After four centuries of colonization, the Philippines, influenced by Spanish, US, and Japanese rule, continues to feel the lasting impact of US colonial practices. This legacy is particularly evident in the emigration and export of Filipino nurses. Despite the Philippines gaining full independence in 1946, the United States continues to drain the country of its resources. The incentivization and employment of Filipino healthcare professionals to fill staffing gaps in the US healthcare system, especially during crises, facilitates their mass emigration.
Colonial History Behind Filipino Nurse Migration
In 1898, the United States acquired the Philippines from Spain through the Treaty of Paris concluding the Spanish-American War. US President William McKinley wanted to garner support from the Filipino population and facilitate a smooth transfer of authority. To accomplish this goal, he characterized the colonization of the Philippines as a “benevolent assimilation,” pledging the protection of individual rights and freedoms throughout the transition of power.
McKinley declared in an executive order on December 21, 1898: “It will be the duty of the commander of the forces of occupation to announce and proclaim in the most public manner that we come, not as invaders or conquerors, but as friends, to protect the natives in their homes, in their employments, and in their personal and religious rights.” To initiate the process of “benevolent assimilation,” the US government dispatched US educators known as the Thomasites to the Philippines to integrate Filipinos into US culture and cultivate a new generation of followers who embraced US ideals and values.
Under this system, Filipinos were taught to speak English fluently, adopt US culture, and ultimately aspire to the American Dream. As University of California, Berkeley professor Catherine Ceniza Choy describes it, “[There were] American colonial officials going to the Philippines and exposing the Filipinos to American culture, to the English language, to Americanized education. And this kind of training influenced so many different groups of Filipinos to dream about the US and to desire to migrate there.”
In 1903, US President William Howard Taft enacted the Pensionado Act, creating a scholarship program enabling qualified Filipinos, known as pensionados, to pursue education and training in the United States. Focused on government and administration degrees, the act aimed to develop future Filipino leaders with knowledge of the US government system. The intention was for them to implement similar practices upon their return, shaping the Philippines’ government and institutions in alignment with US ideals.
Among the pensionados were some of the earliest Filipino nursing students. Upon returning to their home country, pensionado nurses played a crucial role in founding 17 nursing schools in the Philippines between 1903 and 1940. Meanwhile, those who stayed in the United States formed the Philippine Nurses Association in 1922 whose mission statement was: “Championing the global competence, welfare, and positive and professional image of the Filipino nurse.” The Pensionado Act, the largest US scholarship program until the Fulbright Program in 1948, concluded in 1943, just three years before the Philippines gained independence.
Enduring Impacts of Colonial Mentality
On July 4, 1946, the United States acknowledged the Philippines as an independent and sovereign nation, relinquishing its role as the colonizer and withdrawing its authority over the archipelago. Despite this transition, the United States continues to rely on the Philippines to address its medical staffing shortages.
In 1948—about four decades after the Pensionado Act and two years after the Philippines attained its freedom—the United States introduced the Exchange Visitor Program (EVP). This program invited individuals from foreign countries to temporarily study and gain work experience in the United States. Participants were granted admission as nonimmigrant visitors for business under the Immigration Act of 1924. The EVP was implemented to fight Soviet propaganda during the Cold War and spread US democratic ideals.
At the same time, the United States was experiencing a medical shortage after World War II. Numerous nurses left their jobs due to lower wages and harmful working conditions. Rather than addressing the root causes of the problem—such as increasing pay and improving working conditions to encourage people to return to work—the United States sought to fill the void by looking beyond its borders, turning to the Philippines to bridge the gap. This approach reflected the historical framework of “benevolent assimilation” from the early years of US occupation in the Philippines. The system trained Filipino nurses in an Americanized curriculum, creating a direct pathway for their education and migration to the United States.
The EVP was followed by amendments to the Immigration and Nationality Act (INA) in 1965. This landmark legislation eliminated the National Origins Quota System, which had served as the cornerstone of US immigration policy since the 1920s. More specifically, the INA of 1965 terminated a discriminatory immigration policy towards Asia and other regions, instituting a preference system that prioritized the entry of individuals with high educational qualifications and essential skills. These amendments appealed to Filipino nurses as they provided an opportunity to adjust nurses’ immigration status and seek permanent residency in the United States. Simultaneously, the United States experienced a heightened demand for healthcare workers due to the implementation of Medicare and Medicaid under the Social Security Amendments of 1965; for example, after coverage began in 1966, 19 million Americans enrolled in Medicare alone.
