The Philippines: Sun, Sand and a Sea of Healthcare Workers President

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Sun, Sand and a Sea of Healthcare
WorkersPresidents Forum on International Health
The Philippines

• Rey Vivo, MD
• Assistant Professor of Medicine
• Texas Tech University Health Sciences Center

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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 US1)

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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)

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300 years in the convent and 100 years in
Hollywood
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The People

• Manila is 11th most populous metro in the world
• Literacy rate 93
• Language Filipino and English gt180 dialects
• Labor force 34.2 million

11 million (11) overseas largest diaspora
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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

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The Culture

• Harmonious social interaction
• Debt of gratitude
• Colonial mentality
• Hospitality

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Healthcare Issues
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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

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Diaspora
Crisis

• 2001 2004 gt5,000 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

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Physicians

• Top 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
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Why leave?

• Harsh realities Compensation/month for resident
  MDs

Philippines
South Africa
USA
4,000
1,000
300
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Why leave?

• Other limitations
• Poor working/training conditions, quality of life
• Govt budget for health
• MD to person ratio US 1150
• Cuba.
  1225
• Phil... 1gt10,000
• Poor job prospects, difficulties in establishing
  practice
• Specialties
• Research
• Local political/economic forecast

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Challenges

• USMLE
• Cost
• Visas/Immigration laws
• Post-training employment opportunities
• Healthcare differences
• Disrupted families/relationships

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Diaspora

• 2001 2004 gt5,000 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
• gt50,000 caregivers have trained about half have
  left for jobs overseas

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Nurses
Percent of Hospitals Hiring Foreign-educated
Nurses by Country from which They Recruited, 2006
American Hospital Assn., 2007
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Nurses compensation
USA
Canada
Philippines
200
200
200
Daily
Daily
Monthly
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From MD to RN

• 2000 2004 5,000 MDs left to work abroad as RNs
• 2004 2005 gt2,400 MDs took the nursing boards
• Currently, gt4,000 MDs enrolled in nursing schools
• Generalists and specialists aged 25-60 years
• Retrogression

Alliance of Health Workers
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Pros and Cons

• Remittances from overseas workers
• Reduced unemployment
• Technology transfer
• Healthcare cultural diversity

• Expedited but suboptimal training
• Demoralization of MDs
• Brain drain

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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
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Govt solutions

• Manage migration
• Mandatory government service
• Career advancement programs
• Knowledge exchange

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JAMA. 20082991753-4.
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• http//www.youtube.com/watch?vYdBANriBrlw

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Thank you