Everyone knows the ‘brain drain,’ I presume — the flight of educated professionals from the Indian subcontinent in the 1960s, 70s, and 80s to the west. A number of the immigrants were doctors, who were in desperately short supply at a time when the U.S. population was spiking. My own family was part of that event, which admittedly must have hurt the progress of health care in India itself (though I don’t know if this has ever been formally studied).
And while there now are, perhaps, too many doctors in the U.S., there aren’t enough nurses. According to one statistic in today’s New York Times, there were 118,000 nursing vacancies in U.S. hospitals last month, and the deficit could reach as high as 800,000 in the next decade. Now the U.S. Senate’s immigration bill contains a clause that will remove the immigration cap entirely for qualified nurses from India, the Philippines, and China.
The lack of qualified U.S. nurses is due mainly to the lack of places to train them; nursing schools turn away scores of applicants since there simply aren’t enough Professors of Nursing around. But despite the severe shortage, the American Nurses Association is opposed to the current measure, which it calls “outsourcing.”
The repercussions on the health care systems of the affected countries could be severe, even if there is some overall benefit to the local economy:
The flight of nurses from the Philippines, a former American colony, has provided a huge boost to a weak economy, through remittances. Some government agencies there have encouraged the export of nurses, who send home billions of dollars each year to their families.
A nurse in the Philippines would earn a starting salary of less than $2,000 a year compared with at least $36,000 a year in the United States, said Dr. Jaime Galvez Tan, a medical professor at the University of the Philippines who led the country’s National Institutes of Health.
He said the flight of nurses had had a corrosive effect on health care. Most Filipinos died without medical attention in 2003, just as they had three decades earlier. (link)
For the Philippines, there’s already a care drain. The same may be in store for India if this bill passes and goes through the House, as seems likely.
Incidentally, there is already a recruiting company, called RNIndia, that specializes in bringing Indian nurses to U.S. hospitals. And Abhi talked about another side of this issue here.
I’m a little skeptical of whether this will create a nursing shortage in India, as it has in the Philippines. The Philippines doesn’t have the same human capital that India does and considering there’s a billion of us I doubt this will put a huge dent in India’s labor supply in health care. Maybe I’m being naive, but this is just my projection. Will the clause bring Indian nurses in droves? I doubt it.
I second Lavanya on this. The nursing shortage here can be well fulfilled by Indian nurses without causing much of a dent in India. Indian people are not just hardworking they will immediately run to fill the gap. I don’t think India will fill a dent.
My mother has her own positive stereotype about nurses from Kerala. She absolutely loves them and says they are the kinds that are really made to be nurses, empathic and hardworking. Unfortunately she has also observed over the past 3 decades of practicing in India, middle east and UK that the women who migrate for nursing experience a high degree of broken or disfunctional marriages as a direct result of often making more money then their husbands. Especially women that have ventured in the nursing profession in the past few decades were women from the south and came from traditional households that did not sustain their ability to make more money then their spouse.
JoaT, that was actually the subject of Abhi’s post last year. There was a book called “When Women Come First” that looked specificially at Keralan nursess working in the U.S., and some of the problems that come out of that:
As for the question of whether this will make a dent, I’m still worried — or at least I will be until I see how things pan out. If the changeover is gradual it might not make a difference (and maybe new nursing institutes will crop up to respond to increased demand). But if it’s very sudden it may be an issue in dealing with things like the spread of AIDS.
I suppose it would help to find some statistics on the current capacity of Indian nursing schools as well as some kind of comparison of the nurse per capita ratios (how many nurses per 1000 people in India vs. the U.S. currently?). I looked around a little for those numbers, but didn’t come up with anything.
Thanx I just read it. It really is sad. I was quite oblivious to it until fairly recently.
I haven’t read “When Women…,” but I can tell you that nurses have been the breadwinners in American families from Kerala since about the mid-to-late ’70s (the earliest that Indian nurses started arriving in America), and while perhaps then, the shock of having your wife earning more may have been a sore point for our Indian men, people quickly get real. When faced with the realities of having to support not only yourself, but more than likely, family back home as well, Indian men were quick to recognize that it is an asset to marry a S. Indian woman who is a nurse. As a result, most middle-class families I know of in Kerala today (3 decades later!), with at least some financial resources, make it a point to send their girls off to nursing schools – first, for financial reasons, but also to secure them a fair-skinned, money making hubby who appreciates the increased possibility of an American green card. Nurses simply take up the upper rungs of the meat market for middle class families in Kerala.
My point is that, today, most South Indian men don’t seem to have much qualms whatsoever about having a woman earn more – it results in a comfy suburban life in America and assurance that the extended fam. back home is going to be alright as well (never mind the better prospects for their American-born brats).
What is more interesting, I belive, is that the breadwinner status of these women hasn’t necessarily flipped the familial roles – the man is still the “head of the home” and the wife is, um, something less than that.
Amardeep, You are quoting a bmj article from 1995 when you talk of shortage of doctors. The latest articles actually are predicting a shortage of doctors in the workforce in the coming decade.
Interesting — thanks for the link. One small objection after skimming through the AAMC position paper quickly — I don’t see any some actual numbers. And they are a bit vague on when the deficit is projected to begin (“next few decades”).