US immigration policies and sociopolitical conditions motivated an increased number of Filipinos to pursue careers in nursing. In just five years, the number of Filipino nurses in the Philippines grew by an astounding 700 percent, from 7,000 in 1948 to 57,000 in 1953. The surge continued, with the number of nursing schools in the Philippines increasing from 17 in 1940 to 429 in 2005 and reaching 1,282 as of September 24, 2023. Since 1960, over 150,000 Filipino nurses have immigrated to the United States. A 2021 study revealed that registered nurses (RNs) trained in the Philippines constitute one out of 20 RNs in the United States, maintaining their status as the largest group of foreign-trained nurses to date. As of 2022, Filipino nurses constituted 33 percent of all foreign-born RNs—and, as of 2021, four percent of all RNs—in the United States. The Philippines is the largest exporter of nurses worldwide.
Domestic Struggles in the Philippines in the Wake of Nurses’ Emigration
Due to the mass exodus of Filipino nurses both to other countries and from the profession within the Philippines, the country currently faces a shortage of nurses, undermining the quality of healthcare within the country. According to a 2023 study, 200,000 to 250,000 Filipino nurses have left the profession in the Philippines due to burnout, low pay, overextension, and job precarity. A 2021 estimate revealed that 51 percent of licensed Filipino nurses (about 316,000 nurses) had left the Philippines to work in foreign countries. The Philippines now faces a shortage of 127,000 nurses, which is expected to increase to 250,000 by 2030. In response, the Philippines has even lowered professional standards, allowing over 300 nursing graduates without licenses to be hired as nurses.
The United States is not the only country responsible for the mass emigration of Filipino nurses. The Philippines is also complicit in the United States’ continued pull on the nation’s labor export. Filipino nurses are caught in the crossfire between the United States and the Philippines due to various push and pull factors. On one hand, the United States pulls Filipino nurses to address its medical shortage. On the other hand, the Philippines actively pushes workers away due to poor working conditions and lower quality of life. Furthermore, the Philippine government actively promotes the export of Filipino workers globally for economic gains.
In the 1960s, when the United States carried out immigration policies and underwent important cultural developments, the Philippines experienced hardships under the dictatorial rule of former president Ferdinand Marcos. In September of 1972, Marcos proclaimed martial law to combat the growing chaos stemming from violent student demonstrations, perceived threats of communist insurgency by the new Communist Party of the Philippines, and the Muslim separatist movement of the Moro National Liberation Front. Under the Marcos regime, human rights violations and corruption were rampant. More notably, under Marcos’ rule, unemployment was exacerbated and poverty endured, which prompted many Filipinos to seek jobs overseas. In response, Marcos devised the Labor Export Policy in 1974 to tackle the economic struggles the Philippines faced. The initiative sought to address unemployment within the educated sector by providing opportunities for overseas employment, which in turn generated foreign currency revenues through remittances sent back by Filipinos working abroad.
Since the 1950s, money sent back home by nurses employed overseas has played a substantial role in the Philippine economy. According to the advocacy group Filipino Nurses United, about one-third of the over 900,000 registered nurses in the Philippines were working abroad as of 2021. The remittances from nurses contribute roughly US$8 billion annually to the economy, making up approximately 25 percent of all remittances. Collectively, these remittances account for around nine percent of the country’s gross domestic product.
Filipino nurses were significantly affected by US imperialism and misgovernment under Marcos’ dictatorship. During the period of US occupation, Filipino nurses were trained to work in the United States. After the Philippines gained independence, the United States continued to depend on the Philippines to address medical staffing shortages. Domestically, the Philippines’ promotion of overseas labor, coupled with challenging living conditions, has fueled an increase in Filipino nurses emigrating to the United States. The continued mass exodus of Filipino nurses underscores the need for a comprehensive examination of the factors contributing to this brain drain and a collaborative effort to address the associated challenges.
