Medical Apocalypse

As Canada ramps up its plans to hire Filipino medical professionals by the thousands, The Philippines’ health care system is on the brink of collapse, says Dr. Jaime Galvez-Tan, former executive director of the University of the Philippine’s National Institute of Health.

The former Health Secretary predicts a "medical apocalypse" in The Philippines as doctors flee their $500-a-month government jobs for a better life in Canada, with as many as 6,000 Filipino MDs currently training to become nurses in order to land plum jobs in countries such as Canada.

The Philippine Health Department is alarmed over the rising number of doctors and nurses who are leaving the country to seek better pay abroad.

Health officials say the exodus of doctors has forced some hospitals to close, and has brought the doctor-patient ratio in The Philippines to 1 for every 28,000 Filipinos.

Tan, a Health Department consultant and a professor at the Philippine General Hospital, said his country is only now coming to terms with the "medical crisis," with "doctorless" towns and cities in The Philippines becoming an increasing - and alarming - reality.

There are 120 municipalities in the country without a doctor, Tan said. In Western Samar alone, 16 of its 21 towns don’t have doctors, Tan said at a health forum last week.

And Tan places the medical "brain drain" blame squarely on the shoulders of countries like Canada, which is shoring up its baby-boom retirement gap with imported professional labour.

"(Canada) is going to import ‘droves and droves’ of our doctors, and nurses," said Tan. "Canada’s need for our doctors will be for the next 20 years."

"For the past 25 years, Canada was only hiring caregivers. Now Canada is a new market for our doctors and nurses," he added.

The growing exodus of nurses and doctors overseas has prompted Negros Occidental Representative Ignacio Arroyo to file a controversial bill that requires newly graduated health care professionals to render at least two years of service before they are allowed to work abroad.

Philippine Medical Association president Rey Melchor Santos has also pushed for the approval of legislation that will ensure more benefits for health workers to entice them to stay in The Philippines.

Private groups have also joined the campaign to reward Philippine health professionals who have opted to stay and "serve flag and people."

For his part, Health Secretary Francisco Duque III has stressed the need to counter the exodus and allow foreign doctors to undergo training and practice in the Philippines.

Although he has been under attack for this stand, Duque cited the need to fill the vacuum due to the mass exodus of doctors and nurses.

Dr. Tan announced last week that Canada – as well as Finland and Bahrain - has already agreed that for every Filipino doctor and nurse that it recruits, it will sponsor three Filipino students who are taking up medicine or nursing in college.

In Vancouver, The Philippines’ labour attache, Bernardino Julve, says his Philippine Overseas Labour Office is bracing for an influx of medical professionals to Western Canada.

"We expect that under the new ‘regulation regime,’ contracts for medical professionals - like those of others - will be coursed through our office henceforth."

The ‘regulation regime’ Julve alludes to is a series of Memoranda of Understanding, or MOUs, The Philippines has recently signed with the provinces of British Columbia, Saskatchewan and Manitoba. The Philippines expects to sign a similar agreement with Alberta in the coming months.

The MOUs provide for the ethical and orderly recruitment and deployment of Filipino workers in Western Canada. They also provide for compensating arrangements for the loss of human resources, including funding for systems and infrastructure for the replenishment of supply, and training and skills upgrading in The Philippines.

"It is too early to say what effect or impact the recently signed MOUs will have on the medical professionals in The Philippines vis-a-vis the desire of many of them to work abroad, Canada in particular," says Julve, adding his office is yet ot issue guidelines implementing the MOUs.

Dr. Melchor Rey Santos, president of the Philippine Medical Association, said the list of active doctors in his organization was reduced by at least 10,000 doctors for the past several years.

He said of the 35,000 active practicing doctors in the PMA list, 6,000 are now working in different parts of the world while 4,000 have shifted to nursing profession.

In the past 10 years, as many as 90,000 Philippine nurses have taken their skill sets abroad. In 2006, more than 6,000 nurses working in Canada graduated in The Philippines.

And Dr. Tan says the number of doctors who leave The Philippines is increasing more than ever.

"We can expect the exodus to continue," he said at a forum last week organized by the Philippine College of Physicians.

Many doctors, added Tan, leave for abroad because of the small pay or the serious lack of medical supplies in The Philippines. Most of the doctors leaving the country come from public and provincial hospitals, seriously eroding the national health care system.

Next to India, The Philippines is already the largest source of doctors in hospitals abroad. The country also supplies 25 per cent of all overseas nurses worldwide.

Not surprisingly, about 10 per cent of The Philippines’ 2,500 hospitals have closed down in recent years because of the loss of doctors and nurses to jobs overseas.

As doctors and nurses flee, the situation in Philippine hospitals only worsens.

Rita Tamse, deputy director for nursing of the Philippine General Hospital, says patients’ health is jeapordized as novice medical professionals step in to fill positions vacated by doctors and nurses who have put in a few resume-building years before departing for better jobs abroad.

"Our problem is unskilled, untrained nurses," says Dr. Irineo Bernardo, executive officer of the Philippine Hospital Association.

He notes that the turnover of nurses has been particularly high in the last five years.

"In a small hospital, we’d expect one or two to leave for abroad in a year," says Bernardo. "Last year, we had five who left."

Philippine health consultant Dr. Tan says The Philippines must negotiate bilateral arrangements with countries that import Filipino health workers, agreements that would lead to the allocation of development aid or compensation to the Philippines in exchange for sending health workers abroad.

Citing the alarming exodus, he also recommends The Philippine government create a national commission to oversee the planning, production, deployment, retention and development of health professionals.

In 2006, the Philippine Alliance of Health Workers predicted The Philippines health care system would collapse in two to three years.

The AHW said that an estimated 30 percent of the country’s 100,000 registered doctors have migrated to North America.

"I don’t think there is anything that can be done to stop this outflow of doctors from The Philippines," says British Columbia Hospital Employees’ Union provincial executive, Filipino-Canadian Boni Barcia.

"To be a doctor in The Philippines will cost you a fortune and it will take you forever just to break even, especially if you will do your practice in the provinces," he adds. "They might stay if the government gave them high wages and benefits like doctors here in North America, but I doubt that will ever happen."