Philippines: Have Degree, Will Travel
Where have all the nurses gone?
BY Barnaby Lo
December 18, 2007
Learn more about the Philippines' medical brain drain and what is being done to address the problem.
Barnaby Lo is a Manila-based producer and reporter for CBS News. He previously worked for ABC News and Nightline, and as a freelance video producer for NYPost.com. He began his career in journalism as a researcher for I-Witness, a Peabody Award-winning documentary program in the Philippines. He has an M.A. in broadcast journalism from New York University.
I have heard this conversation among Filipinos in New York City over and over again.
"You Filipino? Let me guess, you're a nurse?"
"How did you know?"
It seems like wherever I turn my head, I see Filipino nurses. This may be true in many cities across the United States. The Philippines has been exporting medical staff to the United States for the last half century, and Filipino nurses make up almost half of all foreign nurses in the U.S.
Some health experts predict that the U.S. will have a shortfall of 800,000 to 1 million nurses by the year 2020. American nursing schools are not producing enough nurses to be able to meet the demand of an aging population; so hospitals, with the support of the American government, are now turning to foreign nursing graduates. In 2005, the U.S. approached countries like India, South Africa, and the Philippines, armed with legislation that recaptured 50,000 unused immigrant visas and designated them solely for nurses.
Filipino nurses have been quick to take advantage of the opportunity. Over the last few years, there's been a tremendous increase in the number of trained medical staff leaving the Philippines; last year alone approximately 12,000 left the country. More college students are now choosing a nursing major in one of the 500 training schools throughout the country. Accountants, engineers, teachers and even doctors are returning to school to train for a nursing profession.
The loss of so many trained physicians to the nursing ranks is particularly troubling. According to a study led by former Philippine Secretary of Health Jaime Galvez-Tan, close to 80 percent of all government doctors have become nurses or are in nursing schools. There are roughly 9,000 doctors-turned-nurses and 5,000 of all these medical practitioners are now working abroad.
To find out the impact of this exodus of nurses from the Philippines, I traveled to Sarangani Island at the southern tip of the country. The only way to reach the island from the city was to hitch a ride on a cargo boat without seats, toilets and windows. The night we sailed, strong waves rocked the boat as rain poured. At one point, the boat nearly flooded. I felt lucky just to survive the 8-hour journey.
But that is the way the people of Sarangani Island live. To buy groceries or to go to the nearest bank, they must take that long boat ride. The one hospital on the island is poorly equipped and has only one nurse and no doctor. If there's a medical emergency requiring a doctor, the patient has to take the boat. As I learned, the situation is only going to worsen: The lone nurse on the island tells me he will be leaving soon to work in London. (In fact, since this story was first reported, the nurse has left and the hospital has shut down.)
By the end of 2005, nearly 120 hospitals in rural areas have closed because there is no one left to see patients. Former Health Secretary Galvez-Tan fears that if this brain drain does not slow, the Philippine health care system will collapse.
-- Barnaby Lo
Kevin M. - Allen, TX
The Filipino nurses are deserving of the utmost respect, because of the work that they have done: leaving their homes, working in America, becoming nurses, sending portions of their wages home. Many people may view this as a selfish plight to esape their homelands, but I view it as an attempt to improve life in the Phillipines.
San Diego, CA
I am more concerned about the pilfering of money that's going into Philippines. Did you know 6B USD is received by Philippines every year? Did you know we no longer have a functioning airforce? Did you know General Garcia has not been punished for stealing all those money he smuggled? Did you know we only rescued very few families in Lebanon during their last war? The rest are still scattered in that awful sand.
Nurses and house maids are symptoms of the our disease.Manny Pacquiao and others, although they make us all proud, are just distractions.
Philippin used to be the top country in Asia in the 60's. What happened to this beautiful country? If Filipinos do not care, who cares?
