Eric J. Ulloa, MD, FACP, MMM, Governor, ACP Central America Chapter
Health Quality and Patient Security Coordinator of the Social Security Health Services Provision Department, Panama
— MEDICAL SCHOOL —
University of Panama, Faculty of Medicine, Panama City, Panama
— RESIDENCY —
Social Security Metropolitan Medical Complex, Panama City, Panama
What is your job title?
I became Health Quality and Patient Security Coordinator of the Social Security Health Services Provision Department in July. Previously I was Vice-Minister of Health of Panama from July 2016 to June 2019. I was Director for the Provision of Health Services of the Ministry of Health from 1999 to 2004. At that time I took a Master of Medical Management at Tulane University, School of Tropical Medicine and Hygiene, and I had the opportunity to visit all the health regions in Panama, including remote areas, with indigenous populations and scarce health centers. I saw the importance of the community and health determinants in the health of each person. It is not just personal lifestyles that influences the health of a person, but also the environment, education, and poverty. But even in these public health positions, I continued seeing ambulatory internal medicine patients at my clinic at San Fernando Hospital.
When did you decide you wanted to become a physician?
I attended a primary and secondary Jesuit school here in Panama. In your penultimate year, there's a social campaign where you spend six weeks in a poor, rural community, living and working (digging wells, latrines, and other activities) with that population. It exposed me to the suffering of these communities. I liked biology and sciences, and I think this experience helped me decide to become a physician to try to help other people and alleviate their suffering.
What inspired you to choose internal medicine as a career?
I learned to see people as a whole, and internal medicine, with its holistic approach, satisfied this interest. You try to diagnose and solve some problems that other physicians do not see because they don't follow this approach.
Was there one particular mentor who stands out?
My clinical diagnosis professor, Dr. Anibal Tejada, was an internist and a neurologist and really showed me the science and art of medicine, and the patient approach that helped me to thrive. I had the opportunity to serve at Gorgas Army Hospital, a U.S. military hospital in Panama, where I became Chief of Emergency Medical Services, which introduced me to administrative tasks, and that helped me later in the public health area.
What is the role of the internist in Panama (e.g. primary care, specialist, consultant)? What are the education and training requirements needed to practice internal medicine?
To practice medicine, you study six years and then you go to two years of internship, one at a teaching hospital, and the second at a rural community facility, so you can also practice primary care. Then if you want to take a residency you have to take the national medical exam, which is the same test given to medical students in the United States. If you choose internal medicine, you study three years, usually in a teaching hospital with some rotations in the ambulatory care area. This year, a four-year program was approved for doctors who want to become hospitalists. If you like primary care, you can practice in health centers, which usually act as coordinators of care in that region. Many internists here go into subspecialties.
In our largest community hospital, internists see all patients and the subspecialists act as consultants. You can also practice private medicine, and private practitioners are really appreciated because people are learning that it is better to go to an internist who can act as an advocate for the patients and direct the medical care that is needed.
Does everyone in Panama have access to health care? Who pays for health care services—patients, employers, or the government?
Panama is one of the growing economies in Latin America. Our health system is fractionated. Workers and their dependents are obligated to pay Social Security (most is paid by the employer) which also provides health services. About 70 percent of the population has access to this system, but Social Security has more big hospitals and fewer health centers in the country. Many of the beneficiaries of this group are seen by the Ministry of Health System, which has more health installations across the country, and actually sees about 55 percent of the population. It sees not only the informal workers, or unemployed patients, but also some Social Security and even migrants or foreigners.
About 15 percent of the population goes to the private sector, and Panama has a good standard compared to U.S. hospitals in major cities. But the indigenous population that live in three main reservations, which are remote and difficult to access, do not have readily available health services. We have some problems with maternal and child morbidity and mortality there. We have contracted special groups to visit these remote areas at least every six weeks, but still it is not enough. You also have to work and try to make them understand importance of vaccination, nutrition, and other areas.
What are some of the most significant challenges that physicians in Panama face? What are your thoughts on the best way to meet those challenges?
One of the challenges that we have is improving the quality of health care and making it more accessible to the general population. Panama has some of the more expensive medicine and supply costs in the area, and sometimes certain medicines and supplies are not readily available. The overwork and lack of some medicines sometimes make our work more complicated, and some colleagues are suffering burnout. The government is working on legislation to make medicines more affordable.
How did you get involved with ACP?
I initially started with the Panamanian Society of Internal Medicine where I served as president, vice-president and treasurer, and with the help of former governors, I became involved in ACP.
What do you value most about being an ACP member?
Well, it used to be the learning opportunities, the value of the scientific meetings, and the opportunity to improve your leadership. But now as a governor I see the opportunities in working with medical students and residents to make them leaders and to help improve the medical care in Panama.
What ACP programs have helped you in your career?
I like the challenging questions and the opportunity to keep up to date with MKSAP. Nowadays it is the opportunity to strengthen your leadership, and programs like Wellness and QI tools.
ACP's I.M. Proud campaign celebrates internal medicine and reinforces the theme that internists are the best and brightest. What makes you proud to be an internist and a member of ACP?
Being an internist prepares you to be resilient in your personal life and work, so you learn to work in any environment. Even if you have some administrative inefficacies, an internist has the opportunity to become a leader and make some changes in the work environment, for his personal satisfaction and for his patients and peers.
ACP has helped me through this journey in internal medicine. I have had the opportunity to practice in many different environments and I have been a member of ACP since my last year of residency.
Was there a particularly challenging moment in your career that turned out to be rewarding?
As Deputy Minister of Health, I negotiated salaries and work conditions with almost 42 different groups and unions. It was a very stressful situation, but I was able to work it smoothly and efficiently, and we avoided strikes.
What advice would you give to a medical student who is interested in internal medicine?
You need to be persistent. Some think that in internal medicine you work harder and it is not well paid. But internal medicine forms your character and integrity and you can acquire personal tools that you can use in your personal life and working conditions, if you work for it.
What's something most of your professional colleagues don't know about you?
I am a handyman at home. I repair dripping faucets, some electric circuits, and do some mild repairs at my beach properties. But my wife doesn't always approve of my work, because she says that sometimes they are just partial or temporary repairs!
What are your hobbies and personal interests?
I like nature. When I was working in the military hospital I was introduced by some friends to the breeding of native orchids and bird watching, and Panama is a leading country in bird watching. I also enjoy going to the beach–Panama has beautiful beaches and I own a property at one of the most beautiful beaches in Panama. I go there at least twice per month and it's about 90 minutes from the city. My place is surrounded by nature, and it has iguanas, paisanas (a tropical version of pheasants), and is very pleasant.