Going Beyond Borders: Factors Driving Filipino Occupational Therapists to Work Overseas

Abstract

Background

The Philippines was renowned for its reputation as one of the leading countries in the world, holding notable contributions for supplying the global laborers including occupational therapists alongside other healthcare professionals. The importance of occupational therapists in the healthcare industry was progressively being acknowledged, as they offer rehabilitative care to Filipinos in need within the country. With the continual advancement of knowledge, occupational therapists were fast becoming in-demand professionals locally. However, there appeared to be a dearth of practicing registered occupational therapists in the Philippines, owing to their inclination towards overseas employment as seen by their migration to affluent countries driven by push factors, which are unfavorable circumstances in the place of origin that reinforce migration, and pull factors, which are things that attract the migrant to move to the destination country.

Objectives

This study explored the factors influencing the Filipino occupational therapists towards selecting a working environment, prevailing factors that contributed to the decision of Filipino occupational therapists to work overseas, and significant differences between the working conditions domestically and internationally.

Methods

The study utilized a qualitative descriptive study to conduct a comprehensive exploration, studying the subtleties and complex nature of Filipino occupational therapists' migration. Researchers conducted semi-structured online interviews with 10 participants currently working as occupational therapists abroad across four countries including Australia, United Kingdom, United Arab Emirates, and United States of America. Thematic analysis was used to analyze the qualitative data, resulting in the identification of seven themes that described the factors on why Filipino occupational therapists went beyond the borders.

Results

There are seven themes that describe factors why occupational therapists work abroad. These factors include (a) Labor Provisions, (b) Financial Motivations, (c) Organizational Camaraderie, (d) Presence of Career Progression, (e) Vast Resource Modalities, (f) Individualized Gains, and (g) Political Apathy.

Conclusion

The study stipulated the parameters aimed at improving occupational therapy working conditions and encouraging proactive initiatives to alleviate the shortage and reverse the brain drain among occupational therapists in the Philippines’ healthcare system.

INTRODUCTION

Owing to the growing decision of workers to migrate brought by varying reasons influenced by personal and professional struggles transpiring within their lives, this became an increasingly contentious issue all across the world.¹ Migration provided new opportunities for individuals to experience different environments and overcome political, social, or environmental constraints, primarily for work benefits.² The Philippines is significantly affected by this trend, as the Philippines Statistics Authority reported 1.77 million Overseas Filipino Workers (OFWs) working abroad from April to September 2020. This number was projected to rise to 1.83 million in 2021 and increased to 1.96 million in 2022 during the same period.³

The brain-drain further weakened already fragile health services in low-income countries. This huge movement of healthcare workers from poor countries has devastated the already poor situation of healthcare services. This poor situation has demoralized little remaining manpower through increased working hours and aggravating the ratio of health workers to populations.⁴ Apart from a loss of skilled manpower, the brain drain also negatively affects the local economy, in particular, national salary structures. The 'demonstration effect' of foreign salaries artificially inflates local salaries, despite the lower average productivity of labor in the system.⁵ The annual surge in migration rendered the dearth of medical professionals even worse, exerting further strain on the Philippine healthcare system and dragging it closer to its risk of disintegration. Such an approach had significant adverse consequences on populations as well as healthcare structures, leading to longer queues for essential amenities, less labor availability, higher incidences of errors, and poorer standards of care.⁶ Furthermore, the heightened brain drain dominated this pursuit for overseas employment to compensate for the grievances and low work privileges brought by the COVID-19 pandemic ramifications. From which, there seems to be an imbalance between the demand with rehabilitation workers and its obtainability and supply to hospitals or centers within the scope of Occupational Therapy (OT) practice in the Philippines. Drawing in intended Filipino occupational therapists emerged, however filling in the domestic gap to improve service delivery happened outside the bounds of the country, which consecutively resolved overseas crisis with OT workers, yet leaving the Philippines in a total disarray.⁷

Irrespective of the significance spanning the experience that could have been attained and expounded when working with the home country, Filipino occupational therapists still resorted in showcasing their expertise in another country for the goal of nurturing themselves professionally and personally given the extensive resources prevailing.⁸ Similar to the Philippines, the developed countries including the United States, Canada, and United Kingdom are suffering with scarcity among occupational therapists, nevertheless they can promptly extract workers from different countries aside from their own, allowing them to recover and elevate its healthcare employment rate.⁹ Another factor for migration driving Filipino occupational therapist was the range of economic avenues afforded by the host country, better quality of life shaped by economic development, and the social, economic, and cultural status of the Philippines.¹⁰

