globalization and the health care workforce. describe the history and current trends in...

Chapter 3Globalization and the Health Care

Workforce

Describe the history and current trends in international migration of physicians and nurses

Enumerate the factors that motivate physicians and nurses to migrate to other countries

Discuss the implications of physicians and nurses migration for sending and receiving countries

Understand the policy context and policy interventions that attempt to manage physicians and nurse migration

Explain the issue of ethical recruitment, visa regulation, credentialing, and adaption for managers of foreign-born and trained physicians and nurses.

Learning Objectives

The International Migration of healthcare workers has caused increased debate in recent years.

Issues arise with both the sending a receiving country.

Specifically, developing countries lose trained personnel they have invested resources in.

Managers of US Health Care systems need to understand international migration.

Introduction

WHO Study in 1970 found International Medical Graduates practicing in the US were about 1 in 5.

Significant numbers of International Nursing Graduates were also working in the US

History and Current Trends

Historically sending countries were :◦ Haiti◦ Suriname◦ Hong Kong◦ Jordan◦ Philippines


Characteristics of the healthcare workforce migration have shifted since the WHO study

Now we see migration FROM:◦ Egypt◦ Cuba◦ The Caribbean◦ Sub-Saharan Africa◦ The Former Soviet Union


Push Factors◦ What motivates them to leave?

Pull Factors◦ What motivates them to come?

Cause of International Migration

Brain Drain: Sub-Saharan Africa and the Caribbean◦ Widespread , uncontrolled departure of physicians

and nurses. ◦ High rates of emigration have been seen in:

South Africa Ghana

Sending Country / Region Trends

Brain Drain: Sub-Saharan Africa and the Caribbean◦ In Africa the HIV/ AID epidemic has seriously

depleted the healthcare workforce

◦ 42% of nursing positions in the Caribbean are vacant

Sending Country / Region Trends

Some workforce migration is done purposely.

◦ Cuba has utilized their workforce surplus to supply other countries for decades

◦ Cuba has done this to become a global leader in healthcare

Strategic Deployment: Cuba the Philippines, and India

Similar to Cuba, the Philippines has supplied the world with nurses◦ The Philippines produces about 20,000 nurses a

year◦ In 2004, 85% of these nurses practiced abroad


◦ Up and Coming Player: China China is relatively new to the global market Has only sent workers abroad for the last 15 years


The Policy Context◦ The receiving countries may not be addressing

the root of the recruitment problem. ◦ General Agreement on Trade Services

Liberalize trade in services Encourage economic growth Increase participation of developing countries in

world trade◦ NAFTA

Created special visas between the US, Canada and Mexico

Consequences for Receiving Countries

Policy Responses◦ WHO Activities

Treat, Train, Retrain◦ ICN Statement

Developed guide on the ethical recruitment of nurses Encourages receiving countries to correct their system problem of recruitment

◦ Domestic Policies in Sending Countries Implemented to curb “Push” issues Disincentives in the form of migration fees are sometime used

◦ Domestic Policies in Receiving Countries Turnover for nurses is estimated to be between 10% to 30% Policies implemented to reinvest in healthcare workers

◦ Government to Government Bilateral Agreements Receiving country agrees to underwrite the cost of medical training Staff are recruited only for a fixed period

◦ Compensation Schemes In addition to reimbursement for educational cost, this requires receiving country to

pay additional costs to the sending country for the cost of losing the worker.


Policy Responses◦ Managed Migration in the Caribbean

Promotes regional cooperation in six areas: Terms and condition of work Recruitment, retention and training Value of Nursing Utilization of deployment Management practices Policy development

◦ Code of Practice on International Recruitment in the UK The UK is one of a few receiving countries that have

set criteria for recruitment


Recruitment◦ Twinning◦ Staff Exchange◦ Educational Support◦ Bilateral Agreement

Regulation While in training = J-1 visa After training some convert to a H-1B or O temporary visa H-1B applies to specialty occupations O visas apply to physicians with Outstand abilities in their field Permanent residency through

Labor certification National interest waiver

Issues for Managers

Credentialing◦ IMGs must have a diploma from a school listed in

the International Medical Education Directory◦ Must pass step 1 and 2 of the US Medical

Licensing Exam◦ Must have acceptable scores on the TOEFL

Issues for Managers

Adaptation◦ Must learn the culture of US Medicine

IE: patient centered care for mental illness

◦ Must Also learn American family culture Certain family relationships will effect diagnosis and

treatment (IE: single parent home)

Issues for Managers

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