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Archive for May, 2007

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I have always loved observing animal behavior, particularly those exhibited by the four dogs and three cats that I live with.

Teriyaki, my 1.5-year-old Beagle/Labrador mix, is blessed with the happy, even temperament of both breeds. She is subservient to the caprices of the three cats that she grew up with. I guess this is her way of acknowledging the fact that the felines arrived in my house before the canines did. Despite her relatively big size, she meekly walks away with tail tucked between her hind legs everytime a feline housemate hisses at her for going too near the cats’ territory.

On the other hand, she hates all other cats without exception. She had chased away every single stray feline that tried to enter our gate. Every successful flush-out was accompanied by a triumphant houndish howl. My guess is that Teriyaki was trying to say, “Three cats are enough trouble here!”

But something strange happened to Teriyaki this weekend. A few-week-old calico kitten spotted Teriyaki behind the gate and proceeded to inspect the canine that was making strange growling noises. The kitten must have been really brave or really dense. She tried to scale the gate’s chicken wire screen, but her efforts were in vain as her legs were still not strong enough to hoist her body up a few squares. So, she content herself with inspecting the dog behind wires. A more persistent little kitten, I have never seen. Teriyaki must have been taken aback by the kitten’s brave gesture. She dropped her top dog airs and sat by the gate for a good fifteen minutes, patiently accommodating the kitten’s challenge to play “tap my paws,” separated only by chicken wire and some skinny bars. Teriyaki would occasionally grunt in exasperation, rolling over on her back but still keeping the game much to the kitten’s delight.

I watched with amusement, wondering if Teriyaki would allow this little kitty permanently into her life. This is not Teriyaki’s first encounter with a small kitten, but this is definitely the one “stranger” kitten that Teriyaki tolerated in close range. Perhaps it is because they share the same tri-colored coat. Perhaps it is the kitten’s confidence (or ignorance) that made her earn Teriyaki’s respect in a way–enough for the proud canine to show uncanny tolerance for this tiny kitty.

In the animal world as it is in the human world, size does not always matter. It is a matter of showing one’s true worth, whether it be a certain attitude, talent or capability. It is a matter of perspective. The giant may say, “There’s no midget that I can’t drive away.” The midget may say, “I can win this giant’s heart.” Guess who came out the winner? 🙂

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Who doesn’t want to have a doctor in the family? Here in the Philippines where we put much premium on academic degrees, it is something that brings great pride to the family. To have a family member establish a successful medical practice in the US is a great honor indeed. It also promises better opportunities and (hopefully) a brighter future for the next generation.

But things like these don’t come easy. From what I gathered, one really needs to invest a lot of time, effort, and finances to reach this goal. It started with an almost silly and vague question from me. But my online buddy, Dr. Joel de Guzman (rehabdoc), generously shared his experience about what steps to take to make it as a US-based doctor. The discussion happened at my second Multiply site, but I was granted permission to repost it here. I feel it is an interesting and informative topic.

Read on. I hope this repost will serve as a challenge to those who dare to dream. 🙂


mtsally said
“Boring? Gosh, I don’t think one can get bored with so many things to do before one can practice as MS in the States. Assuming that everything goes as scheduled and without delay, how much time does this whole process take before an MD can set up a private practice there?”

rehabdoc said:

Hmmmm.. tough to answer that question since there are a lot of pathways to get there. I have to have a starting point and an end point.”

Start; HS graduate March 2007 dreaming to become a doctor in the US

BS Biology (most common) – 4 years
Med school – 3 years didactic plus 1 yr clerkship
Internship – 1 year. At this point, he/she just finished his internship and it is already April 2016. he will take his Philippine boards in August 2016, and the results will come out somewhere around November 2016. So roughly 9 years 9 months give and take 2 months. Let just round it off to 10 years.

Next question is, does he/she have a visa? Tourist visa, good chance. Greencard – better chance. Citizen – Best chance. No visa,…depends on the embassy..I dunno..but miracles happen.
Why is visa became so important? If you cannot go to the US for a residency interview, you dont stand a chance.

Lets just say, for some reason he has a greencard/US citizen. So he does not need to do the internship in the Philippines. So He/she went to the US right after graduating from med school. He has to take the 5th pathway(1 more year of medschool and 1 year of sub internship) and that is around 2 years. After that he/she is considered a US graduate. School starts here on September so he/she will be finished by August 2017. By this time, he/she had finished doing USMLE steps 1 & 2 and is eligible for residency interview which starts from Mid November to late February. Let us say he wanted to be a family practitioner, then that is 3 years of residency. He/she will starts on July 1 2018 and finish on June 30, 2021. There is a 3 to 6 months lag time before you can get your state license. So he/she will probably get his license on December 2018. You said private practice? Well, he/she need to get his/her own malpractice insurance, DEA number, CDS number, medicare, medicaid,npi, get affiliated with a hospital, put up a clinic/rent a space..etc..another 2-4 months. So it is already April 2019.

