sun, sand and a sea of healthcare workers president’s forum on international health

Rey Vivo, MDAssistant Professor of Medicine

Texas Tech University Health Sciences Center

The Philippines

The Islands

6 9

11 18

The HistoryNegritos – Malay aboriginals13th century – Islam 1521 – Ferdinand Magellan “discovers” the islands

Manila is established as capital of the new Spanish colonyChristianity

1880s – Propaganda Movement, Katipunan1898 – US defeats Spain; “First Philippine Republic”1935 – Philippine Commonwealth; then WWII1946 – Independence from USThe Marcos dictatorship, People Power revolution(s)

The PeopleManila is 11th most populous metro in the world

Literacy rate: 93%Language: Filipino and English; >180 dialectsLabor force: 34.2 million

11 million (11%) overseas; largest diaspora

The CultureSpanish: names, language,

religion/customs, food, architecture“…a Latin American country

transported to the Orient…”

American: fast food, music, movies, pop culture“Brown Americans”

The CultureHarmonious social interaction

Debt of gratitude

Colonial mentality

Hospitality

Healthcare Issues

Health and healthcareTop causes of mortality: cardiovascular, cancer,

accidents, pneumonia, tuberculosis

1940s-1980s: infectious diseases led all causes

PhilHealth – national health insurance program

Out-of-pocket share emphasizes inequality

75% pharmaceuticals imported

Diaspora2001 – 2004: >5,000 physicians left

30 medical schools

2000 – 2003: 51,850 nurses migrated350 medical schools

Approx. 1,000 hospitals have closed in the last 5 years

Crisis

PhysiciansTop countries of medical education for IMG physicians

Country Total Percentage

India 47,581 19.9%

Philippines 20,861 8.7%

Mexico 13,929 5.8%

Pakistan 11,330 4.8%

Dominican Republic 7,892 3.3%

American Medical Assn., 2007

Why leave?Harsh realities: Compensation/month for resident MDs

$300 $1,000 $4,000

Philippines South Africa USA

Why leave?Other limitations

Poor working/training conditions, quality of life Gov’t budget for health MD to person ratio: US……… 1:150 Cuba…. 1:225

Phil…... 1:>10,000Poor job prospects, difficulties in establishing practiceSpecialtiesResearchLocal political/economic forecast

ChallengesUSMLE

CostVisas/Immigration laws

Post-training employment opportunitiesHealthcare differencesDisrupted families/relationships

Diaspora2001 – 2004: >5,000 physicians left2000 – 2003: 51,850 nurses migratedNursing schools are mushrooming everywhere

40 – 50% of nursing students are “second-coursers” At present 6,000 doctors are enrolled in nursing schools,

all wanting to leave for “greener pastures” abroad>50,000 caregivers have trained; about half have left for

jobs overseas

84%

33%29%

9% 7% 6%

Philippines Canada India Africa China Korea

Percent of Hospitals Hiring Foreign-educated Nurses by Country from which They

Recruited, 2006

Nurses

American Hospital Assn., 2007

Nurses’ compensation

$200 $200 $200

USA Canada Philippines

Daily Daily Monthly

From MD to RN2000 – 2004: 5,000 MDs left to work abroad as RNs

2004 – 2005: >2,400 MDs took the nursing boards

Currently, >4,000 MDs enrolled in nursing schools

Generalists and specialists; aged 25-60 years

“Retrogression”

Alliance of Health Workers

Pros and ConsRemittances from overseas

workers

Reduced unemployment

Technology transfer

Healthcare cultural diversity

Expedited but suboptimal training

Demoralization of MDs

“Brain drain”

Brain drainFilipino-born nurses and Indian-born doctors each

represent about 15 percent of all nurses and doctors in the Organization for Economic Cooperation and Development (OECD).

“The migration of doctors and nurses from the developing to the developed world has only a limited impact on the crisis in health care in poor countries.”

AFP

Gov’t solutionsManage migration

Mandatory government service

Career advancement programs

Knowledge exchange

JAMA. 2008;299:1753-4.

http://www.youtube.com/watch?v=YdBANriBrlw

Thank you