21 June 2005

"Poaching Nurses and Doctors"

Nurses' and doctors' leaders have called on the UK Government to tackle the "poaching" of overseas healthcare workers, at next month's G8 summit.

They say staff migration from developing nations is killing millions and compounding poverty.

Sub-Saharan African countries are some of the worst hit by the "brain-drain".

The World Health Organization estimates that one million more healthcare workers are needed in these countries if they are to meet basic health goals, such as reducing childhood and maternal mortality.

[BBC News - Jun 17, 2005]

The Merriam-Webster online dictionary gives 2 definitions for the term "poaching":
-- one is literally "to put into a bag," and
the other is to "cook in simmering liquid."
I think both definitions connote something dire and dreadful. And dire and dreadful, it certainly is, for us here.

The Brits need not look as far as the Saharan desert to get a glimpse of the problem --- it is also happening here in the Philippines. Consider the following facts:
  1. ∗ In the last 10 years, the Philippines exported close to 90,000 nurses overseas.
  2. ∗ In the last four years, 3,500 doctors left the country to take on nursing posts abroad.
  3. ∗ The number 1 course choice here is now Nursing. I have friend lawyers, engineers, and yes, doctors who are all shifting to nursing to work abroad.
  4. ∗ The Philippines is now exporting more nurses than it is producing, resulting in substandard patient care and a real crisis in hospitals.
  5. ∗ Migrant health workers are still predominantly female, meaning more families are losing their traditional caregivers --- the wives, mothers, and sisters. According to a 2004 Asian Development Bank report, 65 percent of Filipino workers overseas are already women.
  6. ∗ Because of equal opportunity in employment (something non-existent here) abroad, age is not a hindrance to working, and more senior doctors and nurses opt for retirement to study nursing and work abroad. This leaves an unwanted vacancy in health personnel in hospitals especially in the provinces.
  7. ∗ About 10 percent of the Philippines' 2,500 hospitals have closed down in the past 3 years mainly because of the loss of doctors and nurses to jobs overseas.
  8. ∗ Next to India, the Philippines is already the second largest source of doctors in hospitals abroad. The country also supplies 25 percent of all overseas nurses worldwide.
  9. ∗ The preferred country of destination is the United States because of the possibility of acquiring U.S. citizenship and all its privileges. But 57 percent of Filipino nurses abroad are in Saudi Arabia and only 14 percent are in the United States, while 12 percent are in the United Kingdom.
  10. PGH, the country’s premier government hospital, is also seeing an exodus, with up to a quarter of its 2,000-nurse workforce leaving in the last few years. While it used to accept only the top graduates of the country’s nursing schools, it can no longer afford to stick to such standards. Now, as a licensed practical nurse makes the minimum passing grade, an apparently desperate PGH will take the applicant.
  11. ∗ About 5,500 doctors are now enrolled in 45 nursing schools in courses that were tailor-made for them. Two thousand doctors have already taken up the Nursing Board Exams, topping the test in 2003 and 2004. In 2004, the topnotcher in the medical board exam announced his plans to work overseas as a nurse.
  12. ∗ It is no longer hip and cool to become a doctor here. Of the 39 medical schools in the country, three have ceased operating because of steeply declining enrollment. The Iloilo Doctors College of Medicine, for instance, reported a 74-percent decrease in enrollees.

Reasons for this mass migration of our health workers include the prevailing political instability, widespread corruption, and all-too-important financial aspect.

A nurse working in the UK for 6 months can earn as much as P500,000 (half a million pesos). A nurse in the US can get a signing bonus anywhere from to .

Here, nurses in the provinces get about P2,000 monthly (). In government hospitals, nurses get P9,000 monthly (), and in private hospitals, it could go down to P4,000 (). Under Republic Act 9173, an entry-level nurse should get about P13,300 a month (). The key word "should" is most likely a joke. This law is not properly enforced.

Bottomline is that the aging population in western countries will increase in the next 5 to 10 years, and demand for nurses and doctors from developing countries like the Philippines will continue to rise.

What will we do?

