga doctors seeking residency training, BUT NOT when that doctor is already practicing be it as a GP or specialist!! Why is it like this? Politics and MONEY lang ang nakikita ko rito.:(

  43. Then it looks like there will be a LOT of problems, not just for GPs but for many other doctors. God help us all.

  44. There is now a move by certain groups of GPs(GPs practicing outside manila kasi sila yung mas marami), and major LEGAL(SEC registered like PMA) specialists organizations of doctors supposedly not recognized by PMA as so called "specialist organizations" to put a stop to the passing of this bill.Let us pray na maliwanagan ang ating mga butihing senators as to the bad implication this bill will create &that these groups succeed.threat sa practice ng doctors ito.Ang pinaka tatamaan talaga GP.

  45. Hi Dra Stef, would you know if there is an organization or society for GPs here in the Philippines?


  46. Have you heard of WONCA? And no, it has nothing to do with Willie Wonka. ;) It stands for the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians. They have a branch in Asia (WONCA Asia-Pacific).

    Do you know of other associations/ societies for PCPs? Share them here!

  47. Thanks dra. Stef!

  48. Hi stef

    Firsly i apologize for my wrong english.

    Then , why i m concerned about your thread for two reasons?.
    I m a one of the 50.000 GP in France, and we are proud to be here.
    I have been 5 times in Phils to meet my future wife. And i can feel what you mean about stigma among doctors.
    It was happened 20 years ago here. Mainly among hospital and clinic colleagues. But never among the people.
    Now the specialist need us to get more patients;)
    Yes we are proud to provide follow up from babies to the eldest person of FAMILY., for some decades.

    Second, i will be retired in a while, making plan of filipino GP clinic.
    Keep on being Proud dear filipino friends


  49. Wow, Clement. What you said gives me hope. I hope that more and more doctors like you continue to give that hope, even to colleagues in other countries (such as ours).

    Thanks for dropping by and let me know when you're finally staying in the Philippines for good! It would be nice to chat and visit you at your GP clinic. :)


  50. Hi Stef.

    I have to be very honest, I did kind of look down on GPs before, in the sense that every time I was given a choice to either see a specialist or a GP, I always went with a specialist and would always remark with "Is that even a question"?

    After reading this blog post and all the comments posted so far, I feel ashamed for even thinking it. I started asking myself what the reason for my belief is when I actually honestly, have never tried a GP. Shameful, I know.

    Thank you for enlightening narrow minded people like me who allow ones ignorance from influencing my views and opinions about GP Doctors. I will now make it a point to respect GP Doctors, and to view them as Doctors; at least the same way I view the Specialists.

    Kudos for the blog post. I am humbled.

  51. Hi, Jen! Everybody has been tiptoeing around this topic (about how GPs seem to be underrated) so I thought it was a good idea to talk about it and put it out there. So far, the diversity of comments has enlightened me and many other doctors/ patients.

    Thank you for sharing your thoughts with us on this blog! I'm glad that it reaches more and more people each day. "One starfish at a time," as the famous story goes about the boy rescuing starfish on the beach. (Is anybody familiar with that story?)

  52. I am a family physician trainee, and I would like to emphasize that anyone who is being avoided or stigmatized suffers and as health consists of both mental and organic health and if someone is being hurt for who he is daily, it affects his thinking and may cause destructive changes leading to poorer health, collaboration among colleaguesa and doctors patients suffering. Society often misunderstands the true role of primary health care, and mixes the meaning of family medicine.overgeneralizing it. Thedeveloppedcountriesare goingaway from the name general practitioner to family physician or family doctor WHICH IS THE SPECIALTY, GUYS,IT IS A SPECIALTY OF FAMLY MEDICINE AND TAKES 6 YEARS of undergraduation studies and 3 to 4 years of postgraduation training vs,residenture of family medicine which is the separate specialty. Untill we keep up hurting each other or pretend wedo not see it, the health care is not going to improve but worsen. FP trainees in Latvia share with each other this pain of undervaluation and avoidance, which they regularly faceand how un fair it is.I have spoken to delegtes from other countries which confirm similar sorrow.