In line with the existing push and pull factors for migration of Filipino occupational therapists such as job insecurity, average monthly income or higher salaries, limited work opportunities and unsustainable workload, and familism,¹¹ further exploration with persisting reasons for securing an employment in the selected destination country were deemed limited. Therefore, this study sought to elucidate (a) the factors influencing Filipino occupational therapists towards selecting a working environment, (b) prevailing factors that contributed to the decision of Filipino occupational therapists to work overseas, and (c) the significant difference between the working conditions domestically and internationally. This research also underpinned the need to calibrate the quality of occupational therapist employment, consequently halting the scarcity and brain drain of our medical practitioners in the Philippines, and the data to be acquired holds the potential to guide policies and initiatives that support the retention of Filipino occupational therapists.

MATERIALS AND METHODS

This study used a descriptive case study¹² method to understand the personal, social, and economic factors that contributed to the migration of Filipino occupational therapists obtained from multiple sources that will aid informing policy or practice or generate new research questions. Data collection took place primarily via Google Meet that lasted at least one hour up to two hours, and was video recorded for documentation in their respective households. During data collection, aside from the participants and researchers, there are two professors present to observe that interview session. Sessions were conducted during non-peak hours or convenient time to minimize distractions and ensure confidentiality. During the interview, two researchers functioned as interviewers while the remaining two took control over documentation and note taking purposes. To gather the answers to the existing problem, the researchers of this study looked for 10 participants who were Filipino occupational therapists working overseas in any work setting related to OT practice through purposive sampling, as researchers estimated that the ideal number of participants is between 10 and 50 to suffice the collection of valuable and accurate qualitative feedback.^13,14 The study was conducted in the post-pandemic period following the approval and ethical clearance from the College of Allied Medical Sciences. The research protocol was reviewed by a technical committee composed of at least three experts, one being occupational therapist, and was later approved with an emphasis on confidentiality and informed consent. This is the current usual process of clearance to conduct research within the Bachelor’s degree. The researchers conformed with the Declaration of Helsinki (DoH) and a signed Informed Consent Form (ICF) was solicited among the participants prior to their respective schedule of interviews. Out of the initial 50 eligible participants that were selected through purposive sampling, 10 individuals agreed to be participants representing a range of experience levels and specialties within occupational therapy, and four individuals refused to participate in the study. Reasons for non-participation included concerns about the time commitment for the interview session and personal scheduling conflicts. Despite efforts to address these concerns through information sessions and flexible scheduling options, these participants opted not to take part in the study. Thematic analysis was employed for the gathered data, as it is an ideal method to be applied in interviews that thoroughly evaluates an individual's thoughts, personal experiences, and knowledge from an array of data. A total of six phases were covered in this form of analysis involving familiarization, coding, theme generation, theme review, theme definition and naming, and writing up.¹⁵ During the first three steps, each researcher read and reread the transcriptions, proposed codes, and themes. After this, for the review of the theme, all researchers convened and tried to reach a common ground to select an appropriate theme and definition. In the succeeding steps, a positive response from the majority decides the final output. Adopting this approach may support a researcher to construct the analysis without succumbing to confirmation bias.

The respondents recruited should have undertaken OT education and have been registered and authorized as occupational therapists in the Republic of the Philippines along with respondents who migrated from the Philippines to a different country as occupational therapists at least within six months but no more than five years. On the contrary, non-Filipino occupational therapists who gained their license overseas, those Filipino occupational therapists who were trained outside the country of origin, those who changed their Filipino citizenship, and those dual citizenship from the Philippines and to another country were excluded from the study.

At the time of the study, all of the researchers were students practicing Occupational Therapy at the College of Allied Medical Sciences, University of Batangas. Researchers were all female, contributing to diversity and representation within the field. A professional relationship was established prior to the study commencement, with previous interactions through messenger as recommended by professors to build trust and rapport. Participants were informed about the researchers' background and goals to enhance different points of view and therapeutic practices. The researchers assumed that prior interactions would build trust and open responses, that female researchers would provide diverse perspectives, and that professional relationships would enhance data quality. The study aimed to understand motivational factors for Filipino occupational therapists seeking opportunities abroad, improve educational practices in the Philippines, and enhance professional practices. The researchers were interested in personal and professional growth, contributing to the field's body of knowledge, and advocating for policy changes to improve working conditions and career opportunities for therapists.

