Residency Training in a Millenial World

According to the Department of Health Hospital Levels, a level 4 hospital is a teaching and training hospital with clinical services in general medicine, pediatrics, surgery, anesthesia, obstetrics and gynecology, specialized forms of treatment, intensive care and surgical procedures, tertiary clinical laboratory and third level radiology, pharmacy, nursing care for patients needing continuous and specialized critical care.  Our hospital is one such hospital where most district and provincial hospitals, and even local birthing clinics, refer their patients for emergency cesarean deliveries, blood transfusion and/or intensive care.

It is a recurring refrain among district and provincial hospitals that the reason why they continue to refer patients to our tertiary government hospital (level 4) is because of the dirge of specialists like obstetricians and anesthesiologists e.g. to conduct emergency cesarean deliveries.

I recently attended the graduation of medical students at a medical college where I teach.  More than 100 smiling graduates all dressed up with their proud parents and guardians looking on... They will all proceed to internship and take the physician licensure examination (board exams).  Last March 2017, PRC announced that 813 examinees passed the physician licensure examination and are now full-pledged physicians.  Where do these new medical doctors go after passing the board exams?

Some take on the grueling 3-5 years of residency training to become a specialist.  Many apply for jobs abroad. Others prefer the laid back lifestyle of a hospitalist, junior consultant "moonlighting" at different private hospitals. Others work for corporate institutions, occupational doctor for companies and their employees. Others work as cruise ship doctors to enjoy travel while earning a good salary.  A chosen few go into research instead of clinical work.  A handful volunteer as "Doctors to the Barrios" program, serving difficult to reach geographical locations.

During a bi-annual trainors meeting of our specialty society, the problem about dwindling applicants to residency training was raised as an urgent issue.  One consultant gave the explanation that "millenials" nowadays have the YOLO mentality, meaning "you only live once..." hence they opt for career paths other than residency training.  However, for a super-congested level 4 referral tertiary government hospital in the Philippines, the complement of resident physician trainees is the lifeblood of hospital operations.  Without this, patient care and safety will be compromised.

1. What are the different career paths for new medical doctors?
2. How does a 3-5 year residency training program appeal to millenials today?
3. How can we convince new doctors to proceed to residency training?