When Pinoy doctors become US nurses

MANILA, Philippines - Almost every kid once dreamed of being a doctor someday. From the moment they had their first polio shot or underwent a routine check-up, the image of a selfless, patient, and caring doctor has been embedded in children's minds. And who doesn’t want to take care of lives? Care for the poor? Or help save the world? If recent statistics are to be believed, a lot of Filipinos grow up not pursuing that childhood dream. Recent studies show a dramatic drop in the number of college students pursuing a career in medicine. The decline in medical school enrollments can be as high as 50 percent while countless go on an exodus to greener pastures overseas. Since 2001, the Philippine Medical Association noted that about 5,000 doctors have shelved their hard-earned MDs (Doctor of Medicine) to become RNs (Registered Nurses) in countries like the United States, United Kingdom or Saudi Arabia. And it’s not hard to imagine why Filipino medical doctors want to become nurses in the United States, the country where most health care professionals migrate. While a doctor, say from the Philippine General Hospital earns P25,000 a month, an overseas nurse can earn more than 12 times overseas. Faced with the soaring prices of petroleum and basic commodities, most Filipino doctors are forced to make the difficult choice of crossing over to become nurses which in turn create a huge void in the medical health system in the country. When the doctor is out (of the country) It is a fact that medical schools charge among the most, if not the most, expensive fees compared with other courses in the country. Therefore, there is an expected return-on-investment on the part of the family and also the person who has toiled to obtain the coveted degree. In 2005, the Philippine Overseas Employment Agency (POEA) noted that about 14,694 medical-related workers, or 4.4 percent of the total share of Filipino migrant workers, were deployed overseas as newly-hired OFWs. This sector was the sixth top occupation for Filipinos abroad that year, next to domestic helpers, entertainers, factory workers, construction workers and caregivers. However, in recent years, the medical profession has experienced a slump. Dr. Fernando Sanchez, executive director of the Association of Philippine Medical Colleges, noted in a 2005 discussion that there is a declining interest in medicine as a career despite the increase of high school graduates - some of whom might have once dreamt of becoming a doctor in their younger years. “The once popular profession of medicine has lost its glitter," said Sanchez during the 2005 Philippine medical summit. “In the early 1980’s the attention of the government was called to what is termed as ‘reverse education’ or the cross-professional migration of doctors to nursing." He explained that the growing unpopularity of the medical profession can be traced to two primary causes: The economic situation and the lack of nationalistic policies and planning. “Medicine used to be the preferred health profession but the course is too expensive for most and takes a long time before one can start earning, “said Sanchez. The World Health Organization has also considered the loss of health professionals as a matter of utmost concern. Its Western Pacific Regional Office commissioned a study in 2001 which concluded that migration was not a “overspill" but a definite loss to the country, and the negative outcomes are both financial (loss of training costs) and social. WHO noted that the shortage or complete absence of doctors in some regions or areas of specialization will jeopardize progress towards healthy communities, possibly leading to a reversal of recent gains, especially as degenerative diseases become more prevalent.

The country loses the best surgeons, bone doctors, obstetricians, anesthesiologists as well as public health doctors with the persistence of cross-professional migration. GMANews.TV