Guy Rendon - Las Vegas, NV
The Philippine government is one of the laziest government institutions that ever existed on this planet. They promote unknowingly the mass migration of nurses and other professionals to other countries. The government officials are not doing enough to create jobs locally and raise the standard of living for the masses. They forgot to bring development to areas outside of Manila, thus keeping the rest of the country backwards. Tourism is one factor that Philippines could have focused on since they do are blessed with fantastic natural resources and destinations. But yet again the Philippine government forgot to create the proper infrastructure to support this industry. The Filipino people will always find ways to improve living and economic conditions of their respective families and the only way to do it is get out.
equal other countries offer? yes! pay high taxes to the motherland to hinder us to work abroad? wtf? do you know where our taxes go? you guessed it right. instead of helping these politicians use taxes for their campaigns and other worldly personal gustos, id rather send all my salary gladly to charitable institutions. filipino professionals not only nurses go overseas because they see no future in the philippines. filipinos would rather starve in other countries to feed their families rather than staying in the philippines starved and not a single cent to help their families. if we could not get help from our own government, maybe its the right thing to do, turn to others. we are not selfish here. in the us, and other countries we're pampered, respected, and praised for our hardwork. id never trade these for anything else.
atb - DC Westside (as in Daly City, CA), CA
Hi, Barnaby (cool name, BTW). Thanks for this documentary. Very nicely done. This is a highly complex phenomenon. A lot of issues intersect, every person I believe has a God-ly reason why they had chosen the path they had taken. I will not claim I know all those reasons, so I will not judge anyone. But the 'losers' here are the Filipinos back home who are in dire need of medical attention. Is there any way to make some/all our nurses/doctors stay in the Philippines? Can we dampen the draw that takes them overseas? Can we match the salary they would get overseas, for example, if they choose to leave, they would be required to pay taxes to the Philippines, so their pay is roughly equivalent to what they would get had they stayed home? The pay back home needs to go up, of course, to make things equitable. And for those who have already left, we could make a plea to them to pay taxes, but there is no way we could make it absolute. And I do not think it should be limited to Pinoys in the health sector. Anyone who leaves should pay taxes to the motherland. I think it is the right thing to do, even though no one will be forcing you to do so. I think in our "heart-of-hearts" we know this is the right thing to do. It takes a loving and caring heart to fess up and help the motherland. And instead of asking, "but why me?" why not ask "Why not me?". Just help, forget about whether others are helping. Realistically, you could only control what you could do, not what others could do. If you wait for that to happen, then we'll never do anything. Unfortunately, I see this proposal being an opportunity for corruption. So, we need to be careful. God bless the Phillipines, Mabuhay Ang Pilipinas.
Thanks for writing this article but I think these people shouldn't be blamed for taking up the nursing profession and going abroad because first and foremost, the fee for finishing the nursing profession degree is not as affordable as others might think it is. For everybody's information, families tried their best to earn the money to support these students with no help from the government at all. After earning the degree, they can't find jobs since hospitals preferred to use the nursing students who got clinical instructors covering their tails rather than hiring a qualified nurse and using up their money to pay them.If ever that newly qualified nurse get lucky and got the job, the salary is so small it cannot even be compared to the amount of money a student nurse spent in tuition fees and miscellaneous in a month. That's why I don't agree with the Philippine government controlling the nurses by making them work in the country for a set of time first before they can go abroad because they didn't support the student, even a cent, and then have the nerve to ask that from them. Maybe the government can impose that requirement on those students they subsidized rather than on those who were using their personal money to finish the profession. I, myself, am working as a nurse abroad presently but would have loved to stay in our country since my loved ones, friends, and families are there and there's no place like home. Yet I have to sacrifice because if I will be earning the money the same as I received during my time as a nurse there in the Philippines before, my family will be living 'hand to mouth' lifestyle as if their mom didn't finish a profession which would bring them the lifestyle that they could heve enjoyed, just like the lifestyle these politicians are having without a sweat. I sent my two brothers to nursing school and did lots of extra shifts just to earn the money to send them to a private school, sacrificing the time I could have rested and spent with my children -- only to be disappointed with the crap system of PRC (Professional Regulation Commission), who only lavish their own selves with the money they are getting from the students, by posting a system of who can and who can't take the National Licensure Exam after the student graduated thereby wasting the number of months the graduate could have started as a qualified nurse (that if they got lucky to get a job). Maybe the government should start looking at ways how to uplift the status of the nurses in the country because as per my experience, the pay I got when I worked there as a nurse was just equivalent to a sales assistant in a department store who didn't spend as much as I spent paying the tuition fee I paid when I took up and finished the profession. Maybe, they need to set a standard acceptable fee for these nurses equally whether they work in a public or private hospitals to enhance retention of nurses in the country.