  53. Thank you, FP Trainee, for sharing your views. You're right, it is sad that our worst critics are our own colleagues - and they provide all the wrong kinds of criticism, at that. We need not only good doctors, but good people who want to be good doctors. Good luck to us and to Latvia. :)

  54. I will just tell you about my experience with these so called "specialists". My relative is a foreign national, and was admitted in one of the biggest private hospital here in manila. He had three specialists doctors. During his admission, we had a lot of questions about what was happening, but the attending physician only do rounds once a day, and it was very hard to time when she is coming. The residents also would not answer our questions and will just tell us to wait for the consultant. And sadly, the staff nurses would not give us the contact number of this consultant. The only time that this consultant really talked to us was when we threatened to file a complaint! The sadder part of this story came during the clinic follow-up. One of the specialist changed the antibiotic prescribed by the other one, that is rocephin + clindamycin to just ciprobay alone, then after a couple of days my relative had rashes. The next day, we went to the other specialist for the scheduled follow-up, she said, I will not meddle with the other specialist's choice of antibiotics, and she prescribed an antihistamine, and referred us to an allergologist. So, we went to the allergologist, who changed the antihistamine into another class of antihistamine, and prescribed lotion for the rashes! But, none of them ever thought of calling the specialist who prescribed the ciprobay and ask if he can change it. Fortunately, we had common sense to phone that doctor, and so the ciprobay was discontinued and changed to clindamycin again. And so, we spent almost 10 thousand pesos for medicines that we bought but never used. What I really think is that these specialists are heartless beings, and just thinks about money...and they never really care about the patient. A really dedicated GP can do a lot better that them and I think can manage my relative alone, the problem is that, most GP's usually has no affiliations in big hospitals and cannot admit patients. By the way, my dad was a GP in the rural area, and he was doing autopsies during his time. So I think, GP's are the "better" doctors since they know a lot of "simple" things, and they really care for their patients!

  55. Sting, thank you for your detailed story. It sheds light on many things that need to be changed in medical practice. Some (not all) doctors, specialists or otherwise, have depersonalized their practice, looking at it as just a job instead of a public service. This phenomenon is well-documented and is called compassion fatigue. I simply call it the "grumpy doctor" syndrome so that everyone will get it. I wrote about it in my upcoming column.

    But I digress. In an era where specialization might also mean compartmentalization, doctors definitely need to work as a team, not as separate units. They should be able to collaborate and call each other instead of actually using patients as middlemen.

    That is why many general practitioners in the provinces handle these cases with more care: they often have to do it all. That means there is no compartmentalization of services.

    Like I always say, a specialization doesn't automatically transform doctors into good ones. It's something every patient AND doctor has to realize.

    I'm so sorry to hear about what you had to go through! I hope that after all the trouble, your loved one got the care they deserved. Again, thank you so much for sharing your story and thank you also for dropping by my blog! :)

  56. Hi stef! I love this blog!
    yes, the stigma of being a GP haunts each and everyone of us that did not go into specialization. It pains me that after all that i have been thru just to be where I am right now will never be enough for most people. It is frustrating that most people, specialists, medical staff, patients, etc. Look down on us because we are "only" GPs.
    In the hospital that I am currently employed, we are experiencing this sort of bullying. As a GP, i go into 24hrs duty, admit and stabilize patients at the ER for consultants (specialists), see ward referrals and do emergency procedures. Most specialists think that we are incapable of treating patients when in fact they themselves have been ER physicians like us. I dont think their specialty gives them the right to belittle us. They should act as mentors and consultants whenever we refer their patients to them for admission and not communicate with sarcasm. I have only been a GP for 2 yrs and yes, i have been very disappointed with the lack of regard, respect and appreciation for GPs. Being a GP, is not equivalent to mediocrisy. I chose to be a GP not because i dont have the brains to be a specialist. I have been an achiever even upto medical school and i guess it hurts my pride, my person and my profession whenever i am criticized as "just a GP". I am not saying that I am going to be a GP forever, who knowns i might also go into specialization someday but never will i look down on my colleagues may he be a GP or a specialist. For now, my co-GPs in our city are forming an organization to police our rights, try to step up from this stigma and maybe, hopefully, someday this will be a better place for all of us.

  57. This comment has been removed by a blog administrator.

  58. Thank you, Sarah! I love blogging here, so I'm glad someone else other than me loves it, too!

    The injustice GPs receive is something we all have to contend with. My hope is that someday, this all becomes a thing of the past, in the same way many barbaric views now are, hehe.

    Good luck with your organization! Let me know how it goes. I would love to write about your org and how it protects the rights of the GP.

