James Stewart Darlene ClarkPaul F. Clark Darlene Clark and Paul F. Clark James Stewart
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Even if it is difficult to assess accurately the extent of present and future shortages, various sources indicate that they are present and growing in most regions of the world.
In the case of registered nurses, nearly every European country is experiencing a shortage . As an example, in 2001 the UK had 57,000 fewer nurses than needed to staff the National Health Service . The Canadian Nurses' Association has estimated that by 2011 Canada could have a shortfall of 78,000 nurses . Data suggest that Australia was facing a 40 % shortage of nurses to fill open positions in 2006 . In the developing countries of Asia, Africa, Latin America and the Caribbean, the situation is even more critical. Virtually all developing countries suffer from a chronic shortage of nurses. In 2003, the Pan-American Health Organization reported that 35% of nursing jobs across the Caribbean were vacant. The Philippines had 30,000 vacancies for nurses in 2004 . In 2003, Malawi reported that only 28% of nursing positions were filled, and in the same year South Africa had a shortage of over 32,000 RNs . The best estimates indicate that, collectively, sub-Saharan African countries have a shortfall of over 600,000 nurses . The reasons for shortages in less affluent countries are somewhat different from those in wealthier nations. Developing countries generally lack the resources to train an adequate number of nurses. They have fewer nurse-training programmes and fewer qualified nurse educators. Moreover, very low pay and extremely unsatisfactory working conditions make it difficult to attract and retain nurses. Insanitary conditions, lack of medicine, inadequate supplies and equipment, huge nurse-to-patient ratios, a shortage of physicians, and epidemics of HIV/AIDs and other serious illnesses all contribute to making the practice of nursing tremendously stressful in many developing countries .
Foreign MDs make up a substantial proportion of the physician workforce in some of the most affluent countries in the world. More than 34% of physicians practising in New Zealand are from overseas. In the United Kingdom, foreign physicians represent 30.4% of that occupation. Other developed countries have similar proportions of foreign physicians, including the United States with 26.4% ; and Norway with just over 16%, according to a more recent source .
In a report released in 2006, the World Health Organization (WHO) summarised the total stock of healthcare workers, estimated shortages, and percentage increases in the number of healthcare workers needed to eliminate the shortage by WHO region. The Figure is extracted from that report.
Estimated Critical Shortages of Doctors, Nurses and Midwies by WHO Region
Number of countries
In Countries with shortages
% Increase required
Source: World Health Organization (2006)
While these data may provide a starting point for gauging the situation around the world, they likely underestimate the global shortage of healthcare workers. For example, contrary to other sources, no European country is shown to be currently experiencing a shortage of doctors, nurses and midwives. Also, regional studies conducted in two US states suggest that the WHO's estimated shortages for the Americas are too low . The contradictions between the WHO's and other assessments stem, in part, from the WHO's focus on "critical shortages." While shortages of highly-trained healthcare workers in Europe clearly exist, the magnitude of these shortages is small relative to the much larger gaps between demand and supply in developing countries.
Migration patterns: destination countries
English-speaking countries constitute the most popular destination in the global labour market for nurses. The Philippines supplies the largest number of foreign nurses to the United Kingdom, while South Africa, Nigeria and Zimbabwe, Australia, India and a number of Caribbean countries also provide significant numbers of RNs . Ireland is another European country actively recruiting RNs in the global labour market, which is ironic since for decades it was an exporter of nurses. In 2001, about two-thirds of the new nurses registering in Ireland were from other countries, mainly Australia, India, the Philippines, South Africa and the United Kingdom . Norway has also recently recruited significant numbers of foreign nurses. Foreign nurses have long been part of the American healthcare workforce, but their numbers have increased rapidly in recent years. In 1997, foreign-educated nurses represented about 5 % of new RNs in the United States. By 2003, this proportion had grown to 14 %. The most recent data suggest that there are well over 100,000 foreign nurses registered in that country. The Philippines represents the greatest source of foreign nurses in the United States, followed by Canada, the Republic of Korea, India, and the United Kingdom .
Although the global labour market for physicians is not as active as it is for nurses, the shortage of MDs in developed countries has led to an increase in physician migration in recent years. Again, English-speaking countries appear to be the most common target destinations; however, the number of foreign physicians is increasing in many countries where languages other than English are spoken. Almost half of the 10,000 new physicians registered to practise in the United Kingdom in 2002 were from overseas. In 2003, more than two-thirds of the 15,000 new physicians in that country were from abroad .
Migration patterns: sending countries
As suggested by the previous discussion, with over 150,000 nurses working overseas, the Philippines is the country from which the largest number of RNs migrate . A handful of other countries aspire to play a similar role in the global labour market but have not yet established themselves in this respect. These countries include China, Cuba, India and some of the states formerly constituting the USSR. Several sub-Saharan countries including South Africa, Zimbabwe, Nigeria, Ghana, Zambia and Kenya also actively export nurses .
James Stewart is Professor of Labor Studies and Employment Relations, and of Management and Organization, Pennsylvania State University.
Darlene Clark is Senior Lecturer in the School of Nursing, Pennsylvania State University, and Clinical Assistant Professor, College of Nursing, University of Arizona.
Paul F. Clark is Professor and Head, Department of Labor Studies and Employment Relations, Pennsylvania State University.