sun, sand and a sea of healthcare workers president’s forum on international health
DESCRIPTION
The Philippines. Sun, Sand and a Sea of Healthcare Workers President’s Forum on International Health. Rey Vivo, MD Assistant Professor of Medicine Texas Tech University Health Sciences Center. The Islands. 7,107 islands making up an archipelago Climate: Tropical Area: 115,831 sq mi - PowerPoint PPT PresentationTRANSCRIPT
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