Researchers' approach was designed to be empathic and supportive, ensuring that the participants felt comfortable and valued throughout the study. The interview questions included open-ended questions and prompts designed by researchers to elicit detailed responses from the participants. Prior to formal data collection, the interview questions underwent pilot testing with the professors to refine questions clarity and relevance to the study. Feedback from the professors was incorporated to ensure the questions effectively captured diverse experiences within the target population. Field notes were systematically taken during and immediately after each interview session by the researchers. These notes documented verbal and non-verbal cues and contextual observations. Transcripts of interview sessions were not returned to participants for comment or correction in this study.

RESULTS

Ten participants that met the inclusion criteria of the study were interviewed with an age range from 27 to 31 years old with 60% covering female participants. All of the participants had rendered OT services in the Philippines prior to migrating overseas to work similarly as an OT. Of the interviewed therapists, the shortest stay abroad as of the time of the study was six months and the longest was one year and nine months of working without any apparent change of citizenry or dual citizenship. Three participants each from Australia, the United Kingdom, and the United Arab Emirates, and one from the United States of America took part in the conducted online interview (Table 1).

Table 1.

Characteristics of Study Participants (N= 10)

Pseudonym	Age range, years	Sex	Current country of residence	No. of years working in the Philippines	No. of years working overseas	Current area of work
Respondent D	30	Female	Australia	7 years	10 months	Community-based Setting
Respondent B	31	Male	United States of America	7 years	8 months	Skilled Nursing Facility, Long Term Care and Assisted Living Facility
Respondent C	27	Female	United Kingdom	5 years	1.5 years	Neuroscience
Respondent S	30	Female	Australia	6 years	1 year and 9 months	Pediatrics
Respondent V	29	Male	Australia	6 years	7 months	Community-based Rehabilitation
Respondent L	27	Male	United Kingdom	4 years	1 year and 8 months	Geriatrics
Respondent R	29	Female	United Arab Emirates	4 years	1 year	Pediatrics
Respondent J	28	Male	United Kingdom	6 years	6 months	Pediatric and Physical Dysfunction
Respondent E	28	Female	United Arab Emirates	3 years	1 year and 7 months	Hospital Setting
Respondent K	30	Female	United Arab Emirates	7 years	1 year and 5 months	Home Care

Table 1 shows the basic demographic data, years of experience, and specialization of the ten respondents.

During the first three steps, each researcher read and reread the transcriptions, proposed codes, and themes. After this, for the review of the theme, all researchers convened and tried to reach a common ground to select an appropriate theme and definition. In the succeeding steps, a positive response from the majority decides the final output. Seven themes were rooted from the guide questions (Table 2) that represented the factors influencing the decision for migration of Filipino occupational therapists. These themes encompassed Labor Provisions, Financial Motivations, Organizational Camaraderie, Presence of Career Progression, Vast Resource Modalities, Individualized Gains, and Political Apathy. These themes, together with the underlying subthemes were summarized in Table 3.

Table 2.

Key Guide Questions

Guide Questions
What are the values of Filipino Occupational Therapists towards selecting a working environment?
What are the other prevailing factors that contribute to the decision of Filipino Occupational Therapists to work overseas?
Is there a difference between the working conditions domestically and internationally?

Table 3.

Factors that Influenced Filipino Occupational Therapists to Work Overseas

Themes	Sub-themes
I. Labor Provisions	Employment system Defined role in practice Employment benefits Sustainable work-life balance Clientele and facilities
II. Financial Motivations	Increased and better salary pay
III. Organizational Camaraderie	Meaningful exchange of views Lessened presence of drama Non-discriminatory practices
IV. Presence of Career Progression	Mentoring and supervision from seniors Sustained continuous education
V. Vast Resource Modalities	Numerous assessment tools High-quality intervention modalities Adequate budget allocation
VI. Individualized Gains	Distance of workplace Connections in workplace Cultural influences Influenced by a family member
VII. Political Apathy	Electoral campaign

Labor Provisions

This theme explored the associated considerations to the labor provisions fundamental for the participants' navigation of a workplace environment that met their respective demands and facilitated better job functioning. Five sub-themes were presented in this theme encompassing the employment system, defined role in practice, employment benefits, sustainable work-life balance, and clientele and facilities.

