Antonio posts pictures with a celebrated American physician on his Facebook. Adelia sells leather bags to sustain her two-year-old baby in Panama. José fights the prejudices of elitist surgeons in Bogotá. They all have one thing in common: they’re Venezuelan, recently graduated doctors, who left the country as opportunities (and the health system) withered away.

They’re not unique; migration is an obsession in Venezuela, with doctors and med students on top of the list. Their objectives are pretty straightforward: enroll in med school, graduate and right after that, leave the country.

Just from our circle of friends in Mérida, we know more than 20 doctors who left the country for good, most of them graduated in April. Some can’t even wait: Activities at ULA’s Medical School resumed last week after a four-month break, but many students didn’t come back.

Contrary to popular belief, becoming a doctor is not that hard: you have to read a lot and see bodily fluids on a daily basis, but once you get used to it, all you need is a couple of functioning neurons, some dedication, and patience. Now, working and actually saving people is entirely different. You need knowledge and experience, theory and practice, a balance quite hard to obtain.

That’s why doctors have it particularly hard when leaving.

If you’re a health officer planning to let some unknown guy from another country take care of your people’s health, you better make sure he knows what he’s doing. The process to validate medical diplomas from Venezuela abroad is usually a long, tiring and sometimes very expensive one.

Now, if you don’t have the time, will or money to embark on such an adventure, you can always forget about medicine.

Antonio can tell. He’s the definition of success for many Venezuelan doctors, currently taking the United States Medical Licensing Examination (USMLE) three-step test, through which everyone intending to work as a physician in the United States must get through one of the toughest (and most expensive) revalidation processes in the world. He graduated with honors in 2015, left Venezuela one year ago and has already taken two of the three exams, outperforming most candidates in both. This allowed him to start an internship in the prestigious Massachusetts General Hospital in Boston, where one day, he hopes to become an oncologist.

“Many things influenced my choice to leave. The lack of supplies to work properly, the terrible state in which Venezuelan hospitals are and, especially, what I saw as a lack of professionalism in most hospitals. People in charge of the health system simply don’t give a shit if there’s not something as basic as an intravenous rehydration solution. I felt people weren’t interested in improving things. And most of the time, when you tried, they would criticize you.”

His family has made huge sacrifices to finance his revalidation, but since this was always the plan, they were prepared. For him, the biggest problem is not money, but solitude.

“Loneliness is a terrible thing. You yearn and yearn. Sometimes it feels like dying and being reborn with memories of a past life. Some people never get over that, it takes a lot of discipline.”

José was also able to validate his title, not in the US, but in Colombia. He graduated as a General Surgeon in 2015 and moved a year ago only to find out that not even specialists have it easy when practicing in another country. He’s currently operating in Bogotá, but even after getting the paperwork done, he feels the burden of being a foreigner in the orthodox Colombian medical world.

“It took me five months to validate my title as a general medical officer, and eight more to do so as a Surgeon. The process is tiresome, but I was lucky: I have a Colombian passport.”

José tells us he knows several doctors with credentials like his who overcame increasingly difficult obstacles, only to be rejected in the end. In his view, discrimination against foreigners is to blame.

“One of the officers in charge of my process told me the only reason they were accepting my papers was because I was a Colombian citizen. I’ve felt underestimated, but our formation back home is very similar to what doctors get here. That allowed me to prove myself.”

The contrast he found between Venezuela and Colombia was also shocking, and highlights the disaster we’ve been living during these years.

“The only similar thing is that we both speak Spanish. In Colombia, you have state of the art technology to diagnose and treat patients, everything is protocolized and heavily supervised. The Colombian health system is extremely well organized.”

José finds it a bit unnerving: just 20 minutes with each patient, the less you speak, the better. Yet, at the end of the day, he feels that, for the first time ever, he’s getting paid what he deserves, and admits Colombia has given him an opportunity to grow both personally and professionally, in a way he would’ve never found in Venezuela.

Now, if you don’t have the time, will or money to embark on such an adventure, you can always forget about medicine.

This happened to Adelia, a 24-year-old physician from Apure. She finished her med school classes last October and, less than a month later, she was in Panama. Adelia’s husband left six months earlier, hoping to find a job to help her sustain their two-year-old kid. For her, money was definitely the issue.

“It was a tragedy every time my baby got sick. Finding antibiotics was a monumental task, and when I found them, I couldn’t afford them. The only reason I bought food was because my husband sent me money.”

