Medical Tourism - Cebu

CEBU BUSINESS FORUM - SECTION ON MEDICAL TOURISM

2006-06-22T20:18:00.000-07:00

June 22, 2006 - DTI-Cebu Chamber of Commerce's Business Month ended with a big bang today. The main venue is the convention center of Waterfront-Lahug where many activities happened simultaneously, including a very extensive exhibit of Cebu's major trade players and conferences in different venues on different aspects of Cebu Business.

One of the bigger conference was the section on Medical Tourism. The existing major players in Cebu's infant medical tourism business presented interesting perspectives on the issue. Dr. Amores presented "Medical Tourism - the Experience at Cosmetic Surgery Center of Asia". A very interesting discussion followed the presentation.

It became too apparent during the conference that if ever the Philippines wants to get serious about medical tourism, it faces the serious task of institutionalizing this novel segment of medicine. It can start by integrating the disjointed (and at times haphazard) efforts of DTI, DOH and DOT.

BOARD CERTIFIED PLASTIC SURGEON: WHAT DOES IT MEAN

2006-03-02T02:46:00.000-08:00

"Trained in the USA" is a must-have in the promotional materials of clinics and companies involved in medical tourism. Nothing to do with colonial mentality!

Training in the USA is a very complicated, graduated and regulated process. Being one, and passing the specialty boards literally grant one a ticket to treat/perform surgery anywhere in the world.

The training program is often referred to as a residency program. Residency in Plastic Surgery is one of the most coveted and competitive residency positions in the world. One has to lock horns with products of such prestigious universities as Harvard, Princeton, Vanderbilt, Pittsburgh, New York, Philadelphia, and other top universities of the USA - not to mention, graduates from the major universities of Europe, Asia and South America. The prerequisite is training in the USA in General Surgery, or certification in other specialties such as ENT, Orthopedics, Urology and Neurosurgery. By themselves, getting into the prerequisite residencies in the USA is now next to impossible for Filipinos and other Asians.

For graduates of Philippine and other non-USA medical schools, and being foreign nationals, to become a true "USA Trained" plastic surgeon is akin to the proverbial "camel going through the eye of a needle".

The next big step is passing the American Board of Plastic Surgery Part I (Written). As if this is not hard enough, then one has to pass Part II or the dreaded Oral Examinations where one goes mano-a-mano against the world's acknowledged leaders in the field of Plastic Surgery. (When I took my Oral Exam in 1983 in New Orleans, I found myself in a hotel room at the Omni, sitting on the bed, facing a panel of examiners headed by Dr. Tom Krizek, arguably the terror of the Plastic Surgery Boards).

Only when one passes the Oral Boards can one truly call himself/herself a Diplomate or a US-certified Plastic Surgeon.

A certificate of residency training in Surgery (Years I and II at Kings County Hospital Center - State University of New York is not shown)

American Board of Surgery certificate granting the Title: Diplomate, American Board of Surgery

A certificate of residency training in Plastic Surgery

American Board of Plastic Surgery certificate, granting the title: Diplomate, American Board of Plastic Surgery

[Dr. Alfonso Y. Amores belongs to an exclusive group of US Plastic Surgeons who are "double boarded"]

On the next issue: FELLOWS AND FELLOWSHIPS

WHAT DOES "TRAINED IN THE USA" MEAN

2006-02-25T23:30:00.000-08:00

The gold standard by which one’s training in any specialty is measured by is the stamp “Trained in the USA”. This is the precise reason why in many promotional brochures and websites of individual clinics and medical tourism companies, the phrase “Trained in the USA” is invariably mentioned, pretty much with the same weight as the stamp of “ISO Certified” in non-medical establishments.

Many of these are outright misinformation and border on deceptive advertisement.

In the medical specialty and subspecialty fields, the training in the USA is a very long and arduous process under very strict regulation by national agencies. The umbrella agency is the American Board of Medical Specialties. Any Boards of medical specialty not included in the ABMS list is a bogus board (and there are many in the USA, created as corporations with an incorporation fee of $50).

Because of the very competitive nature of specialty training positions, and because of the drastic changes in the immigration and visa policies of the USA, acquiring the stamp “Trained in the USA” has been very scarce for Philippine professionals. And it has been so since the mid 70’s.

When one sees “Trained in the USA” stamped on any clinic and medical tourism professionals here in the Philippines, and for that matter in Thailand, India and other Asian countries, beware! Chances are it is deceitful and fraudulent.

