Stephanie Chan spent four years at Manila Doctors College qualifying to work as a nurse overseas. She never left the country. Instead, she switched careers and now earns almost as much monitoring people’s finances.
Chan is one of thousands of Filipinos each year who study to become health workers to boost their chance of a higher income overseas. She’s also now part of a growing trend of workers who are opting not to go. Chan now works at a call center in Manila, where she reminds Macquarie Bank Ltd. credit-card holders to make payments.
“I’m thankful this career opportunity opened up for me,” said Chan, 23, who works the night shift at a business-process outsourcing company and lives at home with her parents. “If I can maintain a relatively high standard of living as a customer-service representative, why go overseas to work as a nurse?”
Developed countries that rely on Philippine nurses and Indian doctors to hold down costs in the $6.5 trillion global health-care industry face greater competition for talent just as baby boomers in the U.S., Europe and Japan reach the prime age for medical care. Economic growth in emerging economies, despite some signs of recent slowing, is stoking investment in hospitals and creating job opportunities in other industries that mean a growing number of health workers choose to stay at home.
The growth and investments should help reduce an imbalance that has caused a severe shortage of health-care workers in developing nations. Japan had 2.2 doctors and 9.5 nurses per 1,000 people in 2009, while the U.S. had 2.4 doctors and 10.8 nurses, according to the OECD. In Indonesia, the proportion was 0.2 doctors and 1.4 nurses, while in India it was 0.7 and 0.9.
Philippine President Benigno Aquino, for instance, plans to build and rehabilitate more than 2,700 hospitals, clinics and community health centers next year as part of $9.7 billion investment in infrastructure. The nation’s $225 billion economy expanded 6.1 percent in the first half, and the peso is the best performer against the dollar among Asia’s 11 most-traded currencies this year, advancing about 5.5 percent.
“If you are taking more, somebody is losing, unless you put in place a policy that increases the overall supply,” said Kamalini Lokuge, a researcher at the Australian National University in Canberra, who has advised the World Health Organization on improving health care in developing countries. “There’s a shortage everywhere because of that.”
The world is short more than 3 million health workers, including at least 1 million community nurses and doctors, Westport, Connecticut-based Save the Children said in May.
In New Zealand, 34 percent of doctors and 21 percent of nurses are from abroad, the highest among developed countries, while in the U.S. 27 percent of doctors and 5 percent of nurses are foreign, the WHO said in its 2006 World Health Report. More than half of the health workers in the Persian Gulf states are foreign-trained, according to the Geneva-based agency.
Philippine and Indian nationals lead the supply, each making up 15 percent of all immigrant nurses and doctors respectively in the 34-member Organization for Co-operation and Development. About 3 percent, or 89,000, of the 2.9 million registered nurses in the U.S. are Asian, Native Hawaiian or Pacific Islander, according to MinorityNurse.com, Westford, Massachusetts-based resource portal.
The health-worker deficit has reached a crisis level in 57 countries, according to the Global Health Workforce Alliance, a partnership created in 2006 by the WHO. Thirty-six of those countries are in sub-Saharan Africa, which has a quarter of the global burden of disease and only 3 percent of the world’s health workers, it said.
$78,000 a Year
For countries that can afford to pay, the cost of health-care workers is likely to rise. That means migrant workers stand to more than double their pay from landing a job in an advanced economy. Full-time registered nurses in the U.S. make about $57,000 a year, according to MinorityNurse, while in Australia they earn as much as A$75,000 ($78,000). In the Philippines, an entry-level nurse at a public hospital earns about 8,000 to 13,500 pesos ($195 to $325) a month, according to the Bureau of Local Employment website.
Indonesian Wahyudin lifted his pay 2,900 percent by moving to Japan from a clinic in East Java.
To get the job as a caregiver in one of the world’s fastest aging nations, the 30-year-old nurse, who uses one name, had to study Japanese language and script day and night for three years to pass the country’s challenging examination.
Wahyudin sends most of his salary home to his parents, who sold rice paddies to pay for his education. With the money, they have bought a coffee plantation and built a two-story house in the mountain village in Lampung, Sumatra. Wahyudin’s earnings pay for his younger sister’s schooling.
“I cried when I first got my salary,” said Wahyudin, who earns 185,000 yen ($2,390) a month -- the equivalent of more than two and a half years’ pay as a nurse back home. He is one of 80 Indonesian and Filipino nurses at Kenshokai Group, which operates 114 nursing homes and daycares in Tokushima, southwest of Tokyo.
The shortage of caregivers in Japanese hospitals and nursing homes is worsening as the population ages. About one in three Japanese will be over 65 by 2025, from one in 4.4 in 2009, according to government data.
Japan opened its labor market for nurses and caregivers to Indonesia and the Philippines as a part of trade agreements in 2008. Since then, 1,360 candidates have come to Japan and only 100 of them -- or 7 percent -- have passed the exams.
“We need to do whatever it takes to find workers,” said heart surgeon Takaaki Kameda, chairman of Kameda Medical Center in Chiba, east of Tokyo. “Demand for medical care will be much higher when baby boomers in urban areas get older. We definitely need to fill the shortages with immigrants.”
The hospital opened a university for nurses in Japan and is considering setting up Japanese classes at colleges in China to help people there pass the test to work in Japan.
More than 40 percent of the population will be at least 60 years old in Japan and South Korea by 2050 and almost 35 percent of the population in Europe is projected to be 60 or older by 2050, from 22 percent in 2009, according to the United Nations.
The prospect of more, better-paid jobs back home appeals to migrant worker Angel Claudio, who went to Singapore in January to work as a staff nurse at Khoo Teck Puat public hospital.
“If the economy gets better and the salary gets better, I think fewer Filipinos will work abroad,” said Claudio, 25, during her break in the hospital cafeteria. “Who wants to be far away from their family?”
The biggest losers in the talent battle may be the poorest and most disease-prone countries. A billion people worldwide lack reliable access to basic health services, the Global Health Workforce Alliance said.
Three quarters of doctors trained in Mozambique are working aboard, mostly in Portugal, South Africa, the U.S. and the U.K., the Alliance said. HIV treatments that require administration by physicians are being carried out by environment officers with six weeks’ medical training in Zambia, said Lukuge at the Australian National University.
To address the challenge, the WHO adopted a Global Code of Practice in May 2010 -- the first such use of the organization’s constitutional authority in 30 years -- to provide a framework to regulate aggressive recruitment. It recommends countries aim for self-sufficiency of workers and developed nations provide poorer economies with technical and financial assistance.
Meantime, nurses like Chan, who said she earns about 25,000 pesos a month at her call center, increasingly find opportunities elsewhere, often in related industries.
Vackie Jonn Licudan, who qualified to work as a nurse in the U.S., said he had wanted to move to America since he was a boy. While he was waiting for an immigration pass to work in Vermont, he took a job at an outsourcing company in Manila. Now he earns more than 80,000 pesos a month running a team of other nurses who review medical insurance claims.
“I belong to an industry that is growing and, given the career path and opportunities I have and will have, I no longer want to move,” said Licudan, 31, who bought a 3.9 million-peso apartment, goes clubbing twice a week and eats out almost every day. “I can build my future here.”