Drawing on the pandemic consequences, it outlined that the former employment system experiences had challenged the healthcare workers, including occupational therapists to survive every day, as support measures were slow, uneven, and uncertain thereby exacerbating vulnerabilities where they faced immense pressure and stress due to the increased workload and the high risk of infection. A systematic review found that fear of COVID-19 exposure, psychological stress, and adverse working conditions were major factors leading to burnout and turnover intentions among healthcare workers, including nurses, physicians, and allied health professionals.¹⁶ Participants were confronted with deferred wages and damages in working hours creating a toll on work satisfaction. Respondent E emphasized improper compensation from the government during COVID-19, which influenced her to somehow improve her situation, given that

“Considering the pay, public hospitals have higher salaries than the private hospitals. At those times, I had two jobs including home care, and worked in a hospital and other three jobs.”

Respondent S likewise mentioned that

“Clinics were shut down, so I had to work in a hospital, with a toxic environment and low pay. That’s why I left.”

Other participants revealed that the pandemic crisis created both fear and community restrictions, leading to fewer to no patients visiting clinics, hence there was no money being generated, as payment was solely dependent on the number of patients handled per day. Workload and schedule were added facets deemed significant under employment system, provided that ample awareness with such will build an atmosphere that is far from being obstructive, instead accommodating to oneself. Respondent K disclosed that

“You need to think… before you accept the job offered if… you’re okay with the workload that they will give you as it requires figuring out time-management and work-life balance.”

In line with this, Respondent L pointed out that being a part-time or full-time employee along with its corresponding minimum and maximum hours, combined with either working lunch or lunch break alone, had to be taken into account before securing a spot in any setting in other countries as an occupational therapist.

The respective encounters of the participants unearthed the discussions on the aspect of the perceivable recognition and clarity with the actual role and responsibility to be carried out as an occupational therapist that is applied in needed contexts. Respondent B shared that satisfaction in work environment transpired if the organization would be upheld, wherein there should be a clear boundary with one’s role to be fulfilled within the facility so that goals for one job is secured and not overlapping with another, similar to the things that are being performed by an occupational therapist and a physical therapist in a workplace. Comparably, Respondent V stressed that the act of specifying and establishing a definite function and purpose of an OT would enable higher focus to be allotted, thus improving performance, but

“Then, if there are instances where you need to take on additional roles or tasks, you’ll also feel compensated for your efforts and time spent on those tasks.”

Respondent C also disclosed that even with independence and determined roles and responsibility, there should be protection to maintain credibility and transparent work image.

Another facet that surfaced about labor structure was the level and scope of competitive benefit packages offered which turned out to be the baseline of productivity and attraction for the participants. Respondent E disclosed that benefit wise

“Your work here is fixed… you’ll be continuously working and then there are policies like 30 days leave.”

Unlike the medical insurances offered in the Philippines only for those working at hospitals or government facilities and pediatric setting appears to be exempted. This was similar to the experience of Respondent J where they were also granted one month leave and one paid leave which could potentially increase the longer you stay at the workplace. Meanwhile, Respondent R voiced that health insurances, incentives or bonuses every month, and standard fixed salary even if the targeted patients for a day are not being complied were applied in her selected workplace, nevertheless she added that

“Even if they give you a compensation [here abroad], the stress cannot be relieved.”

As per Respondent L, the major indicators for when seeking new employment outside the country of origin is the equivalent overseas salary per hour and its comparison to the counterpart domestic setting, along with

“[If] someone will teach you there when you start working for the first time, if they offer free training or you’ll be on your own, and if there will be a senior to guide you or none.”

With the right place and set-up, sustainable work-life balance overseas could be consistently acquired for the participants. Respondent J and Respondent C mutually shared that profound extent of respect was demonstrated in their respective working environments, notably on adhering with the accustomed clock out at 4 pm, as the former highlighted that

“We use computers in terms of documentation when logging out. You’re not required to work once you leave the OT room. So, they are not allowed to disturb you, they are not allowed to message you. [They] can email you but you are not required to read it.…even if it’s a life-or-death situation, no more therapy sessions when it’s already 4 in the afternoon…and then when you work on weekends such as Christmas, they will double your salary.”

And it was not demanded to work during weekends, yet there would be no changes or deductions with the standard salary. Time dispensed for carrying out recreational activities or personal hobbies was focused by Respondent V provided that

“You value your time for your family…there are times, especially during the pandemic, we need to supervise our interns through telehealth even when we are on leave.”

However, Respondent K contradicted such an impression as she emphasized that work-life balance was more sensible and explicit in the Philippines than UAE whereby

“In the Philippines if you reach let’s say 12 clients per day, you can group them. Here, in UAE, for 12 patients, if someone is absent or they canceled, you need to replace them. Therefore, it felt like there was no time for other things. You are coming home tired and there will be no time for yourself, for exercise, to take enough food, cook and wash. It’s like your IADLs and even your ADLs are compromised and ranked as poor.”

