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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

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

The Philippines

Sun, Sand and a Sea of Healthcare WorkersPresident’s Forum on International Health

Rey Vivo, MD

Assistant Professor of Medicine

Texas Tech University Health Sciences Center

the islands
The Islands
  • 7,107 islands making up an archipelago
  • Climate: Tropical
  • Area: 115,831 sq mi
    • #72 in the world
  • Population: 91 million
    • #12 in the world
  • Capital: Manila
  • Currency: Peso
    • (PhP47 = US$1)
slide5

6

9

11

18

the history
The History
  • Negritos – Malay aboriginals
  • 13th century – Islam
  • 1521 – Ferdinand Magellan “discovers” the islands
    • Manila is established as capital of the new Spanish colony
    • Christianity
  • 1880s – Propaganda Movement, Katipunan
  • 1898 – US defeats Spain; “First Philippine Republic”
  • 1935 – Philippine Commonwealth; then WWII
  • 1946 – Independence from US
  • The Marcos dictatorship, People Power revolution(s)
the people
The People
  • Manila is 11th most populous metro in the world
  • Literacy rate: 93%
  • Language: Filipino and English; >180 dialects
  • Labor force: 34.2 million

11 million (11%) overseas; largest diaspora

the culture
Spanish: names, language, religion/customs, food, architecture

“…a Latin American country transported to the Orient…”

American: fast food, music, movies, pop culture

“Brown Americans”

The Culture
the culture1
The Culture
  • Harmonious social interaction
  • Debt of gratitude
  • Colonial mentality
  • Hospitality
health and healthcare
Health and healthcare
  • Top 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
diaspora

Crisis

Diaspora
  • 2001 – 2004: >5,000 physicians left
    • 30 medical schools
  • 2000 – 2003: 51,850 nurses migrated
    • 350 medical schools
  • Approx. 1,000 hospitals have closed in the last 5 years
physicians
Physicians
  • Top countries of medical education for IMG physicians

American Medical Assn., 2007

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

Philippines

South Africa

USA

$4,000

$1,000

$300

why leave1
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:>10,000

    • Poor job prospects, difficulties in establishing practice
    • Specialties
    • Research
    • Local political/economic forecast
challenges
Challenges
  • USMLE
    • Cost
  • Visas/Immigration laws
    • Post-training employment opportunities
  • Healthcare differences
  • Disrupted families/relationships
diaspora1
Diaspora
  • 2001 – 2004: >5,000 physicians left
  • 2000 – 2003: 51,850 nurses migrated
  • Nursing 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
slide20

Nurses

Percent of Hospitals Hiring Foreign-educated Nurses by Country from which They Recruited, 2006

American Hospital Assn., 2007

nurses compensation
Nurses’ compensation

USA

Canada

Philippines

$200

$200

$200

Daily Daily Monthly

from md to rn
From MD to RN
  • 2000 – 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 cons
Remittances from overseas workers

Reduced unemployment

Technology transfer

Healthcare cultural diversity

Expedited but suboptimal training

Demoralization of MDs

“Brain drain”

Pros and Cons
brain drain
Brain drain
  • Filipino-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 solutions
Gov’t solutions
  • Manage migration
  • Mandatory government service
  • Career advancement programs
  • Knowledge exchange