Adelia found a job a few weeks after leaving, but not as a doctor. Working as a foreign physician in Panama is practically impossible; due to the country’s extremely closed migratory policies for healthcare workers, job opportunities are limited to highly specialized physicians who are only allowed to work in the interior. Jobs in the capital are limited to Panamanians.

“It took me a month to find a job managing the distribution of products for a local store. I can’t complain, but this is not my thing. I tried to find a job in my field, but it’s impossible. I talked to several physicians and they all told me I needed to become a Panamanian national: I could have a Panamanian-born kid and then wait five years to get my papers done, or if I was in a hurry, I could marry a Panamanian man. I can’t have another kid right now, and I don’t think my husband approves the second option.”

So Adelia adapted.

“I don’t want to stay here forever, I’d like to move to Canada. But right now, I’m intending to get a Masters degree in Health Services Administration. It’s the closest I can get to being a doctor in Panama.”

There are other options too. Some lucky and really talented people decided to skip the validation process, sacrifice clinical practice and start an entirely new career, currently developing research that no one financed in Venezuela, at top-level institutions around the world. Such is the case of Dr. Lisbeth Berrueta, one of our former immunology professors at ULA’s medical school, whose research at Harvard was recently acknowledged.

According to estimates, up to 15,000 doctors have left the country in the last decade, and training each one of them could have cost the Venezuelan State up to $60,000. The government chose to create a parallel, academically-flawed and ideologically-committed career, rather than planting the seeds; so recently graduated doctors aren’t forced to exploit their talent abroad.

With no prospective changes on the horizon, doctors will keep fleeing… And people here will keep dying.

35 COMMENTS

  1. Given the current exodus of physicians from Venezuela, it might be appropriate to review what our friends at Counterpunch once told us about The Achievements of Hugo Chavez (2012)
    *In 1998, there were 18 doctors per 10,000 inhabitants, currently there are 58, and the public health system has about 95,000 physicians;

    Fifty eight doctors per 10,000 inhabitants would translate roughly into 174,000 physicians, with a population of 30 million.

    From 2015:Around 13,000 doctors have left Venezuela since 2003, and the vacancies have gone unfilled, said Dr. Douglas León Natera, president of the Venezuelan Medical Federation, in an interview with a local radio station last week. It’s a sizable chunk of the medical community: The federation’s most recent census estimated there were about 70,000 Venezuelan physicians in the country in 2007, 25,000 of whom have died or retired since then, León Natera said.

    Conclusion: 174,000 physicians in Venezuela is one more in a long line of lefty lies from Counterpunch.

    http://www.ibtimes.com/venezuelas-medical-exodus-result-its-contracting-economy-spurs-fears-national-health-1885490.

  2. My physician Venezuelan expat wife read the first few paragraphs. She got to the part that read,

    “…becoming a doctor is not that hard: you have to read a lot and see bodily fluids on a daily basis, but once you get used to it, all you need is a couple of functioning neurons…dedication… patience”

    and she said to me, “This is why I don’t engage anyone on that (CC) blog. I don’t think I would have anything nice to say” Whereupon, she got up and walked off.

    So, people who aren’t physicians think that any moron with a strong stomach, patience and dedication can get into, then through medical school, then into practice… or just this just pertain to Venezuelan medical schools and medical practice?

    I think the problems concerning Venezuela is MUCH deeper than anyone suspects, if that is the actual worldview of the Venezuelan masses. Does it really come down to class envy?

    My wife never went to a Venezuelan college/university. Her parents (butcher father/homemaker mother) and uncles scraped together all they had to send her to school here. She graduated Magna Cum Laude from a small Liberal Arts college in the US, and got accepted into a first tier medical school in the US. We married during her second year of med school, after dating her through college. And I can sure as shit assure you that it takes more than a few neurons to get into medical school, residencies and fellowships. Hours in labs, lectures, the library and long nights with the books… thousands of hours away from a life that others had already started living by the age of 17, she had to put off for 12+ years. We didn’t go on our first vacation together until we were both nearly 30. We didn’t have kids until she was 31.

    My Spanish isn’t that good (and my hearing not that acute) that I can easily understand the vulgarities she said under her breath. But I can assure you the vocabulary was quite salty, and can be best translated as, “Venezuela gets what it deserves. F*ck them.”

