Staff the system

It’s 2:07 a.m. in a provincial ward. One nurse watches 20 patients. A monitor keeps dying. “Doc, puwede bang pakitingnan si Nanay (Doc., can you look at my mother)?”

Buildings don’t heal — people do.

The shift we live with

We don’t have enough hands for the work. In some wards it’s 1:20. That isn’t care; that’s a countdown. You can feel it in the room. When we lose one more nurse to burnout or one more young doctor to the plane out, the night gets even longer for everyone left behind.

So here’s the compact we owe the country: build the pipeline, make the first job worth taking, and make staying rational.

Train for where the patients are

Who we admit -– and how we train – decides who gets care later. Students from underserved areas are far more likely to serve there. Let’s select more from the communities that need doctors the most and put more training where those communities actually live. Rural and community rotations shouldn’t be a token month; they should be stitched through the curriculum - so fixing problems with limited tools becomes muscle memory, not a shock.

The Medical Scholarship and Return Service law has the right heart. Make it work without the friction: funded slots, on-time stipends, decent housing when trainees rotate outside the city, and priority placements in underserved local government units (LGUs) after graduation. Track retention for two years beyond the service term – not to punish, but to learn what helps people stay. Align the scholarship pipeline with deployment posts and permanent plantilla positions so graduates move from student → service → stable job without falling through bureaucratic cracks.

Recruit like we mean it

The first contract sets the tone. Spell out workload, supervision, and growth. Pay must be competitive – benchmarked to our Association of Southeast Asian Nations (ASEAN) neighbors, aligned to workload and specialization, with rural hardship and housing allowances built in. If a young clinician can imagine a five-year future in a public hospital - with real mentorship and a visible path to subspecialty, educator, or leadership tracks - recruitment stops feeling like a favor – and starts feeling like a future. Let the offer show a five-year arc - mentorship year one, formal training year two, senior responsibilities by year three, promotion windows by years four and five. If people can see the path, they’ll walk it.

Speed matters. Announce anticipated vacancies. Keep standing pools. When funds arrive, appoint within weeks, not quarters. Administrative delay says, “You don’t matter.”

Retain by making work possible

People stay when the work is doable and the growth is visible. Enforce safe staffing where standards already exist; our problem isn’t the absence of rules, it’s compliance. Post facility-level dashboards so communities can see if ratios are being met, how many hires are pending, and by when. Tie a slice of PhilHealth reimbursements and budget support to adherence the same way we do for infection control - because safe staffing saves lives.

Careers need ladders you can climb. Create clinician-educator and clinician-manager tracks with time-bound promotion windows and protected time for teaching, quality improvement, or research. Continuing education shouldn’t require personal financial loss; release time and scholarships cost less than turnover.

Support is not “soft.” It’s oxygen. Give people reliable supplies, equipment that works, IT that doesn’t crash mid-shift, and leadership that backs clinicians who follow policy. When systems fail, people take the hit. When systems work, people give their best. A broken suction or dead battery can undo a heroic shift in thirty seconds.

Make provinces livable – not merely possible

Families don’t move on a memo; they move for a life. If we want doctors and nurses to choose regional posts and stay, place has to feel like home. Think Iloilo, think Cebu - hubs in motion. Set city-level targets. Measure them. Post them: specialist density, school quality, broadband uptime, transport safety. Build parks and libraries, keep the lights and water steady, and make sure there’s decent work for a spouse. Clinicians choose lives, not just jobs.

Compassion that’s financed, not crowdsourced

We love to call for “compassion” at discharge. But compassion isn’t a business model; it’s a virtue. Fund it properly. When No Balance Billing applies, make it real – zero balance, professional fees included, clearly marked on the statement. When it doesn’t, use means-tested professional-fee scales in government hospitals supported by PhilHealth case rates and LGU funds. Doctors should not be coerced into unpaid labor after a 12-hour case; patients should not face surprise charges.

Klaro bago alaga. (Care should be clear)

Fear fades when expectations are clear.

Accountability that protects patients and respects professionals

Make the promises public – then keep them. For the pipeline, show the numbers - how many scholars admitted, deployed, and still serving two years later - so people see tax money turning into people at the bedside. For staffing, show quarterly compliance by facility and what’s being done where standards are missed. For hiring, show time-to-fill and vacancy duration by province. None of this needs a new miracle or a new law; it needs will, follow-through, and sunlight.

The test we should all want to pass

We’ll know we’re getting it right when a student from a far-flung town is admitted on scholarship, trained in communities like their own, deployed without delay, mentored into a role that fits, promoted on merit, and raising a family in a province that feels like home. That’s not sentimentality. That’s policy doing exactly what it promised.

Staff the system on purpose.

Protect patients. Respect physicians.

Everything else starts working.