THE REGULATION OF MEDICAL PRACTICE Miguel L. Noche Jr., MD PRB of Medicine Professional Regulation Commission

Outline of Presentation 1. Legal basis for regulation 2. Objective of regulation 3. Classification of Physicians 4. Requirements for each classification 5. PMA as APO 6. Provisions in the Physician Act 2012 7. Weaknesses in our systems

Regulation of Medical Practice: Legal Basis 1987 Constitution, Article II, Section 5 provides that: “The maintenance of peace and order, the protection of life, liberty and property, and the promotion of the general welfare are essential for the enjoyment by all of the blessings of democracy” “Police power of the state” “General welfare clause”

Legal Basis 1987 Constitution, Article II, Section 15 “The State shall protect and promote the right to health of the people and as a policy instill health consciousness among them”

Professional Regulatory Board of Medicine: Legal Basis The Medical Act of 1959 (RA 2382) Article I, Section 1. Objectives – This Act provides for and shall govern: (a) the standardization and regulation of medical education (b) the examination for registration of physicians (c) the supervision, control and regulation of the practice of medicine in the Philippines

Legal Basis RA 8981: The PRC Modernization Act of 2000 Section 9. Powers, Functions and Responsibilities of the Various Regulatory Boards (a) To regulate the practice of the profession (b) To monitor the conditions affecting the practice….adopt such measures as may be deemed proper for the enhancement of the profession….maintain high professional standards

Legal Basis The PRC and the Professional Regulatory Boards are the only bodies expressly created by law to regulate the professions The Professional Regulatory Board of Medicine: supervision, control and regulation of the practice of medicine

Clear Mandate for the PRBOM To maintain high professional standards No compromises because physicians deal with the health, and the lives of patients PRC Legal Division Statistics: Gross negligence and incompetence (60% of cases filed against physicians)

REGULATION OF MEDICAL PRACTICE Powers and Functions of the PRC and the PRB’s 1. Quasi-legislative 2. Quasi-judicial

Quasi-legislative Power of the PRB The power to make rules / policies / resolutions, including the power to interpret / construe or to give opinion on matters pertaining to the profession Final approval by the Commission Proper

Quasi-judicial Power of the PRB Hear and investigate violations of professional regulatory laws, rules and regulations, Code of Ethics, etc. Render judgment and impose penalty in the form of reprimand, suspension, revocation of certificate of registration

The Professional Regulatory Board of Medicine Formulated proposed revisions to the pending Physician Act regarding medical education, licensure examinations, medical practice, classification of physicians, specialization requirements Submitted to both Houses of Congress

REGULATION OF MEDICAL PRACTICE Main Goal: ensure high quality of care for the protection of the public; maintain high professional standards Methods: Before entry: licensure exams In practice: requiring credentials requiring CPE continuing assessment enforcing regulatory laws

Guidelines Classification Requirement General Practitioner Specialist Graduation from recognized medical school, 1 yr Internship Passing Licensure exam Specialist Graduation from accredited residency training Passing Certifying exam Subspecialist Graduation from accredited subspecialty training

Clear Application of Guidelines At end of medical school and internship, a graduate may have acquired an academic MD degree, but if he fails the licensure exams, he cannot be a licensed MD (GP) A physician may have finished residency training, but if he fails the certifying exams, he cannot qualify as a specialist

Recognition / Accreditation Process PRC final approval PRBOM selects and recommends PMA (APO) Specialty Organizations / Certifying Boards Training Programs

PMA as the APO Status/authority of the PMA emanate from its being the professional organization recognized and accredited by the PRC and PRBOM Met requirements for being the APO Since Sept. 18, 1975 Accreditation No. 012

Implication Only specialty organizations, specialty boards, training programs accredited by the PMA are recognized by the PRC and the PRB of Medicine Therefore, specialty organizations and specialty boards also possess and wield regulatory functions in their own disciplines

Implication If the certificate of accreditation of PMA as the APO is suspended, cancelled or not renewed, it will cease to represent the profession of medicine