How can one tell? Simple:
1. Ask the doctor who is going to do the treating where and when did he/she train.
2. Ask to see the certificate of training. If it is less than 5 years (for general surgery and some other specialties), and does not say “Chief Resident” somewhere in the certificate, it’s not valid. It also helps if the certificate is issued in the name of a university medical school. If the certificate is for a super specialty such as Plastic Surgery, the duration of training in the certificate should be stated no less than 2 years. (By the way, training in Plastic Surgery requires previous training in other specialties, most commonly General Surgery).
3. Ask to see the Board Certificate. It will say “American Board of _ _ _ _ _”. Taking and passing any American Specialty Board is a major endeavor and is not for the faint of heart. Some specialists from countries other than the USA elect to go home without taking the American Specialty Board. Nonetheless, these are true “Trained in the USA” just as long as #1 and #2 are satisfied.
4. The crowning glory of these all is the Fellowship Certificate such as “Fellow, American College of Surgeons” (FACS).

[On the next post: In Cosmetic Surgery, what does “USA Board Certified” mean; and what does “FACS” mean]

AN EMAIL FROM PHIL OF PRIMECARE-CEBU

2006-02-23T17:07:00.000-08:00

Hi doc,

I really had a good time reading your blogs... Since we are handling Lear Clinic - biggest company in MEZ, I usually forward your blogs to our nurses assigned there and they also send this thru e-mail to all employees as health and community updates. More than 4,000+ employees there gets a copy of your blogs. hehehe

More Power to you!

THE ISSUE OF COMPETENCE IN COSMETIC SURGERY - A COMMENT

2006-02-21T17:51:00.000-08:00

Great edition. I hope more people read this, including,perhaps more specifically gov't policy makers.

THE ISSUE OF COMPETENCE IN COSMETIC SURGERY

2006-02-19T19:55:00.000-08:00

The phenomenon of the worldwide boom in cosmetic surgery in general and cosmetic surgery in medical tourism in particular is fueled by the constant concern of people about their physical imperfections. Riding on this crest of popularity, individuals and institutions are constantly jockeying and positioning themselves to take advantage of the demands of the patient mass.

Oftentimes, one will find in the promotional materials (brochures, websites, etc.) of the cosmetic clinics and centers such catch phrase as: "Trained in the USA".

This brings into focus the issue of competence in cosmetic surgery. I frequently speak in hospital conferences and medical society conventions on the broad topic of Cosmetic Surgery. One that always generates plenty of to-and-fros is the issue of competence.

I break down this issue into: a) Cosmetic Surgery by Non-physicians, and b) Cosmetic Surgery by Non-surgeons.

Cosmetic surgery by non-physicians is outright illegal and falls under the category of serious physical assault. The Philippine Medical Act of 1959 is the law of the land concerning medical practice. The Act simply states that anytime one diagnoses and treats any illnesses, it constitutes medical practice. And, the only ones allowed to practice medicine are licensed physicians. To be licensed, one has to graduate from an accredited medical school and pass the Philippine Medical Board Examinations.

Diagnosis and treatment of warts, melasmas, eyebags, and of congenital deformities of the nose, breasts and buttocks constitute medical practice. Anytime the integrity of the skin is broken in the pursuit of corrections of blemishes and deformities, it is already medical practice.

And yet, how many shops do we see in malls and other business centers offering these practices - without a physician involved? We know of high-school level beauticians going around the country doing injections for nose, breast, buttocks, etc. These are clearly criminal acts, and therefore should be treated as such.

In the issue of Cosmetic Surgery by Non-surgeons: By definition, if one wants to do surgery he/she must be a surgeon. A lot of eyebrows are raised in professional and social circles regarding Doctor so and so offering and doing cosmetic surgery. Nothing illegal about this!

When one graduates from an accredited medical school, he/she earns the title "Physician-Surgeon". The Medical Act of 1959 does not distinguish special training in different specialties. There is no legal prohibition against a freshly licensed physician to open a clinic in any field of medicine, notwithstanding is/her training. For cosmetic surgery patients out there, it is "Buyers Beware". It is the patient's responsibility to check the particular physician's training and experience.

[On the next issue...What Does "Trained in the USA" Mean]

SERVICE FACILITIES AT COSMETIC SURGERY CENTER OF ASIA (CSCA)

2006-02-17T16:28:00.000-08:00

Cosmetic Surgery Center of Asia stands out among the cosmetic surgery facilities in the Philippines in that the servicing plastic surgeon (Dr. Alfonso Y. Amores) may be the only one in the country who is a Fellow of the American College of Surgeons.