Dr. Jaime Galvez-Tan, executive director of the National Institutes of Health-Philippines and former Secretary of Health, has proposed definitive Strategic Solutions to the problem. Sadly, the government is not responding as quickly as it should.

Dr. Jaime Galvez Tan's Solutions to the Nursing Crisis
Lack of Nurses Burdens an Ailing Healthcare System
Global Congress to Tackle Nursing Crisis in RP

25 reactions:

rolly said...

I find it quite ironic. They leave because they want to live (comfortably?) and yet, their loss may mean dying for those left behind.

Wawa naman tayo, no?

may said...

i choose not to feel guilty because i opted to be here. i do want to live comfortably, and i was also raised to think of my family and help them live comfortably.

Dr. Emer said...

Tito Rolly: The choices we make define us.

May: "Here" means the US, right? Well, I've got nothing against that. I salute you. I think love of family is also a heroic act. But we can't also escape the fact that the massive migration (of health workers) worsens the health condition here in our country.

Owen FV said...

i agree with you. i have a very good friend who almost gambled all his family wealth in studying medicine in UP only to end up looking for a placement as a nurse to US after he passed his Medical Board Exams. haaayyy.... let's just hope for the best for Pinas!

nice post!

Dr. Emer said...

Thanks, Owen.

Oh, I know a lot of stories like that. True-to-life. As long as we are preoccupied with politics, gossips, and intrigues, we can always hope but nothing much will happen. Did you hear the latest on Congress? They act like a bunch of impish kids there.

may said...

i know i can't ignore that fact...isn't it also a fact that a lot of filipinos die at home because they can not afford to go to the hospital? isn't that supposed to be considered a crisis too? just curious...

and thanks for dropping by :)

Dr. Emer said...

Yes, May. A lot of Filipinos also die at home because they cannot afford to go the hospital. But now the problem gets even more confounded --- there are also those who die because there are no doctors, no nurses, and no hospitals in their location. If the massive migration goes unabated (and I do believe it will), even those who can afford to go to hospitals might die because there's no one to attend to them.

Thanks also for the visit. I appreciate the exchange. =)

may said...

is the government doing something about the issue of those dying because they can't afford to go to the hospital? obviously, they are cracking their brains out trying to solve the "poaching problems"; is it because it is okay to die if you can't afford to go to a hospital, but not okay if you can afford to go?

sorry, i'm taking this a little personally because my mom would have died way way earlier than she did if she didn't have kids abroad to send her to the hospital when she badly needed to go.

in my post "about a nurse from abroad", i talked about the reasons why i am here, in response to an american nursing student's concern that foreign nurses are flooding the US, instead of their government doing something about their nursing shortage by making the nursing programs more accessible.

it seems to me that in this aspect, the US and Philippine governments have the same approach to the problem: go and take the easy way out. the philippines "blaming" the migration of nurses, and america "taking advantage" of the migration.

too long for a comment, but it feels good to "talk" to somebody back home. thanks for bearing with me :)

Dr. Emer said...

Well, the government 'appears' to be doing something. During the time of (former President) Ramos and Flavier (Health Secretary and now Senator), "Doctor to the Barrios" was launched and is still here with us. But these days, that program is not enough, and confounded with the health personnel migration, it gets a tad more difficult.

No need to apologize for "taking it personally," May. I am taking it personally, myself. And a few other doctors here also, foremost of which are Doctors Galvez-Tan, Dans, and Peña, who are medical society and health leaders here. But again, it is not enough. The problem is so colossal (and continues to grow) and hardly a dent can be mustered. I think Dr Galvez-Tan's solutions are feasible. The sad thing is that no one is paying too much attention to his proposals. Everything here (as you probably know) is about politics, gossip, and intrigue. The leaders are easily sidetracked, and the more important issues expectedly ignored.

Feel free to comment. I appreciate it. I'm also delighted to have known you. I can see you also read some of my friend US bloggers like Dr Allen of GruntDoc, Dr Charles, and the Cheerful Oncologist.

bayi said...

The fact that this topic has been raised again and again in your blog is an indication of how crucial the problem is to the people and how close to your heart the problem has become. I cannot agree more.

