The Doctors Are Out

The doctors are out
BIZLINKS By Rey Gamboa
The Philippine Star 05/16/2005

At last, a reasonable voice in the cacophony of grumbling about the brain drain of qualified Filipino doctors and nurses that the country is currently experiencing. I’m referring to Dr. Jaime Galvez Tan, a former secretary of the Department of Health who is actively campaigning for strategic solutions to this issue. Let’s just hope that someone in government hears it – and has the guts and balls to do something about it.

For so long, the Philippines has been a leading source of health professionals for many countries. Our physicians, nurses, midwives, and even physical therapists are well liked not only because they can speak and understand English, but because they are also compassionate and caring.

Even in the 70s, almost 70 percent of our doctors were working abroad. Today, the Philippines is the second biggest exporter of physicians in the world, next only to India. As for our nurses, we continue to lord it as the world’s coveted source, so much so that an increasing number of our doctors desperate to go abroad are willing to do whatever is required to be qualified and work in other countries as nurses.
Push And Pull
It is not difficult to comprehend why this is happening. Many western countries are experiencing longer life expectancies, so much so that their elderly are living longer. On the other hand, their local schools are graduating less and less health care professionals who have become averse to the rigors demanded of chronic and degenerative disease treatment.

In the Philippines, by contrast, the abundance of nursing schools (approximately 370, as of the last official count) produces more nurses than the country needs. In recent years, unofficial data indicates a migration of more than 10,000 nurses a year, with the US now as the biggest recruiter.

The US and the UK are the top employment choices of our nurses and doctors-turned-nurses. In fact, in the UK and Ireland, Filipinos are a major ethno-linguistic component of the countries’ migrant nursing work force.

US hospitals are very aggressive in directly recruiting Filipino nurses. Those who pass the required tests are immediately given migrant visa status, including their spouse and children, plus a work contract guaranteeing at least $4,000 a month. Compared with the monthly starting salary in the Philippines of $180, no wonder our doctors have started to enroll in specialty nursing courses tailor-fitted for Filipino physicians who have either newly graduated or have put in some years of actual practice.

While this exodus of Filipino health workers is welcomed by our government, mainly because of the marked increase in dollar inflow contributed by this overseas manpower sector, nothing else is being done to address the looming health care manpower shortage especially in provincial hospitals and clinics.

The oft-repeated solution proffered by our health bureaucrats is to increase the salaries of doctors and nurses, and to allocate more public funds to the health care system. But given the sad state of government finances, we all know that these solutions are not doable.
Pragmatic Approach
That is why it is refreshing to hear from Tan. He says that the objective is not to stop doctors and nurses from leaving the country, but to take steps to ensure that – while Filipino health workers are being utilized to deliver services to citizens of other countries – our own people are not left dying because there are no doctors or nurses to attend to them. Some of the steps would cover the need to provide funding for the education and training of our students who aspire to be doctors, nurses or dentists. One possible source of this funding is to convince the top five Filipino health worker importing countries like the US, UK, Saudi Arabia, Ireland and Singapore to channel part of their official development assistance (ODA) to the Philippines for human resource development. Funds can be set aside that will be used to expand and upgrade the education and training programs for medical practitioners and to improve the working conditions of doctors and nurses who continue to work in the Philippines.

Another out-of-the-box idea to augment these funds is to negotiate with countries for certain amount of fees to be paid to the Philippines for every Filipino health professional that leaves for jobs abroad.
Unified Health Policy
But what I think is urgent before any of Dr. Tan’s proposed approach to the issue may be developed is for the various government units involved in health, the hundreds of medical and nursing schools, hospitals both private and public, and the health professionals, to get their act together and agree on a unified policy on what to do with our health human resources. There are currently two distinct but conflicting messages from government: the labor and employment department says "Go abroad!" while the health department says "Stay and serve the country." The former is motivated by the promise of dollar remittances, while the latter is desperate to save our dying poor.

The country is now experiencing lower ratios of nurses and doctors to patients; even the quality of professional health workers is deteriorating. The prestigious state-owned Philippine General Hospital is so desperate that it is presently accepting nurses who barely make the passing grade.

If there are people who will move to get everyone’s consensus on what to do to stave off an impending national health crisis, we will be able to agree on a win-win solution that will keep all major stakeholders in the industry happy. I guess the parting words here, to borrow and paraphrase from Sen. Juan Flavier’s cache of catchy slogans, is "Let’s do it!"