Dr. Amores is Board Certified, American Board of Surgery, having trained extensively at the Kings County Hospital Center - State University of New York, Downstate in Brooklyn, New York and at the Charleston Area Medical Center - West Virginia University School of Health Sciences. He is Board Certified, American Board of Plastic Surgery, having trained at the University of Kansas Medical Center, Kansas City, Kansas.

He had an extensive practice in plastic surgery in Charleston, West Virginia and in Pittsburgh, Pennsylvania beginning in 1982.

Dr. Amores was formerly Clinical Associate Professor in Surgery (Plastic Surgery) at the University of West Virginia School of Health Sciences. He has steered quite a number of his students into the field of Plastic Surgery. Their practices are now scattered all over the USA.

While in the USA, Dr. Amores' Plastic Surgery Associates of West Virginia held the distinction of the being the only facility in the state certified by the American Association for the Accredition of Ambulatory Plastic Surgery Facilities (Quad A), the most strictly discriminating accreditation agency of its kind in the US. Central to the accredition are the qualification of the plastic surgeon and the equipment in the facility.

These two above are now the cornerstone of the Cosmetic Surgery Center of Asia. With the opening of his practice here in his native Philippines, Dr. Amores has brought home with him all the equipment from Plastic Surgery Associates of West Virginia...including the sink, so to speak.

More importantly, Dr. Amores has brought the concept of confidentiality to his practice here in Cebu, having designed his consultation set-up and operating room facility with precisely that in mind.

Almost all cosmetic surgery procedures are done at CSCA. Only tummy tuck, which requires general anesthesia, is done in a hospital setting.

SERVICE FACILITIES IN COSMETIC SURGERY

2005-11-28T12:20:00.000-08:00

If there is an institution with more complicated operational systems than most third-world government agencies, it is the hospital. The bureaucracy is so circuitous that it makes asking for an aspirin a true adventure. Those who have had the experience of having surgery in a hospital can attest to this.

The cosmetic surgery patient is a truly discriminating client who puts hassle-free routine, convenience and confidentiality at a premium. Therefore, cosmetic surgery is best done in an outpatient facility. A well-equipped, well-run outpatient surgical facility is the safest and most convenient place on earth for the typical cosmetic surgery patient.

The most common procedures in Dr. Amores' experience in cosmetic surgery practice in Metro Cebu starting in 2000 (in the order of frequency) are:

Surgery of the eyelids (removal of eye bags, creation of double folds)
Botox injection
Nose lift (silicone implants and/or "nose trimming")
Liposuction
Tummy tuck
Facelift/facial suspension

Of these, only tummy tuck is done in the hospital owing to the need for inpatient care following surgery, and the need for general anesthesia. Everything else is done at the outpatient surgical facilities of Cosmetic Surgery Center of Asia (CSCA) and now, PrimeCare-Cebu. Eyelid surgery, nose lift, liposuction and facelift are all done under local anesthesia with sedation at CSCA. At PrimeCare, there is an option for general anesthesia.

Just how safe is outpatient surgery? Enter Quad A. This is short for American Association for the Accreditation of Ambulatory Plastic Surgery Facilities (AAAAPSF). It is by far the strictest accreditation agency of its kind in the US. In the whole state of West Virginia (like for us here in the Philippines, the whole country), Dr. Amores' outpatient surgery facilities at Plastic Surgery Associates of West Virginia, owned and operated by Dr. Amores himself, was the only Quad A accredited facility. Central to this are the plastic surgeon's credentials and the facility equipment. Both were transported to, and are now in place at CSCA.

The surgical facilities at Cosmetic Surgery Center of Asia and at PrimeCare-Cebu are put together with the safety and convenience of the cosmetic surgery patient foremost in mind. International quality standards are guaranteed.

to be continued...

TRAVEL, HOTEL AND OTHER ISSUES

2005-11-25T13:30:00.000-08:00

The balikbayans are pretty much attuned to the travel nuances. Getting in and out of the Philippines is a cinch. However, the non-Filipinos will find a few practices shocking. The Department of Tourism and/or Department of Health will need to decide as to how deep their involvement should be in the actual day-to-day, trip-to-trip management of the client/patient. This has to be truly user-friendly for the foreigners, they are stressed enough as it is, thinking about going into surgery or some serious check-up. If not, DOT and/or DOH can give seminars to the travel agencies, port of entries, Philippine embassies in the various capitals all over the world, and make specialist people in "Medical Tourism".