So the final answer is……Roughly 12 years since finishing HS. 🙂

Others:

US citizen/greencard holder who stayed for 1 year of internship in PI. 11 years but…lesser chance of getting a residency than the person above…unless he/she has a very high grade in USMLE steps 1 &2, and had a good interview.

No visa…even if you get an invitation from university hospital/ training hospitals here in the US, if the US embassy there in the Philippines would not grant you even a single entry tourist visa, your luck will run out. Once they(embassy) found out you are an MD and will try to get a visa, chances are…pray, miracles happen.

HS graduate who took up nursing/PT/OT/MT as a pre-med course then went to med school. better chances of getting work here,& get a greencard. But need to finish a 2 -3 year contract. Roughly 16 years.

And the Finale and probably the most common scenario..an MD who took a 2 yr nursing course. Got a greencard, got a job as a nurse but needs to finish his/her 3 year contract. 18 years since HS or 9 years minimum from graduating from med school in the Philippines..

Some might not agree with the number of years give or take a year or two. But obviously, a nursing job is the way to go.

Advantages of taking up nursing:
1. Become a legal resident. As a legal resident, you dont need to think about overstaying. Preparing for the test, taking the test, matching, interviews takes time…how long..could be as short as 2 years and as long as…forever.

2. Its a work that pays, and pays well. Exams, review materials, review class, plane fare, hotel fare for interview cost alot of money.

3. US medical experience. One of the question which they ask during interview period is, do you have any US medical experience? Working as a nurse is next to being a doctor as having a US Medical experience.

4. Letter of Recommendation. Interviewers prefer LOR from US doctors. When you work as a nurse, you can easily get an LOR from an attending.

5. If you get to work in a university hospital, it is a big help to know somebody who could get you at least an interview.

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Reading Frenzy

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“There’s a time to read… if we just decide we want to do it.”
Dave Llorito, my online buddy.

Words of wisdom, these are.

Until Ash Wednesday, I had not held a book in my hands for years. I really have to thank my good friend Nel Pascual — he gave me an “assignment” which was to read one chapter of Rick Warren’s The Purpose-Driven Life each day for the next forty days. And what an astoundingly life-changing book it was! I will not make a summary of that book here. You really must get your copy (our Multiply friend Bugsey has an e-book, even!) and read through it to appreciate the wisdom and the inspiration contained therein.

So here again, my blog topic. I was “bookless” for a good four years. Unless I can count the three-inch-thick Stedman’s Medical Dictionary, the PDR, and Principles of Surgery as the best nonfiction materials ever, I do not recall having read anything that normal people call BOOKS in the recent past. Blame it on medical transcription school. Blame it on Dogster, Multiply, and WordPress that came to my life after medical transcription school. Blame it on my own laziness. Staying online most of the time each day, I almost forgot about the charming, “old world” feel of paper on my hands. That was fine with me until I started blogging a bit more seriously. English is a second (maybe even a third) language for me, and I noted much to my consternation that I have been having difficulty expressing my thoughts in writing. I suddenly remember that I have not reading as much as I used to. I am no longer as comfortable with the English language as I used to be. My written communication skill has diminished in direct proportion to my reading.

I MUST start reading, I thought. In a fit of frenzy, I dug through stacks of books I have at home. I have forgotten about these as the bookshelf has already been dominated by medical dictionaries and references. There were management books aplenty. I set aside the heavy hardbounds and rested my hands on a small black book and smiled with much pride at having found a buried treasure…Sun Tzu’s The Art of War. This book was my favorite companion years ago as I served time in the human resource department of the Manila Standard. I dug some more and came across a few cookbooks and laughed. I don’t cook. I can’t cook! Funny I even bothered to buy those recipe books. Perhaps it was because the photos looked nice and good enough to eat. A few more minutes, and I was leafing through the pages of books discussing philosophy, religions and beliefs. There were a few classics too, including my favorite Greek and Roman mythology books. Gee, I thought, I did read all sorts of stuff.

It did not take long for me to find unread books stored in the covered bottom shelves. Even though I have stopped reading for quite some time, I still find myself visiting my favorite book store and buying a few books that I hope/wish/promise myself to read. I had kept all of these in their original book store plastic bags, and I already have quite a few. That’s quite embarrassing, really. I’m such a hoarder. I MUST start reading, I told myself again. That was a week ago. It was like learning to read all over again. Reading from a book somehow feels different from reading an article online. But I discovered that I still love the charming, nostalgic feel of a warm book on my lap. I still enjoy the feel of paper, the textured and the smooth, on my fingertips.

I have finished reading “The Alchemist” by Paulo Coelho. I am halfway through “Warrior of the Light” also by Coelho. I still have the 25th anniversary edition of M. Scott Peck’s “The Road Less Traveled” to go through. Next in line would be “Maybe LIfe’s Just Not That Into You” by Martha Bolton and Brad Dickson, “Cat & Dog Theology” by Bob Sjogren and George Robison, and a not-too-big coffee table book, “Best Regards–A Treasury of the World’s Great Spiritual Letters.” And that is just scratching the surface.

Wish me luck. I intend to make the most out of this reading frenzy that I am in. I only hope that time will be be my friend.

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