But USA Today is more specific. I stand corrected.
The same may be in store for India if this bill passes and goes through the House, as seems likely.
no, i the first posters had it right. there are just too many brown people. the latest work on the ‘brain drain’ that is saw seemed to suggest a minor effect on nations like india or china, but a big hit for smaller countries, especially in africa. i was surprised, but i don’t see how nursing is any different than those professions. a popular summary of the brain drain research.
Life without proper mangoes is one kind of thing, but death without a kind and careful Desi nurse– well, that’s unthinkable. Speaking selfishly, I’m all for it.
The article states that the fact that nursing professors make so little money results in the lack of nursing professors in the U.S. If there are more Americans applying for nursing schools than before, why don’t nursing schools hire professors with greater incentives such as higher pay?
I agree. Why doesn’t the American government invest in building more nursing schools and training more nursing educators here in the States, rather than relying on health care workers from developing countries.
Bringing nurses here from developing countries may not put a ‘dent’ in their health systems but i believe it will impact many public health interventions that rely heavily on health care workers to provide care to communities suffering from global health problems. I just don’t think it’s fair to utilize nurses and other health care workers who can are needed to help alleviate health disparities in the developing world.
When America did this in the past (bringing doctors here from abroad) it only solved part of the problem — however, the American health care system is one of the most expensive and least efficient systems in the world and bringing doctors here from abroad didn’t help to build a better health care system. Bringing nurses here from abroad will not solve the problem that we are facing with our health system — maybe the government should think about fixing healthcare here first rather than selfishly using resources from other countries.
I agree. Why doesn’t the American government invest in building more nursing schools and training more nursing educators here in the States, rather than relying on health care workers from developing countries.
Bringing nurses here from developing countries may not put a ‘dent’ in their health systems but i believe it will impact many public health interventions that rely heavily on health care workers to provide care to communities suffering from global health problems. I just don’t think it’s fair to utilize nurses and other health care workers who can are needed to help alleviate health disparities in the developing world.
When America did this in the past (bringing doctors here from abroad) it only solved part of the problem — however, the American health care system is one of the most expensive and least efficient systems in the world and bringing doctors here from abroad didn’t help to build a better health care system. Bringing nurses here from abroad will not solve the problem that we are facing with our health system — maybe the government should think about fixing healthcare here first rather than selfishly using resources from other countries.
You would be surprised by the number of male students in Karnataka’s nursing colleges (there’s one in every locality there). Most of them are from Kerala.
The NY Times article was very one-sided and didn’t point out the true desperation in today’s hospitals and the impact that the international nurses are having at hospitals throughout the country. There is a real crisis in hospitals throughout the country — especially in States with mandated ratios — and this crisis needs to be addressed with an immediate solution. Without international nurses many of the largest and most prominent health systems would not survive.
This whole argument of depleting the Indian healthcare system is ridiculous. There are a total of 25,000 foreign nurses entering the country each year; about 45% from the Philippines, 25% from India, and the balance from everywhere else. India produces 30,000 nursing graduates each year and that number will be going up substantially in the next several years. Indian nurses have historically been an exported service, migrating to the Gulf countries and the UK for generations. Since the U.S. opportunity became available earlier this decade, nurses chose the U.S. over the Gulf and UK and continue to do so.
I agree that it will be great if the US Gov’t invests in nursing schools and faculty but that will have no impact on the emergency situation that hospitals are facing on a daily basis today. That will only begin to have an impact 3-4 years from now, and not a meaningful one. In California, one of the States with the largest shortages, a study by the Board of Nursing estimated that the state would still have a 40% shortfall even if every nursing school and college doubled its enrollment.
Foreign recruitment cannot be the answer to solve the problem in healthcare today. But it absolutely HAS to be a part of a broader recruitment and retention strategy for hospitals coping with the dire circumstances today.
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The problem in California, is that the Nurses union pushed thru’ a mandated ratio that was totally unnecessary and was not well thought out. When the Governor wanted to postpone the implementation, he was shouted out as being against health care providers. The solution is to have nurse’s aides and other people with lesser training to take over duties that don’t need a nurse, but unfortunately the union rules will not allow it. The other problem is there are not a lot of hospitals that allow nurses to train and get certified. I know of one Iranian-American who after a lot of difficulty got certified by California for a foreign nurses certification program (where foreign nurses can come and study for the qualification exam), but can’t get an authorization from a hospital to facilitate the practical training required. That is because the unions don’t really want to expand the labor pool and the hospitals are afraid to cross the nurse’s union. I am all for better conditions and wages for the nurses, but it should be done in a rational manner without jeopardizing the health care system. Anyway the discussion will be out of scope for this forum so I will not get into any more detail.
A hospital executive would feel more comfortable contracting a nurses from an agency dedicated to temporary medical staffing than from a one-stop-shop that also places welders, janitors and filing clerks.
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Wrong. It was available over three decades ago, when nurses were often choosing the U.S. over places like Kenya. You wouldn’t have an entire generation of Malayalee offspring who were born here, if that opportunity had only been available this decade.
what is the current status of indian nurses in USA?Is there still a good demand for indian nurses?What about their earning & living there?