To leave or not to leave

Ernesto F. Herrera
The Manila Times

Policies aimed at retaining existing and reattracting emigrant Filipino professionals are likely to have much greater success in a transformed political environment where hoping is not a futile exercise.

Philippine health professionals, in particular, have been migrating in search of greener pastures outside the country’s borders for decades and in droves. Does this phenomenon negatively affect the quality of health care offered in the country? Definitely. By how much? Experts disagree. Some say the country can very well produce new health professionals who can replace those who seek employment overseas, while others would contend that the accelerating and seemingly irreversible movement of health professionals primarily out of the country to the US, the UK, the Middle East, Japan and Europe is already taking a heavy toll on the country’s health system and would be disastrous in the near future.

Regardless of what you believe, I think you have to admit, the brain drain of nurses and doctors as well as other health professionals is significant. We need a thorough, honest-to-goodness study, jointly conducted by the private sector, civil society and the government, to establish the magnitude of the migration of our health professionals, its causes and to document the associated impacts on health service delivery in the country.

Over the weekend, the Trade Union Congress of the Philippines issued a press release, which said the Philippines has lost almost 48,000 registered nurses to the United States alone in a 10-year period. This is according to the results of the US National Council Licensure Examination for Registered Nurse (NCLEX-RN) from 1995 to 2004.

According to the US National Council of State Boards of Nursing, the number of people passing the NCLEX-RN "is a reliable indicator of how many new nurses, including those educated internationally, are entering the profession in the US."

The numbers, which translate to 4,800 yearly, do not include Filipino nurses who left for Europe, the Middle East and elsewhere. According to the World Health Organization, the Philippines has been sending overseas some 15,000 nurses annually, more than any other country. If this is accurate then there may be as many as 150,000 Filipino nurses who have gone abroad in the last 10 years, which would probably mean around 80 percent of the country’s total nursing workforce are working outside the country.

But those numbers don’t paint the bigger picture. It’s not just nurses who have been lured by better pay abroad but also doctors (or more appropriately, doctors who took up nursing), pharmacists, physical therapists, even dentists.

If my father who was an army doctor were still alive today he would think it absurd for a doctor to take up nursing, but as the song goes, "the times, they are a changin." Now there are thousands of doctors studying nursing just to be able to work overseas.

According to the Professional Regulation Commission, 4,000 doctors-turned-nurses have already left the country. And this phenomenon is happening at a time when most of the country’s public-health institutions are grossly understaffed and the skeletal staff that remains are reeling under heavy workloads; it is happening at a time when more and more Filipinos are dying of preventable diseases without ever having seen a doctor or health professional.

Obviously, existing policy responses are not having a significant impact on the retention of our health professionals. What might be done to stem their mass emigration?

The government, I understand, plans to spend some P43 billion annually over the next four years to augment the salaries of public-sector nurses, doctors and teachers, but can they really match the salaries and benefits these professionals would get abroad? For instance, a nurse in the US could easily earn $6,000, or P312,000 monthly, without counting health insurance and other benefits. I don’t think the government would be able to provide the same.

In a free economy and increasingly borderless world, skilled labor will instinctively seek the greatest reward, in the same manner that investors will take their money to wherever it will get the best return.

This is the reality, although I am sure it’s not the entire reality. Not all Filipinos pack their bags in search of foreign employers who can (as that Tom Cruise movie famously put it) "show them the money." Some, maybe a lot, just decide to leave because they think the country is hopeless; they’re desperate for something better and it’s a desperation that is not just economic in nature but also sociopolitical.

Just recently, I was shocked to learn from a friend that he’s moving to Canada. The guy had a moderately successful business, his family was well-off, his kids went to an ivy-league school. He wasn’t in any kind of financial trouble. He is the last person I would think of who would decide to leave, and one can’t blame me from questioning his sense of patriotism.

But he told me, "I’m sorry, sir. It’s not about the money. It was never about the money. I’m just tired of all the crime and corruption, of all the things that we’ve been trying to change in society since Marcos but just seem to keep getting worse. I don’t want to raise my kids in a country where hoping is a futile exercise."

I suspect he’s not alone in his sentiments. But I am also hoping that for every Filipino like him there’s one who would stay to help make things better.

And perhaps, a speedy resolution to the current political crisis might also be a prerequisite for curbing the ongoing migration of health professionals from the Philippines. Policies aimed at retaining existing and reattracting emigrant Filipino professionals are likely to have much greater success in a transformed political environment where hoping is not a futile exercise.