Submitted to ASEAN MRA Secretariat The following are the official professional regulatory authorities (PRA) for the practice of medicine 1. Professional Regulation Commission 2. Board of Medicine 3. Philippine Medical Association

Dilemma Our main responsibility as regulatory bodies is to set a high standard and maintain it to protect the interest and safety of the public On the other hand, we are dealing with graduates of training programs who have not passed the certifying exams

Options Some of our colleagues are recommending that we call them “board-eligible” or give them titles like “affiliate members” This may be the easy part of the problem

Main Problems Delineating their scope of practice Placing a limit on what they can perform (will they be allowed to perform specialty procedures?) Placing an effective monitoring system Defining sanctions for violations Recognizing the risk for patients Facing the possibility of medicolegal problems

International situation The requirements for becoming a specialist is universal: undergoing residency training and passing certifying exams At present, we are working on the ASEAN MRA looking at the training, core competencies, scope of practice and certification of specialists

American Board of Medical Specialties Website

Most important Provisions of the Physician Act 2012 (SB 3137 Sen Most important Provisions of the Physician Act 2012 (SB 3137 Sen. Trillanes) Art. V. Sec. 28. Disciplinary Sanctions (k) Performing any act constituting the practice of an area of medical specialization without fulfilling the specialization requirements prescribed by the Board Sanction: reprimand, suspension, revocation

Most Important Provisions Art. VI, Sec. 39. Penalties (9) Any registered and licensed physician or medical specialist who shall use or advertise any title or description tending to convey the impression to the general public that he/she is a specialist in an area of medical specialization when in fact he/she is not Imprisonment: 1-5 years Fine: P200,000-500,000

Most Important Provisions: Article VI, Section 39. Penalties 10. (b) when death occurs as a result of the commission of the prohibited act in paragraph (k) performing an act without fulfilling specialization requirements, Sec. 28, the offense shall be considered as qualified violation of this Act Punishable by life imprisonment Fine of 500,000 to 2M pesos

Very strong message Physicians should have the proper education, training and certification They can only perform procedures in areas of practice where they have been trained and certified There are regulatory bodies governing the practice of medicine There are sanctions and penalties for violating the regulatory laws

Weaknesses of our systems At the level of medical schools Weak regulation by CHED Giving permits to open/operate Computer school with college of medicine Poorly performing med schools difficult to close down

Weaknesses 2. At level of students NMAT: cut-off score decided by medical schools themselves Inappropriate use of a national screening test Allows entry of students who may not deserve to be admitted

Weaknesses 3. At level of practice of medicine (PRC, PRBOM, PMA) Physicians declaring and marketing themselves as specialists Physicians forming unrecognized organizations Physicians misinterpreting the provisions of the Medical Act that they can do anything once they are licensed Physicians engaging in questionable practices

Weaknesses 4. At the level of continuing professional development CME activities heavily subsidized by drug companies

Weaknesses 5. At level of Philhealth Creation of the Tier 2 GP’s with training Mainly for remuneration purposes Unintended consequence: conferring an “official professional title”

Official Position of the PRB of Medicine Clear basis for classification and requirements Creating precedents in the profession of medicine is not good (will affect the other 45 professions under the PRC) Between basic medical graduates and specialists, the standards for specialists should be higher.

Position of the PRB of Medicine Bottomline: Among all professions, the medical profession should set the highest standards

Cycle in the Amendment of regulatory laws Medical Act of 1959 Physician Act of 2012 (?) An interval of 53 years, so let’s not wait for 2065 to introduce changes We have to do what needs to be done NOW! Our legacy to the future generations of physicians and to our people

Question Will you fly in an airplane handled by a “pilot with training” but did not pass his final certifying exams?

Summary of presentation Legal basis for the regulatory bodies Objectives of regulation Powers and functions of the regulatory board General guidelines on the classification of physicians Pertinent provisions of the Medical Act Weaknesses of our systems

“The roots of education are bitter, but the fruit is sweet” - Aristotle

THANK YOU