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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 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

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  1. 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

  2. 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)

  3. 6 9 11 18

  4. 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)

  5. “300 years in the convent and 100 years in Hollywood”

  6. 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

  7. 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

  8. The Culture • Harmonious social interaction • Debt of gratitude • Colonial mentality • Hospitality

  9. Healthcare Issues

  10. 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

  11. 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

  12. Physicians • Top countries of medical education for IMG physicians American Medical Assn., 2007

  13. Why leave? • Harsh realities: Compensation/month for resident MDs Philippines South Africa USA $4,000 $1,000 $300

  14. 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

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

  16. 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

  17. Nurses Percent of Hospitals Hiring Foreign-educated Nurses by Country from which They Recruited, 2006 American Hospital Assn., 2007

  18. Nurses’ compensation USA Canada Philippines $200 $200 $200 Daily Daily Monthly

  19. 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

  20. Remittances from overseas workers Reduced unemployment Technology transfer Healthcare cultural diversity Expedited but suboptimal training Demoralization of MDs “Brain drain” Pros and Cons

  21. 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

  22. Gov’t solutions • Manage migration • Mandatory government service • Career advancement programs • Knowledge exchange

  23. JAMA. 2008;299:1753-4.

  24. http://www.youtube.com/watch?v=YdBANriBrlw

  25. Thank you

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