  59. "General practice is an essential part of medical care throughout the world. GPs are also the first point of contact for most patients..."

    Above from this site:

    Seems like GPs there feel as unappreciated as here so they are leaving in droves. Plus existing ones are retiring and so there are lots of vacancies - thousands. Salaried GPs are the most widely advertised.Salary from 70k british pounds.
    Any takers?

  60. True, Joe. Underappreciated and underpaid. Thank you for the heads-up - I'm sure it will be helpful to those looking for work as GPs. :)

  61. Hello, Doctora!

    Let me first thank you for creating this blog site. It not only provides reliable information and facts but also gives insight on the medical profession.

    I am a licensed Filipino physician that went straight into residency 2 months after passing the board exam, first and only taker (there's a stigma, too, by the way on the number of times you took the exam), because any exam taken more than once regardless of the circumstances why is like a blemish on one's record, 'Di ba? To my parents who paid for my education, the relatives, and to society, you're not much of an asset or source of pride if you're not a specialist. So I just had to.

    Before I was done with specialty training, I developed what you said earlier, "compassion fatigue". It was, to me, a nebulous idea before. Call it arrogance or naïveté, I didn't put much stock on something like that happening to me, because there's also a stigma attached to doctors who just break down even in the most subtle of ways. I trained in a government hospital (another stigma, Doctora, versus training in a private institution where doctors are said to be all about money and not really about serving the poor) where days and nights were filled with plans on how to please consultants, filling up the census, and worrying where my Class DEF patients were going to get funds to get treated (because nothing is 100% free in a government hospital, not even with Philhealth.).

    I finished residency, at least, and graduated. And unfortunately couldn't muster enough willpower to even get through a diplomate exam. Realization hit hard that I wasn't prepared for the curveball I was thrown. I wondered if I had been tenacious enough to have gone on to become a GP and used the period to reflect and figure out the direction I wanted to take professionally, I wouldn't have "bled out" that much. Because starting out private practice as a GP, at least to me, can also be a stepping stone...or a lay-over where one can have wheels vulcanized or changed so as to better ride through the race.

    I wanted to become a doctor because I dreamed of serving the people in my parents' hometown in the province. I remember the dream but I don't remember anymore what it "felt" like. And I want to remember and feel it again.

    Life nowadays is admittedly centered on survival and financial stability is a priority, regardless if you have a family of your own or you're single. Now, I'm split in the middle between continuing with a specialty clinic in Manila (where I earn a paltry amount that gets even "paltrier" when I pay tax because that's one thing I'll never be remiss on) and going to my parents' hometown in the province to practice as a GP (where I'd have more patients in actual need of medical care and possibly earn more). I was told they needed specialists there, a small barrio, when what they truly needed were GPs.

    What have I done?

    Doctora, what advice can you give a colleague?

    To add, when I see patients at the specialty clinic, they end up asking me questions on health and medical care not even related to the specialty I trained for, questions a GP can answer anyway, with some of them requesting me to treat even their illnesses unrelated to the specialization.

    Isn't that just ironic?

    1. "I remember the dream but I don't remember anymore what it 'felt' like. And I want to remember and feel it again."

      You put that into words quite nicely. I feel your anguish and your desire to go back in time and be the bright-eyed and bushy-tailed doctor you used to be!

      And you're not alone, which is a bad thing (coz it means there might be a systemic problem that no single individual can solve) and a good thing (because it means it might be a systemic problem, instead of something we can pin on individual doctors).

      It seems what we need is a solution that changes the infrastructure so that our GPs make good use of their knowledge, and so that we don't run out of GPs because they all want to be specialists! A study on primary care as one of the keys to universal healthcare (and a potential solution to the deficient healthcare workforce) has started. I believe its findings just might solve many of our problems as a country, including your own personal issues!

      Thank you for sharing your story. For sharing your epiphanies. For sharing how GPs have been undervalued when in fact they are sorely needed. You are, I believe, more enlightened than you think!

      While I can't give advice about what steps you should take next, I think that you already have the answers to your questions, and that all you need is to address any cognitive dissonance. Your needs and wants may be conflicting, and until the conflict is resolved, you just might stay undecided. Ask yourself when you are happy, full, and well-rested -- you might surprise yourself with an answer you thought you don't have yet.

      Sooo wonderful to read this comment from you! I hope others get to read it, too. Fellow doctors like you make me PROUD.