    • Hi ElGuapo, I’m one of the authors of the piece, currently on the last year of med school and I wrote that particular paragraph. What I mean is that people think you must be some sort of genius or prodigy to graduate in med school. That’s not true. Excellent people graduate, regular people graduate and some terrible people also do it, just like it happens with any other career in any part of the world. Now, as I point out in the next paragraph, being a good doctor is what actually is terribly hard. You can graduate, even with honors, but only after starting to work, you’ll know how good or bad you really are, and it dependes solely to yourself and the effort you want to put. I’m sorry to make your wife angry and I hope she can read the whole piece eventually.

      • You’re out of your fucking mind.

        Obtaining a medical degree in civilized societies (not VZ for the past two decades) should and DOES require an extraordinary combination of hard work and INTELLIGENCE. You can’t learn that material without the INTELLIGENCE, which shortens the needed effort in the hard work involved. I mean, you claim medical expertise, and just don’t understand this simple human fact?

        Smarter people learn faster, and only smarter people can learn their trade in the accepted timeframes for certification..

        JESUS!!!!!!!!!!!

        You’re advocating a Cuban style medical system in the U.S.! Thankfully, the U.S. Is saying NO thanks. However, their ARE good things to say about Cuba’s medical expertise:

        I killed Chavez, and who can complain about that?

        This is seriously the most ignorant artcke on CC that I’ve ever read.

        “WAHHH!!! Give me a job! Chavez and Maduro say I’m a doctor! Why don’t you believe them!?”

        Move to Africa. They would love you there.

      • JuanCarlos

        Congratulations on your career. It isn’t an easy path to take. I can’t tell you the number of times my wife was ready to throw in the towel during medical school. Her biggest concern was, “I cannot see a future where I am studying like this every single day for the rest of my life”… because that is what others had told her a physicians life would be like. IT DOES GET BETTER!

        I guess we misunderstood that the author wasn’t a medically trained person, who knew medicine. You are correct, that there are very good (and very bad) physicians. (Q. “What do you call the person who graduated last in their class, from the worst medical school in the nation?” A. “Doctor”.) You’re like any profession.

        In regards to the rest of your piece, it is a common complaint when people leave home to practice their profession elsewhere. Physicians are a tough bunch, and every country has its rules. We are friends with many, many physicians from all over the world. Some absolutely brilliant and world renowned. Most went to medical school in their own country, then came to the United States. From my understanding, there are tremendous hurdles facing every single one of them. An MBBS doesn’t translate to MD (or DO), so further education and test outs are the norm.

        We are friends with a former Venezuelan physician who is now working as a CSA (surgical assistant) here in the US. Oswaldo laments that he cannot work as a physician in the United States, as it was always his dream to be a physician. But it was more important for him to support his family than to self actualize. He hated working “for Venezuela”… he was obligated to sacrifice for Chavismo. So he left. Could he get licensed in the United States? Probably, but the sacrifice in time and money aren’t worth it for him. In addition, he makes more money as a CSA in the United States than he ever did working in Venezuela. (for better or worse, I suppose, depending upon your perspective)

        These Cuban physicians? WHAT A JOKE. They aren’t qualified to give CPR to dead rats. At best, they are medical system “gatekeepers” who see the sick and injured first, give care within the limits of their ability, and send on those needing medical treatment to those trained and skilled. That doesn’t necessarily mean physicians… my wife is MIGHTILY impressed with mid level practitioners (Nurse Practitioners, Nurse Anesthetists, etc) in the United States.

        *FWIW, my wife is a board certified Anesthesiologist, who now is doing R&D for a large medical device manufacturer. We still go on yearly mission trips (ie Operation Smile) to underdeveloped countries. We adopted an abandoned Guatemalan girl 20 years ago (cleft palate) who is now in her first year of medical school!

        • Thank you, ElGuapo.

          I appreciate that you took the time to read the rest of the piece. Oswaldo’s case is not the only one, I know at least a couple Venezuelan MDs doing the same. I personally think revalidation processes are important and necessary, no matter the country where doctors come from. It’s the only way to objectively assure the people that a professional is qualified enough to help them. It’s sad to be doing something you don’t like in another country, but it’s even sadder to see that you trained to work in a country where medicine is 50 years in the past.

    • A good bit of entitlement and snobism is always due when talking about medicine, is not like there is a stereotype concerning doctors or anything. The only career that requires that sort of commitment apparently.

    • Jesus fucking Christ. Can you believe the bullshit we’re reading here? And the balls of CC for publishing it!?

      God bless your wife. Give her a kiss for me.

      These shmucks are actually advocating that a VZ medical degree is comparable to that in the U.S., and “Poor me! My VZ credentials aren’t accepted in the U.S.!”