From MD to RN Based on the 2006 Center for Migrant Advocacy (CMA) working paper on overseas migration, the scarcity of doctors and nurses are partly to blame for the shut down of more than 100 hospitals all over the country. However, the effect of cross professional migration is felt earlier even before the doctors attain their MDs. Dr. Armando Crisostomo of the Philippine College of Surgeons noted that the number of examinees who took the National Medical Admissions Test (NMAT)—a prerequisite in applying for medical school—has dropped by 33 percent in 2004. Throughout the country, medical school enrollees also decreased from 18 percent to74 (??) percent. “At least three medical schools have closed down due to lack of enrollees," Crisostomo noted. National Institutes of Health Philippines executive director, Dr. Jaime Galvez Tan echoed the same reasons of Dr. Sanchez why the medical professionals leave the country. Tan identified the various push and pull factors why some doctors find it simply irresistible to shift to nursing. According to him, some of the pressing reasons why doctors are pushed out of the country include the “country’s stagnating economy, unstable political conditions and a general climate of apathy and hopelessness." Among the pull factors or inducements that for Filipino doctors to try their luck overseas are more socio-political and economic security, attractive salaries and compensation, more job opportunities, career growth, availability of advanced technology and the acquisition of immigrant visa. The medical doctors becoming nurses come from previous specialties like surgery, orthopedic, obstetrics, pediatrics, anesthesiology, internal medicine, family medicine, general practice, and public health. “Their age range is from 25 years old to 60 years old. Years of practice as physicians range from zero to 15 years, “Tan said. Since 2001, about 5,000 of the country’s MDs left the country as RNs, most of them preferring plum posts in the US, UK and the Middle East. Migrant Filipino professionals prefer countries like the US and the UK since some of them offer benefit packages not only for the doctors or nurses but also for their families whom they can petition to join them abroad. The nursing trend has indeed attracted doctors to shift that based from the preliminary findings of Tan, at least 43 nursing schools are offering abbreviated nursing course “tailor-made" for doctors. The cross-professional migration, Sanchez asserts, is evidenced by a drop in the enrollment of freshman medical students (an average of 30 percent in 2006) as well as the decrease in applicants for residency positions in training hospitals (dropping from 50 to almost 100 percent). In 2006, about 6,000 doctors enrolled in nursing schools that have mushroomed throughout the country, according to Health secretary Francisco Duque. He added that the number of MDs taking a step back for a more financially rewarding RN license, has steadily increased since 2000. CMA noted that between 1994 and 2003, more than 85,000 nurses left the Philippines. Duque fears that the alarming rate of Filipino doctors leaving the country would pose as a big threat to the situation of the health care system in the Philippines. To curb the mass migration of health care personnel, Duque formed a team which will work on a bill requiring doctors to serve three to four years in the Philippines. ’Limited’ impact? According to the Organization for Economic Cooperation and Development (OECD), the exodus of doctors and nurses worldwide bears little impact on the countries they leave behind. In its 2007 International Migration Outlook, the group found out that the migration of medical professionals to 30 developed countries throughout the world represents only a small fraction of the needs of health care sectors in developing countries. “In short, although stopping the flow, if this were indeed possible, would alleviate the problem, it would not by itself solve the shortage issue," the OECD explained. The report has challenged the perception that doctors or nurses are over-represented among the number of skilled immigrants who leave their respective countries to more industrialized economies. It noted that in 2000, 18 percent of doctors working in other countries were foreign-born. It indicated that 50 percent of the immigrant health professionals working in OECD members are in the United States, 40 percent in European countries, and the rest are scattered in Australia and Canada. Filipino nurses and Indian doctors each represent 15 percent of all nurses and doctors in the OECD. The OECD also said that in countries identified as large suppliers of overseas medical workers like India, China and the Philippines, "the number of health professionals working overseas, although high, is low relative to the domestic supply and the number of doctors per person has not been strongly affected." This means that despite the perceived high outflow of medical professionals from the Philippines, there are still enough left behind to cater to the health care needs of the country. As far as the OECD study is concerned, migration’s impact on poor countries’ health care is ‘limited.’ But with more and more health care professionals leaving the country, the government fears of a looming crisis in the medical sector. The void left by the departure of medical professionals has now reached an alarming rate and left an indelible effect on the country.

Doctors seek more socio-political and economic security, attractive salaries, more job opportunities, and availability of advanced technology in looking for overseas employment. - GMANews.TV

Recommendations To address the looming crisis in the medical health sector, caused by the exodus of Filipino doctors, the Philippine Medical Association’s 2005 summit suggested steps to mitigate the problem. Among the recommendations of the group is entering into bilateral agreements between the Philippines and countries like the US, UK, Saudi Arabia, Singapore, and Ireland that are considered as major importers of our health human resources. It also includes provisions on mutually beneficial agreements like the establishment of a trust fund to be used for health professional scholarships and continuing education; the encouragement of exchange of information between the Philippines and the health human resource importing countries; the formulation of rational and nationalist-oriented programs and the creation of medical tourism centers in several growth areas all over the country. However, Duque was quoted in a news report as saying that if he had it his way, doctors should be prohibited from migrating elsewhere to work. “While we’re out there treating other people, the irony is we don’t have anyone to treat our own people. Of course, the authorities will not allow it. Political leaders will not allow that. I will not allow it. If I have to respond to it today, I will close the door," Duque said. The government is planning to ban the migration of Filipino doctors by imploring the provision of Republic Act No. 8043, better known as the Migrant Workers and Overseas Filipinos Act of 1995. Duque invokes Section 5 of the law which stipulates that “the government, in pursuit of the national interest or when public welfare so requires, may, at any time, terminate or impose a ban on the deployment of migrant workers." He noted that the same provision was used to counter the alarming exodus of Filipino pilots in the late 1990s. But for the Health Alliance for Democracy (HEAD), banning doctors from seeking greener pastures overseas is not the real solution to the problem. According to Dr. Gene Alzona Nisperos, HEAD secretary general, Duque’s move does not address the real roots of the problem, the government’s lack of support in the health care delivery system. "The DoH (Department of Health) is proposing solutions without recognizing the roots of the problem. This is why their solutions are untenable and token at best," said Nisperos. With the country's economy facing a recent slump, the exodus of medical health professionals has no sign of stopping anytime soon. – GMANews.TV