Regarding hotels, most of my foreigner patients complain about the service. Just the same, the hotel personnel need to be brought up to speed as far as international patients are concerned. We're not talking about 5-star hotels here. We're talking about the Php 2,500 - 3,000 range (Remember: these people are bargain seekers). Sure there will be some looking for something like Shangri-la. Even the better.

One particular service that I have arranged with one hotel here in Lapu-Lapu is a door-to-door pick-up during surgery day. After recovery, the hotel van will drive up to my Recovery Room door. The RR door literally opens straight into the opened van door, keeping the patient's (sometimes heavily bandaged in the head) privacy assured. The van then proceeds to the hotel's basement service elevator, without the patient ever passing through the hotel lobby.

Cosmetic surgery is a pre-pay surgery. About the only thing we can do for the true "medical tourist" is bank-to-bank transfer. A lot leaves to be desired regarding this type of fund transfer. One thing, the transfer gets charged coming and going. This can get really expensive for the true bargain seeker. Maybe the authorities can look into this. (Hint: talk to Thailand; talk to Pakistan).

to be continued...

INTRODUCTION PART II - STARTING ON THE WRONG FOOT

2005-11-22T22:04:00.000-08:00

The other day, I watched very painfully on TV a Usec of the Department of Health very excitedly talking about medical tourism. So, this is where the ball field is! The poor fellow was talking about:

Publishing the records of the doctors. What!? You don't publish the records of lawyers, engineers, architects, teachers, nurses, merchant marines, accountants, etc. Do you?
Going to the hospitals and clinic in Manila to talk them into joining the program. Hello! It's going on here in Cebu as you are talking about planning there.
Accrediting doctors for international standards. You are going to accredit me? Who the heck are you? Do you know what international standards are? Ask me and I will tell you.
Bringing the earning of doctors and nurses up to US standards so they do not leave the country anymore. Wrong! The whole point is giving the service for a fraction of the fee in the US. Meaning you earn a fraction of what US doctors and nurses earn.
Thailand is not a player anymore in medical tourism because Phuket was wiped out by the tsunami. And, our coral environment is more biodiverse. Wrong! And wrong! Thailand is the biggest player in medical tourism. And, our reefs, being 90% damaged (by us) is a fraction of the biodiversity in the Phuket area despite the tsunami.

...abangan

INTRODUCTION

2005-11-14T20:55:00.000-08:00

Medical Tourism is a new phenomenon, a boon to the developing economies of the third world countries. The major players are Thailand and India.

The biggest health care system in medical tourism is Bumrungrand International (BI), operating all over Thailand and other Asian countries. In Thailand alone, BI brought in more than 350,000 "medical tourists" last year. Services provided range from Executive Check-ups to Dentistry to Facelifts to Total Hip Replacements to Cardiac Cath/Angioplasty/Bypass, and almost anything else any world-class medical facility can provide.

Can you imagine how far the dollars of 350,000 tourists can go in contributing to the Philippine economy? And, this is just one hospital!

In medical tourism, if Thailand is at college level, the Philippines is barely at kindergarten. Consider these:

The language medium in medical tourism is English. If the Philippines' English proficiency is at college level, Thailand's is barely kindergarten.
Filipinos are brought up in westernized society, a perfect fit for clients coming from the capitals of the West.
We are blessed with the vaunted hospitality ("service with a smile").
Whereas we are at the crossroads in world travel, Thailand is fairly "out of the way".
The Filipino medical professionals are very well known in the West for their quality of service.

Something is truly amiss here. One thing for sure, the medical tourism in Thailand is heavily supported and promoted by the Thai government (see Tourism Authority of Thailand). Contrast that to the Philippines (see Lapu-Lapu Times).

Unbeknownst to the Philippine tourism authorities, Cosmetic Surgery Center of Asia has been doing medical tourism since it opened in 2000. Over 90% of patients are balikbayans and their friends from the USA, Japan and Europe. The one working formula is:

$surgery at home (US,etc)>>>Phpsurgery at CSCA + plane ticket + pasalubongs

In short, surgery by FACS (Fellow, American College of Surgeons) at relatively cheap Philippine peso price.

In my subsequent posts over the next few weeks, I will touch on:

Travel and hotel issues
Quality of the service facilities (hospitals and out-patient facilities)
Nursing care
The medical professionals (physicians and dentists)

...abangan