The lack of basic healthcare does not affect only the present population but also the quality of the future generation.

I shall not dwell on suggestions because Dr Jamie Galvez Tan's paper has presented some of the most comprehensive and practical solutions there can be. They have to be implemented as a package to be effective and the present government of GMA should not ignore this paper. If GMA wants to leave a memorable legacy this is one that she can initiate and implement.

I don't think I am wrong to say that for many, the frustration about inadequate healthcare is that the government appears to have chosen to ignore the problem. The apathy is in part caused by the perpetual politiking that is all-consuming as evident throughout the tenure of GMA. Personal political survival is the agenda of the day, not basic healthcare, not the issues of deteriorationg quality of education, unemployment, etc.

Dr Jamie Galvez Tan's paper needs to be widely circulated and discussed wherever possible to give the proposal momentum.

Dr. Emer said...

Hello Bayi.

Thanks for putting into words what I really feel about the whole health situation problem here.

Anonymous said...

hi doc, really cant blame these people leaving the country. the reason is economic, obviously. so what does the gov't do to address the issue? have they come up with an alternative to stop the diaspora? i don't think so. and if they do, it's probably ningas cogon.

Dr. Emer said...

Hello Mari. Long time, no see. I haven't seen you in Berk's Cafe these days. I can see you've turned cynical about the whole health crisis. Hold on, we got to have more patience. There are a few good men addressing the problem.

Anonymous said...

If a patient can afford to go to a hospital, or, If a patient has medical insurance that covers hospitalization, then, hospitals will the have money to pay doctors and nurses. Most Filipino Doctors and Nurses would rather fulfill their sworn duties to serve fellow Filipinos but let's face the facts.

Anonymous said...

The basic problem of the philippine health system is money and renumeration. YOu do not expect people to pay for expensive medical education only to end up poor and severely underpaid.

Anonymous said...

I feel that we in the Philippines are reaping what we sow. The economic system cannot and will not support the decent pay of nurses, paramedical personnel and more so doctors. In the meantime we continue to pay those in media and entertainment well.Hehehe. Those healthworkers doctors, nurses, and other paramedicals should leave the Philippines for better pay and a better life.

Dr. Emer said...

Anonymous 1: We are facing the facts and we already know it's a problem. We are now trying to work on a solution.

Anonymous 2: We know medical education is expensive. We also know doctors/nurses are overworked and underpaid here. We also know that the massive migration of our health personnel is a ticking time-bomb that can trigger a health system catastrophe in the future. Remember the case of the hospitals before which ask for a deposit fee first before they treat patients? I think we can find some analogy there. When sick patients can no longer ask for help not only because they have no money, but because there is no doctor around, don't you think that is a real tragedy? Wouldn't we help if we can?

Anonymous 3: Here's a no-brainer question: If all doctors and nurses left the Philippines because of better pay abroad, what will happen to our sick countrymen?

TO ALL ANONYMOUS COMMENTERS: I appreciate and thank you for your comments and sentiments on this issue. However, I would appreciate it more if you can put a NAME on your comments. No need to be shy.

Sheila said...

Hello from the UK. My colleague and I teach managers in our NHS and have big concerns about our poaching of staff from countries like the Philippines. We are using your blog as material on a programe this week to help raise the voice of those most affected and help UK managers understand what they are [unwittingly] doing. Hope it can help in a small way to make it clear we are all in one huge health system and need to see it as a whole and not in hermetically sealed parts.

Dr. Emer said...

Thanks so much, Sheila. That is a most welcome development indeed. We hope something positive comes out of your programme.

Lynda Galarrita said...

i dont think that its right for nurses to be forced to work in the philippines when they are not fully compensated......We have to be practical here, all we want is to help each of our families and working in the philippines wont help them..........

Dr E said...

No one is forcing Filipino nurses to work in the Philippines, Lynda. That is why the exodus continues. It is everyone's right to work hard, and if need be, somewhere else where the "grass is greener." Everyone is being practical. My main issue here is exploring some possible answers to the question --- what will happen to the Philippines when all, or practically all its nurses and doctors have left?