      I can’t believe this. CC has sunk to a new low.

      • Great!!!more nonsense from CC house troll Ira.Why don’t you just stop fucking posting if you hate CC so much?All you do is fucking troll on every post and have absolutely nothing of fucking substance to say EVER.Go to the You Tube comment section and name call there like the juvenile prick that you are.We get it Ira.Trump is the greatest and Venezuelans are worthless.Thanks for letting us know.

      • Some people hide what they really think, and try to slyly insinuate their thoughts via some candy-coated time-bomb that goes off on the unsuspecting. However, as I have noted previously, one great virtue in you, Ira, is that there is rarely, if ever, any shadow of a doubt as what you really think!

  3. As they say what comes around goes around. My immigrant mother, an experienced physician with work experience in both the U.K. and US as well as published papers was never allowed to practice in Venezuela. The Venezuelan certification for immigrants requirements included, among other things,that she spend two years practicing in a remote village. With a professional husband who couldn’t relocate to such a place and no one to care for her children this was just impossible. She never went into medicine for the money, only to help people. And Venezuela to this day won’t allow her to work even for free, even under current conditions.

    • The rural service is required to every physician, national or not. It’s in the eight article of The Law of Medical Practice. I’m absolutely sure your mother is an incredible doctor and have no doubt of her willingness to help others. But that’s part of the legal framework of the country. Every country in the world has its own revalidation process, some more tiring than others.

      • How do you define rural?

        And how does that stupid law preventing an obviously qualified doctor from treating people actually HELP people? And does he/she have to work for free?

        When was the last time YOU worked for free?

        And while we’re on the subject, are you saying the law should dictate where the doctor wants to live, and offer treatment? In other words, the medical professional has no say of his/her own, and the STATE is going to dictate where he/her and that family live?

        Or do doctors not have families, plans, dreams and aspirations of their own? Or are doctors just slaves of the state, like in Cuba?

        No fucking way.

        Take your Eighth Article and….

        Take a guess what you can do with it.

    • Karma,

      A loooooong time ago, my dad graduated from the Sorbonne Medical School and immediately after graduating went to Venezuela, where his family had recently migrated to because of political issues in their home country. When he got to Venezuela, he could not do a revalida as it required him to become a Venezuelan citizen, which he did not want to do. He could, however, work as a “medico rural” and he ended up working in rural towns, with me, my mother and brother in tow, for what was then called SAS (Ministerio de Salud y Asistencia Social) in medicaturas rurales. Every few years he would be rotated in and out of places with exotic names like Soledad, Burbusay, Baragua, and Valera. My dad had some really good things to say about the administrators at SAS and the locally trained physicians – in fact, one of them delivered me. So, the restrictions that you speak of in your post were in effect in the early 1960s.

      What I do not understand is given the aforementioned restrictions, how it is that Cuban physicians are able to legally work in Venezuela. Does any one know if they are required to have accreditation from the local Colegio de Medicos?

      • The Cuban Medical Service in Venezuela is one of the biggest scams this country has faced. The state invested over 100 million dollars bringing doctors who were not needed. Cuban doctors didn’t revalidate their diplomas, but were usually limited to first level attention in rural towns and outpatient clinics. Anyways, they made absolutely no difference, and didn’t solve any of the problems why they were brought to Venezuela in the first place. Today they are also leaving Venezuela as fast as they can.

      • Encp,

        Your dad was fortunate to have a wife who could relocate to Rural places. the only way we could have done what your family did is if my dad abandoned his career to become a househusband.
        In general revalida laws penalize women more than men because they are expected to follow the husband not the other way around. My mom did not choose to emigrate to Venezuela, it was my dad who did and she was forced to give up her career to save her marriage and family as typically expected of women.
        I really wish colegios de medicos worldwide would reduce their artificial Barriers for foreign trained doctors. Human bodies and their maladies are the same everywhere.
        I find it hypocritical for any country to complain about healthcare shortages while forcing foreign trained professionals who legitimately lack the resources to go through revalida procedures to sit home, and in my experience this also disprortionstely penalizes women.

        Btw Ira Venezuela-educated doctors are as well trained as any in the first world. I have taught many medical students in the USA and don’t find them particularly exceptional as compared to those in other careers.

  4. I tried my hand at medical school and after one semester switched to engineering. Hats off to those that make it all the way through.

    But the fact is, not every country has the same standards for medical training. The US and British are by far the most strict. I’m sure everyone can name a “doctor mill” in some 3rd world country. But moving from one area of the world to another is like the author said.

