Symptoms persist: Nurses leaving, docs still so few

Nursing students wait for the capping and pinning ceremony. —INQUIRER FILE PHOTO

A lawmaker on Thursday expressed alarm over a possible fresh wave of mass migration of Filipino nurses to the United States as the professional board regulator reported that the ratio of doctors to the population remained below the standard set by the World Health Organization (WHO).

Quezon City Rep. Marvin Rillo, vice chair of the House committee on higher and technical education, noted that 26,972 Filipino nurses took their first US licensure test from January to September this year.

It was an “all-time high number” for the country’s nursing graduates, Rillo said. It was more than double the 12,399 who took the test during the same nine-month period in 2022.

Figures from the US National Council of State Boards of Nursing Inc., which administers the National Council Licensure Examination, show that 49 percent of Philippine-educated nurses pass the exam on their first take. Passing the exam is the final step in the US nurse licensing process.

“The surge in the number of nursing graduates from the Philippines taking the US licensure examination betrays a looming new wave of mass migration of practitioners to America,” Rillo said.

“The government should take forceful action now and invest more money to hang on to some of our nurses in the local health sector,” he said, suggesting a major salary hike for entry-level nurses in government hospitals.

According to data compiled by the Philippine Overseas Employment Administration (POEA), 18,644 nurses went overseas in 2019, 16,711 of them as temporary migrants and 1,933 as permanent migrants. Due to the migration ban during the pandemic, POEA recorded 5,787 temporary nurse migrants in 2020 and 10,610 in 2021.

A 2020 study by the University of the Philippines (UP) showed that there were 8.2 nurses per 10,000 nationwide, below the WHO-prescribed ratio of 1:1,000, or 10:10,000.

The standard nurse-to-patient ratio set by the Department of Health (DOH) is 1:12 but according to other studies, in most government hospitals, the usual nurse to patient ratio in general wards is 1:20.

The UP study also showed an average of 3.7 doctors per 10,000 population, also below the 1:1000 (or 10:10,000) prescribed by WHO.

Dr. Eleanor Almoro, a member of the board of medicine of the Professional Regulation Commission (PRC), said there were nine registered physicians per 10,000 people in the country last year. She noted, however, that there was a wide disparity in their distribution across the country, with some regions showing small doctor to population ratios.

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Lowest in Davao region

The lowest at two per 10,000 is in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM). Metro Manila has 29:10,000, according to Almoro, who led the medicine board from 2019 to 2022.

Figures from WHO showed that there were 7.86 doctors per 10,000 population in 2021, up slightly from 7.52 in 2020, but still below its recommendation.

Other statistical sources show the small number of doctors per 10,000 people. The data and business intelligence portal Statista reported in its October 2023 report that there was only one doctor for approximately 26,000 people in 2022.

In September, it reported that Davao region accounted for the lowest doctor-to-population ratio in 2022—one doctor per 40,680 people. In contrast, it was 1:15,300 in Metro Manila.

Comparing doctor-to-population ratios with other countries in Southeast Asia, WHO figures show that there were 22.28 per 10,000 in Malaysia and 9.28 in Thailand, both in 2020. But the Philippine figure was higher than Indonesia’s 6.95 per 10,000 and Laos’ 3.27, both in 2021, and Myanmar’s 7.51 in 2019.

Almoro noted that the ratio may be much lower if specialty doctors were considered, but there was no available official number of specialists per region.

“So, the unequal distribution of physicians is primarily the problem … assuming that everyone is in the country practicing. That is one of the things we need to address,” Almoro said in a roundtable discussion on Thursday.

The concentration of doctors and nurses in urban areas in the country calls for effective strategies to encourage medical workers to remain in the country and to serve in rural areas, especially remote places.

Raising base pay

For nurses, Rillo is seeking to remedy the situation with his proposed House Bill No. 5276, which would raise the lowest monthly base pay of nurses employed by government hospitals by 75 percent—from P36,619 to P63,997.

This will increase the minimum base pay of government nurses by six notches to Salary Grade 21 under the Salary Standardization Law of 2019.

Rillo cited WHO’s warning that overseas migration could result in a nurse shortfall in the Philippines of 249,843 by 2030.

According to DOH data, there are around 10,600 registered nurses annually and Philippine schools produce some 80,000 nursing graduates every year.

The PRC reported that there were 475,995 licensed nurses in the country in 2021.

In the case of doctors, Shirly Pador, chief of learning and development division of the DOH’s Human Resources Development Bureau, said the deployment of doctors to far-flung communities sought to address the problem.

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Benefits

These doctors get higher salaries based on national rates compared to their local counterparts, Pador told Thursday’s forum. But she acknowledged that this “solution” created another problem—unequal pay.

The DOH deployment program under the National Health Workforce Support System aims to provide “fair compensation and benefits” to encourage health practitioners “to stay where they are needed the most.”

Among the benefits given to health workers under the program are personal economic relief allowance, hazard pay, productivity enhancement incentive, subsistence, laundry and clothing allowance, mid-year bonus, and cash gift.

On the other hand, the pay of a doctor employed in a local government-run hospital is dependent on the capacity and income classification of the municipality, Pador said.

She said that if the local government could not match the financial benefits provided by a national government facility, they are encouraged to provide non-financial benefits, like housing and food allowances.

Another “come-on” for health practitioners to stay in poor communities is by providing them “continuous learning opportunity,” such as enrolling them in one of the government’s partner institutions in a master’s degree program, Pador said.

Widening pay gap

The widening salary gap between public and private health-care workers is another issue in the health sector that has yet to be resolved.

Dr. Madeline Sosa, former president of the Association of Philippine Medical Colleges, pointed out that private institutions could not give high salaries because they had “revenues [to meet] to be able to cover all of (their expenses).”

Sosa, who also served as dean of De La Salle Medical and Health Science Institute, noted that a doctor undergoing residency training at a public hospital may get a monthly pay of around P60,000, while a counterpart in the private health facility may receive around P30,000 per month.

—WITH A REPORT FROM INQUIRER RESEARCH