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

2. 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

3. 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”

4. 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”

5. 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

6. 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

7. 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

8. 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)

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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. American Board of Medical Specialties Website

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

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

34. 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”

35. 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.

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

37. 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

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

39. 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

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

41. THANK YOU