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


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)

6
11
9
18

 Negritos – Malay aboriginals
 13 th 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)

 Manila is 11 th most populous metro in the world
11 million (11%) overseas; largest diaspora
 Literacy rate: 93%
 Language: Filipino and English; >180 dialects
 Labor force: 34.2 million

 Spanish: names, language, religion/customs, food, architecture
 “…a Latin American country transported to the Orient…”
 American: fast food, music, movies, pop culture
 “Brown Americans”

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

 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

 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

 Top countries of medical education for IMG physicians
Country
India
Philippines
Mexico
Pakistan
Dominican Republic
Total
47,581
20,861
13,929
11,330
7,892
Percentage
19.9%
8.7%
5.8%
4.8%
3.3%
American Medical Assn., 2007

 Harsh realities: Compensation/month for resident MDs
Philippines South Africa USA
$300 $1,000 $4,000

 Other limitations
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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

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

 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

84%
Percent of Hospitals Hiring Foreign-educated
Nurses by Country from which They Recruited,
2006
33%
29%
Philippines Canada
American Hospital Assn., 2007
India
9%
Africa
7%
China
6%
Korea

USA Canada Philippines
$200 $200 $200
Daily Daily Monthly


MD
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

 Remittances from overseas workers
 Expedited but suboptimal training
 Reduced unemployment
 Technology transfer
 Healthcare cultural diversity
 Demoralization of MDs
 “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

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

JAMA. 2008;299:1753-4.

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