After spending the last few years getting my diploma and becoming a registered nurse in the Philippines, I can attest to the number of students going into nursing. As you talk to college students and ask them their major you will notice the disproportionate amount taking up nursing. The statistics are huge. In the last year alone over 60,000 nurses passed the board. Some say there are another 950,000 making their way through school to get that bachelors degree in nursing.
The report indicates that 12,000 nurses have left the country. The question is where are the rest? Surprisingly most are still in the Philippines. They cannot leave due to a cap on immigration. The US alone has a 5( ) year waiting period to leave the country. Other nations have closed their doors to foreigners seeking employment. The reality is you dont automatically have a nursing job after you graduate, nor do you jump on the next plane to catch that job abroad. There are plenty of out-of-work nurses to staff the hospitals and clinics. The problem is not on the labor end, but the funding side. There is little or no budget to hire these nurses in the country. Hospitals are inundated with 100s of resumes for a single position. I know of registered nurses who have left the field for another career because they couldn't find a job as a nurse. As for the term "brain drain" to indicate an exodus of medical professionals. I can tell you the nurses and doctors who were my professors and clinical instructors are all still here. Not one has been granted a work visa or wanted to leave. If there is a brain drain, I haven't seen it.
Filipinos are hospitable. I am a student nurse. I believe that nursing is fate for me.
For your information, it is not just RNs who are leaving, but also our best engineers, I.T. workers, and others skilled workers. But still, it's better to have a "brain drain" rather than a brain in the drain.
Excellent, if terrifyingly sad, documentary. About half my high school class in Manila became doctors, and most of them are in the US. I myself live in Spain (though I do not work in the health sector). What is it about this country? And a government whose leaders practically push nurses to be "heroes" and leave their country so they can send money back to prop up the corrupt economy?
Medical treatment is so much easier to obtain in America that I guess I never really thought about what it's like in third world countries or where all my doctors have come from. It's unbelievable that with around 100,000 nurses graduating in the Phillipines that they have a shortage. Doctors have given up their careers as actual doctors to help fill the need for nurses in the U.S. because there is simply nobody else to do it. In a way the country blames America for pulling the nurses away from where they are needed most because of things like the attraction of living in America and of course the salary differences. It's sad that with such prestigious nurses coming from this one country that they are still in need of their own natives help who are abandoning their nation, where they learned everything they know.
Robert Hu - Allen, Texas
I have often heard talk show radio hosts and uneducated Americans complain about the idea of immigrants taking jobs in the US, being paid in US dollars, and then mailing it back to their country of origin under the plebeian opinion that they are stealing jobs from Americans and are ruining the US economy; as if the controversy surrounding intercontinental currency mailings were that black and white. This documentary indirectly puts up several good points about moral limbo surrounding the issue. While the money may be siphoned off one country's economy, it keeps another from collapsing. The immigrated Philippine nurses worked and endured hardships for their money, and as it is theirs, they should be free to do what they wish with it. And the truth is, there is currently a shortage of nurses in the US. Soon there will be a suffocating deficit of RN's and MD's in America due to the retirement of the baby boomer generation. So essentially, these immigrated workers are not stealing jobs. Quite to the contrary, they are keeping the numbers of hospital workers afloat, just as the US dollars they mail back to the Philippines keeps the country's economy afloat.
Thank you Barnaby Lo for this story.
Anna Vanessa Carvajal - Jeddah, Saudi Arabia
I have watched this documentary about MDs in the Philippines becoming RNs for 1st world countries like the United States and UK. It presents a depressing truth about the current situation of brain drain (in the medical aspect) and an almost hopeless future for the Philippine health care system. After watching the documentary, there is a feeling of a terrible discomfort.My father and my brother recently got hospitalized in one of the best private hospitals in the country. I must say that they have an ample supply of nurses compared to what they had 5, 10 years ago. But all the nurses were young, and new, and inexperienced. One (registered) nurse, as I remember, couldn't even puncture the IV bottle and asked me if I could do it for her. Unbelievable!!! And when I asked one of my brother's doctors if he had any plans of leaving his practice as a doctor or take up nursing, he said he may have plans. It is really happening.So I can imagine the situation on the far side of the Philippines, where health care needs to cross bodies of water and mountains just to get through to an isolated population. This is not just a documentary for those in the government, but for all of us Filipinos.
Excellent, Barns! I love It! Keep up the good work. Merry Christmas and a Happy New Year. Merlyn