Jorge said...

Dear doc emer,
very interesting..
the solution may be in the hearts and stomachs...
a simultaneous system of promoting lucrative health oriented businesses back home in the Philippines with the help of the tycoons could make the Philippines an economic health tiger.
Our people are tremendous in talent.
There is much to look forward to.

best regards

Blake said...

D.I.D. (DEAD) joke...
ive read on an article about the situation that nurses and doctors here in the philippines is actually borderline to "sufficient"..the problem "daw" is that there is apparent maldistribution of health care personnel in the country. graduates of MSU prefer to go to bigger cities to work, and so on. local government must work on these areas to at least alleviate the problem, hospitals in mindanao are closing because of inadequate health care delivery, midwives and nursing aids are forced to function as a nurse or even more thatn their scope of work. oh well, my personal dilema is whether im going to proceed to medicine after graduating to my BSN degree, or ill take on one step to going abroad like everybody else. im not financially compromised, so being a doctor here in the philippines with uncompensated salary would be okay. but if i come to think of it of being a nurse abroad, i will be able to save more time and earn better than being a doctor, which is obviously a very "pain in the ass" situation to still go through 4 year medical course, residency training, etc etc.
i know some doctors who are really dedicated to work for their countrymen, but it's always the same strory, in the long run they shift to nursing and work abroad.

Anonymous said...

1. Asking the US or UK to compensate the Philippines for each nurse recruited will only drive them to get nurses elsewhere: China, India, and even Africa. In the hospital that I work in, a lot of nurses are of African origin.

2. "Compulsory Health Service Act" is a sham. The government does not spend a centavo on our education. Why should they be allowed to conscript graduates to render service?! Maybe they can do so to graduates of UP and other State Universities wherein the student's tuition has government subsidy.

It is ironic that crab mentality persists. Rather than welcome the chance of increased remittances by OFWs Dr. Galvez-Tan somewhat portrays second course RNs as traitors whom are eager to abandon the Philippines. Take note that a key reason that the Philippine economy is doing good is due to the fact that OFWs which include RNs and second course RNs are key contributors to remittances.

Dr. Galvez-Tan was in Baltimore recently and gave a speech at John's Hopkins. Part of his lecture included poking fun at a Munincipal Health Officer whom late in his life is studying Nursing. Is it now a crime to re-invent oneself for the purpose of improving future options? Or is it only a crime for Doctors who after serving the country for countless years are now disillusioned with the political state of the Philippines and are now seeking a better future for themselves?

Some people ride popular issues to advance themselves. Dr. JGT is no different. Perhaps he is deluded to think that he can use this issue to get him elected as a Senator. Whereas during his term as health secretary he did not really get anything done to improve the plight of nurses and doctors. Does anyone still remember the time when RNs were selling PowerPage pager units because of lack of jobs?

It is easy to castigate Doctors who take up Nursing in able to work abroad. Let me correct all those who refer to MDs who take up Nursing as MDRNs. In the US either you are a MD or a RN...there is no such MDRN job title.

We served our country, we paid our way through Nursing School. Why can't he leave us in peace?

Anonymous said...

West Visayas State University
College of Arts and Sciences
La Paz , Iloilo City

February 28, 2008

Dear Dr.______________:

We are the third year BS Biology students of the College of Arts and Sciences, West Visayas State University , Iloilo City , Philippines . We are conducting a study on “Exodus of Medical Doctors”.

As one of the chosen respondents of this study, please be kind enough to answer the following.

Part I. Personal Data

Name (optional):
Place of work/Residence:
Place of residence in the Philippines :
School/ University graduated:
Present Occupation:

What is your main reason for leaving the Philippines ?
How did you get your current job?
What profession/professions do you practice in this country where you are in now?
Why did you prefer to migrate in this country?
What are your most memorable moments in your present job?
What consequences do you experience in these countries with regards to your present job?
Any words of wisdom/advice for the would be doctors and those planning to work abroad?
Other experiences you would like to share?

Thank you very much in anticipation of your positive response.

Very truly yours,





*pls reply to
thank you so much