The global shortage of healthcare workers is taking its toll

THE SHORTAGE OF HEALTHCARE WORKERS in the United States has been well-publicized, but many Americans are still unaware that there is also a global shortage of more than 4 million healthcare workers.

The World Health Organization says that 57 countries, most of them in Africa and Asia, are facing severe health workforce shortages. Wealthy countries like the United States and the United Kingdom, which also are experiencing such shortages, have turned to recruiting healthcare workers from other countries to fill the gap. This practice threatens to ravage the healthcare systems of developing countries, which face significant public health challenges when they lose their workers’ essential knowledge, skills and expertise. The problem has become so widespread that the Global Health Workforce Alliance (GHWA) held a conference in Kampala, Uganda, in March to discuss the crisis.

“The issue is not about stopping migration, but about management and regulation,” says GWHA executive director Francis Omaswa. “Freedom of movement is a fundamental right, and migration is a staple of human history. Globalization has accelerated this trend significantly. But the grave effects of health workforce migration on developing countries call for a responsible, regulated management of migration, with a critical aim that all countries move toward self-sufficiency.”

The exodus of healthcare workers takes a huge toll on healthcare systems, limiting the number of people who can receive care and diminishing the quality of that care. Health worker shortages limit treatment for diseases such as HIV/AIDS and tuberculosis, limit immunization coverage and primary care outreach, and are directly related to infant, child and maternal mortality. In addition, developing countries that have invested heavily in training their healthcare workforce face a devastating loss of that investment.

Since 2001, more than 66,000 foreign-born registered nurses have joined the United States healthcare workforce, and that number is growing. But nursing isn’t the only profession that will see the arrival of more foreign-born workers. The healthcare pro-fession is experiencing double-digit vacancy rates for pharmacists, X-ray technicians, laboratory technologists, and housekeeping and maintenance staff. Long-term care facilities and home health agencies also are having trouble recruiting nurses, therapists and aides. Many of these positions will be filled by foreign-born workers.

The “push, pull” factors

There are many reasons why healthcare workers choose to leave their home countries and take their skills elsewhere.  The “push factors” that encourage health professionals to leave their countries include low pay and benefits, unsafe working conditions and a deteriorating healthcare infrastructure.

In many developing countries, healthcare workers often don’t have the necessary medicines, equipment or support to effectively care for patients. The biggest “pull factors” are wealthier countries’ shortage of healthcare workers and those countries’ active re-cruitment of skilled health professionals abroad. Workers’ desire to seek a better life also draws them to new jobs in wealthier countries.

Jossily Joseph became interested in nursing in the United States because the salaries were much higher than in India. She worked for two years in the cardiac recovery unit of a large hospital in New Delhi before deciding to come to the United States in 2004. Joseph is now a nurse in the progressive care unit at Centerpoint Hospital in Kansas City, Mo.

Although conditions at her hospital in New Delhi weren’t bad, migrating to the United States simply offered better career opportunities and better living conditions, says Joseph, who is a member of Nurses United for Improved Patient Care/AFT Healthcare.

Opportunity for a better life also brought Ellen Grace Parpana to the United States. Parpana was a nurse in a community hospital in the Philippines before she migrated to Danbury, Conn., in 1988, with a group of 15 other Filipino nurses. Although she had to leave her husband and two children behind, they joined her in Danbury in 1992. “It was difficult without my family, but we [the other nurses she migrated with] were close,” Parpana says.

Danbury Hospital was refreshingly different from the hospitals in the Philippines, says Parpana, who works in the hospital’s orthopedic unit and is a member of the Danbury Nurses, Local 5047. “Here everything is at your hand. Patients get diagnosed right away.”
Unions would improve working conditions and salaries in the Philippines, says Parpana. “It’s so nice to have a union here. But there are no unions in the Philippines—things would be very different there if there were unions.” Even so, Parpana says, “I have no regrets [about migrating from the Philippines to the United States]. We have a good life here.”

What we must do

The time has come for the United States and others to find ways to address their shortage of healthcare workers, says Candice Owley, chair of AFT Healthcare’s program and policy council and an AFT vice president. In 2004, Owley visited Botswana, South Africa, Swaziland and Zimbabwe, where she toured hospitals and met with nurse union representatives. The hospitals were not only overcrowded and poorly equipped, they also had high nurse-vacancy rates.

“We have an ethical and moral obligation to let others know that, as we recruit nurses and health professionals from their countries, people in those countries are dying,” says Owley. “If we don’t figure out a way to address the healthcare worker shortage [in the United States], hospitals will bring in thousands of foreign healthcare workers to take on the problem.”

Agreements between “importing” and “exporting” countries, or a code of practice for the international recruitment of health personnel—especially from developing countries—would help, recommends Omaswa of the GHWA. These could ensure an ethical, transparent balance between the rights, expectations and obligations of everyone involved, including recruiting agencies and migrant health workers, he says.

According to the AFT’s policy statement on migration, all governments should be strongly encouraged to include workers and their unions in the development and implementation of measures to attract and retain healthcare workers in their own home countries. Such measures include improved terms and conditions of work, increased benefits, and career development activities.

At the same time, U.S. unions must actively reach out to new members migrating from other countries, to ensure their full involvement and participation in the life of the union.
Molly Varghese, a native of Kerala, India, came to the United States in 1982. She left India to be with her husband and to study computer science even though she had always wanted to be a nurse.

“I wanted to be a nurse as a child but in the 1950s and ’60s nursing was not seen as a respectable job in India,” says Varghese.

Today, the perception of nursing has changed in India, she says. “There is more respect for nursing.” As a result, there are a lot of nurses from India who have gone abroad to the United States and countries like Kuwait and Dubai, and they are sending money back home, says Varghese, who works in Occupational Medicine Services, an employee health department at the University of Medicine and Dentistry of New Jersey. She is also a co-president of the union, Health Professionals and Allied Employees, Local 5089.

“I am aware that some unions are trying to help members who have migrated from other countries, but at the same time, I know that a lot of union members are against immigrants too. I have been asked why I can’t go back, instead of coming here and taking away their opportunities.”

But coming to the United States was not about taking away anyone’s opportunity, she says. “I am not here illegally, and the opportunity is out there for anyone to grab.”  Instead, her journey has been about fulfilling a lifelong desire to be a nurse.

“Nursing gives you that special feeling you can only get from helping others. We can also use our work to guide youngsters into careers that will give them a better future, and the whole country can benefit from that.”