Generalists vs Specialists

It is probably obvious to a lot of patients already that there are two types of medical doctors, the General Practitioner and the Specialist. The General Practitioner or the GP is usually the kind of doctor who sees all kinds of patients and is the primary care physician since the GP is expected to manage all sorts of illness. While the specialist is the kind of doctor who performs higher and more complex care or services and focused only on a specific type of illness or group of patients. In other health systems, a patient cannot proceed to a specialist without a referral from a GP. And GPs are usually regulated and would undergo special certification in order to work as a GP.

In the Philippines, there are a lot of GPs however there is a mental mindset that pulls young doctors to prefer becoming specialists instead of generalists. Among the many factors is the pay. As a specialist they can charge relatively more than the Generalists and since their services involved more sophisticated and at times expensive techniques, Specialists would earn twice or thrice than any generalist. So in many areas, the Specialist has become the front-liner of the health system which can be expensive and costly for the community.

It is a choice any young doctor has to make. Even among generalists the group can even be further divided into those who practice privately or those who work for government. And usually a handful of generalists would serve in government and are assigned to far-flung rural areas where there is a high need for medical doctors. In recent times, the Philippine Department of Health has started a program back in the 1990's called "Doctors to the Barrios Program". In the past, doctors who would want to serve under this program would "volunteer" to become a DTTB. Nowadays, the DTTB program has been exclusively a program for government scholars as their "return of service" for having enjoyed free medical education. There are advantages and disadvantages to having this type of doctors entering the program. It has been observed that some scholars see the DTTB program as that- a payback for the free education they have received. There is nothing wrong with that however if the scholar does not see past this obligation to pay back, there is a high tendency to feel entitled and to not stay longer than expected.

However, not matter what your motivation is in joining the DTTB, the fact is the communities especially in the far flung areas need doctors but not just clinicians. They also need doctors who can educate, manage, implement programs, if possible even reform the system. That is why current DTTBs would also enroll themselves in a post graduate course on management.

It cannot be denied that more and more generalists working in far flung areas are needed in our communities especially in the rural Philippines. I am honored to be part of this family of likeminded and "likehearted" Filipino doctors.