    One region has very loose standards while another is much more strict and has higher standards. This is to be expected.

    The same holds true for chemical and industrial engineering. Construction, more so.

    My roommate in college was construction management engineer and did a summer in Africa as a volunteer.

    “Chicken wire is not the same as rebar.” He would profess. Yet hundreds of homes and buildings were routinely built with one and not the other.

  5. By the way, the to follow on what Mitchell’s comment, I have many friends and associates who are engineers (of all kinds) who left Venezuela, whether willing or by force (Mostly after 2002 PVDSA riots). They relocated all over the world. That is a part Venezuela problems – the brain drain.

    All that is left now is: the true believers, those that don’t know how to escape and criminals / Drug Lords (including the politicians / military)

    • My wifes family got the picture of what was going on in Venezuela during the PVDSA strike (2002-2003) when Chavez fired the employees and replaced them with Chavista jobsworths. Shortly thereafter, Chavez decided to “nationalize” (confiscated at the end of a gun) her two uncles concrete/cement business, when they wouldn’t sell products (at a loss) to Chavez.

      Of course, they were promised to be compensated, but not a single worthless Bolivar was ever seen. The Chavistas soon discovered the rules of economics… and the business was defunct within 3 months. (Chavistas don’t like to pay their suppliers, nor skilled employees) The site has sat rotting now for nearly 15 years. Naturalmente, Chavez blamed the uncles for “economic sabotage” and threatened them with prison if they didn’t return to the business and fix things. Instead, they fled to the US.

      My wife is pissed off at Venezuela. Not so much the people, but the ignorance of the people. It is as if they have been brainwashed into thinking that Chavista benevolence replaced a work ethic, sacrifice and vision. The ones who can still think clearly see the writing on the wall and are fleeing if they can. What is being left behind is a country that is rotting from the top down. (From the Dutch Disease?) She doesn’t consider herself a Venezuelan any longer, anymore than her parents considered themselves Spanish after her grandparents fled Franco.

      Most of my wifes family is in the US now. Some remain behind, but they are distant relatives who aren’t that close. Some are hard core Chavistas who literally hate my wife and uncles for being selfish and greedy Capitalist opportunists who sucked away all the good things Venezuela “gave them” (!!!) and offer nothing in return. “Good! LEAVE! Venezuela is better without you!” is what they like to say on social media (but never naming anyone by name, lest they want to flee in the future… never burn bridges!)

      ——

      An aside: My in-laws have mentioned this many times over the years, and I have always thought it was just an angry political stereotype: “If you are Colombian and want your daughter to win a beauty contest or son to be in the military, you send them to Venezuela. If you are a Venezuelan and want your daughter to be a doctor or your son to be an engineer, you send them to Columbia.”

      Is there any sort of truth to this sort of thought process?

  6. Thanks for the article. I’m happy to see more coverage of health issues in Venezuela.

    I agree it takes a certain type of individual to become a physician, but as a physician myself… I can tell you I wholeheartedly agree with the statement that many people can become physicians with hard work, passion and dedication… the competitiveness (demand/supply) makes it such, that only the best and brightest are accepted. They are not the only ones capable capable of doing it I can assure you.

    I applied to medical school just to get my dad of my back… as it turns out, I got accepted started, finished, migrated, and have no regrets. I’m not a genius, and I was not passionate about it either. I migrated, worked as a physician in a highly specialized field and actually chose to move into something else and don’t practice anymore.

    The barriers for physicians are high because the supply is limited, both of human and material resources allocated to health… anywhere in the world. I never understood why the government systematically pushed us out in droves, but it did and will continue to do so. Not everyone is cut out to be physician, but many people can be good physicians without having to fall within the stigmatized stereotype of being a genius and having to sacrifice themselves to whatever extent people believe we sacrifice.

  7. Please stop posting stuff about doctors leaving Venezuela, otherwise Maduro could vex himself reading this and not giving us ” soon to be doctors ” our degree to gtfo of this shit hole. Ty in advance

  8. Apreciado Interno. Osler, in his grave, surely must be disappointed if a future MD writes something like “becoming a doctor is not that hard”. Suggestion by someone much older, but -probably- not wiser, don’t go into deep medical philosophy and the very complex and unique intricacies of the art-science that is medicine, at least until you’ve gained a couple of miles (Millaje mijo) and more experience. Best regards and at your service if you need medical philosophy bibliography to improve the many inaccuracies in your article. E.B.

Leave a Reply to Luis Pereira Cancel reply