You may have seen on the front page of the NY Times an article on the Immigration Reform bill in the Senate that has a provision that would remove any visa cap on RNs for the next 7 years. The article talks about the potential negative impact on the health care systems of poorer countries (citing specifically the Philippines). The Philippines, as a matter of economic policy, deploys its citizens to work in countries all over the world. It also produces more RNs than it could ever use in its own health care system so that RNs can work in other countries and return a percentage of what they earn back to their families in the Philippines.
Specifically in the Philippines, you need to consider the number of BSN RNs their educational system is producing. Here are statistics from a report published by their Professional Regulation Commission on RNs sitting for the Philippine Nursing exam over a several year period of time. Their latest report covers years 1999-2003. The national total of RNs sitting for the Philippine Nursing Board exam during those years was 55,744. And we know from our trips, many of the Nursing Colleges have greatly increased their RN enrollments since 2003.
The Philippines has its share of unemployed RNs and RNs who have left the profession. What we have found on our many recruitment trips to the Philippines is many unemployed RNs turning to other countries for employment. There is no nursing shortage in the Philippines; the shortage is of PAID NURSING POSITIONS. There are large numbers of qualified RNs who have turned to other means of work because the pay for RNs is so poor and the work is so very hard. Many RNs simply cannot afford to work in their profession.
There is no lack of unpaid positions. There is another phenomenon in the Philippines which has been taken to the extreme, the "Volunteer Nurse." It used to be that new grads would work as Volunteer Nurses while studying for the Philippine Nursing Board exam. Now many of the hospitals will only take on RNs who are willing to be Volunteers for extended periods of time (1-2 years) with the hope that the position will turn into one that pays them. We have interviewed countless RNs returning to the Philippines from an overseas assignment, from a place like the Middle East, who are unable to find paid employment in the Philippines, despite extensive years of solid nursing experience.
The Philippines deployed close to a million citizens for work overseas in 2005 (981,677). These statistics are from the website of the governmental agency that manages this deployment of talent, the POEA (Philippine Overseas Employment Authority). Looking at their deployments for the year 2005, here is a breakdown of the destinations where OFW (Overseas Filipino Workers) went for all kinds of occupations, including healthcare:
393,654 The Middle East
253,276 Asia
52,970 Europe
11,258 The Americas (7,753 of 11,258 came to the U.S. in 2005)
9,098 Africa
2,859 Oceania
7,595 Other
247,707 sea-based workers
Deployments in 2005 to the U.S. were less than 1% of the total Filipinos deployed throughout the world (0.79% if you do the math).
The above information was extracted from the POEA website. You can check it out yourself by going to www.poea.gov.ph
The issue is more that just statistics. Removing the visa cap for RNs is not a straight line to admission to the U.S. as an RN. Removing the cap will not open the flood gates for RNs from everywhere in the world to come to the U.S. Except for the first 6 months in 2005, visas have been readily available for RNs since 2002 when Direct Source first entered this arena.
There are many other factors besides the number of visas that are available that naturally limit the number of exiting RNs for the U.S. from any country, including the Philippines.
The U.S. has rigorous requirements from credentials verification to qualifying exams. To begin with, there are only so many seats available for the U.S. qualifying exams each year. We don't see lifting a visa cap as changing that picture all that much.
Here are some statistics from the Commission on Graduates of Foreign Nursing Schools (CGFNS) which offers the most widely taken Nurse Qualifying exam for the U.S. The info appears in their 2005 Annual Report which is on their website: www.cgfns.org
From October 2004 - September 2005, there were 25,607 CGFNS exam test takers. Of that number, 9,211 passed (about 36%). Passing the CGFNS exam is only step 1 in the process. The RNs then need to pass grueling English qualifying exams (written and spoken). This is where some percentage stumble. Best guess on the percentage of CGFNS passers who get through the English exams on the 1st try is 65%. So the 9,211 CGFNS test passers in the year cited becomes about 6,000.
Another program that helps gauge the number of foreign-educated RNs potentially entering the U.S. in a given year is the Visa Screen program. Once qualifying exams are done, the RNs still need a Visa Screen Certificate in order to be eligible for a U.S. employment-based visa. During the same year 10/04-9/05, CGFNS, the only organization authorized to issue Visa Screen Certificates for RNs, issued approximately 13,000 Visa Screen Certificates; this is a worldwide number. Having a Visa Screen doesn't mean the RN will enter the U.S. We see plenty of applicants who get all their testing done and apply for Visa Screen and get the Certificate, but they do not yet have an employer to sponsor them. But it is a good enough gauge on the number of RNs who potentially can enter the U.S. in a given year.
Of the 13,000 Visa Screen Certificates issued, here are the countries of origin of those RNs. It is true that the Philippines is the largest; this has been the case for years and years.
7,138 Philippines
2,702 India
2,373 Canada
584 South Korea
The other countries in the world have very small numbers of Visa Screen recipients.
The Philippine health care system is not like ours. There are private hospitals and there are provincial and government hospitals. The private hospitals may have a small percentage of their beds for "charity cases" but the vast majority of beds are for "paying patients." If you can pay, you will get the treatments you need. The government hospitals can't turn away patients; so, a person may get admitted to a government hospital. However, if the family cannot come up with the needed funds for the operation the person needs or the medications needed for treatment, the patient doesn't get treated. This is not new. This is their system. So when an article cites people going untreated, you need to understand how their system works. People indeed may not be receiving the treatments they need but it is not due to a nursing shortage, but due to the financial construct of their health care system. One of the positive things about a job in the U.S. (or any other 1st world country) as expressed by the RN candidates, themselves, is the fact that people they will serve will get the treatment they need. This is not the norm in the Philippines.