But she reiterated that there were still positive perks and that was the five working days with two days off. Although Respondent E, another occupational therapist from UAE, communicated that she had all the time to do anything she desires after her working hours, since the documentation report was accomplished solely within the time frame of working. Along with that, she admitted incidents of burnout whereas

“It is inevitable to experience burnout especially if it is continued experience [at work].That is why I try to explore a lot of things to… just to keep me sane… like going to the gym after work or riding a bike.”

Participants concentrated lastly on the area of clientele and facilities, because these elements enabled the best way to identify a suitable, comfortable, and engaging working environment during job search. Respondent S stated that it was imperative to examine the types of clients to face as this would serve as the foundation in a better understanding of their goals, as well as to oneself on whether you are capable of meeting such aspirations for them. For respondent E, researching the facilities was a step in the workplace hunt that should not be disregarded in which

“Perhaps because many Filipinos have been scammed, or perhaps it’s because they generally prefer other nationalities over Filipinos.''

Also included that the presence of essential facilities forms an opportunity for her to obtain certifications, particularly in hand therapy. Furthermore, Respondent K uttered that a workplace must encapsulate the facilities aligned with the selected area of practice as an occupational therapists wherein she specified that

“For example, I personally preferred the pediatrics setting and in my working environment I want to have a sensory room or to have an inclusion among schools because you will be able to feel more collaboration on that… let’s say in school there are teachers, and speech, and PT and OT.”

Financial Motivations

This theme explored the greater and improved compensation pay, which could be powerful motivators in the sphere of professional endeavors. A larger wage not only gave concrete rewards for one's efforts, but it also represented recognition of competence and contributions to the workplace. Regardless of the labor, all participants acknowledged the pull of much greater wages in other countries. Illustrating this point, Respondent J emphasized a significant salary disparity when comparing government compensation to the private sector, expressing a notable difference where he described

“So if you compare the salary here to the government, the difference is huge, I can say that it's 10, 10 times higher.”

Respondent J also pointed out that salaries differed depending on area of practice as pediatrics salaries in the Philippines were three times those in the United Kingdom. In support of this, Respondent R, who worked in the UAE, said that her annual compensation had been smaller compared to her annual salary in the Philippines.

“The difference is almost 10 times.”

Meanwhile, Respondent B from USA, Respondent C from UK, Respondent K and Respondent D from UAE disclosed that their annual salary increased 4 times with their 7 days salary in the Philippines. Given the foreign countries in which they worked, the two other participants, Respondent L and Respondent S, reported that their income increased by double regardless of whether their client showed up or not. While the remaining two participants reported that their earnings had climbed by 100% despite being in a different country. Respondent V, who worked in Australia, revealed that

“My 2 weeks of salary here is 1 month salary in the Philippines.”

Organizational Camaraderie

The importance of organizational camaraderie was a common sentiment among the participants when discussing workplace functionality. This theme explored how, despite differences, the participants still felt connected and a sense of belonging in the workplace. It was further subdivided into three sub-themes. The first sub-theme highlighted the significance of meaningful exchanges of views. Given the participants' experience working alongside colleagues of diverse nationalities, they expressed positive relationships and affiliations with them. Respondent R emphasized the significance of having a meaningful exchange of ideas with colleagues and participants. She stated that,

“If you have workmates who’ll push you through your limit or challenge you, that would be great.” “It’s great to have colleagues who help each other out, for example, if someone has a problem at work and they will say things like “okay, you can go ahead and fill in for them.”

Moreover, Respondent D, being the only Filipino in her workplace, deeply appreciated the camaraderie spirit she experienced in Australia. She sought external support from her colleagues and asked for their ideas on various tasks. She turned to her colleagues and asked

“Maybe you could help me. Maybe you have some ideas on how to do this, to do that.”

She believed that since she worked with a disciplinary model that incorporated strategies from each discipline, highlighting and valuing this camaraderie was crucial.

Apart from that, having a whole new working environment internationally equated to dealing with varied human tendencies and emotions and sometimes, it was inevitable that the relationship between the workers and their egos could lead to workplace drama, thus causing an impact on workplace performance and productivity levels. Respondent J supported this by expressing that

“If your workplace is toxic, it’s often a result of arrogance or carelessness, making it exhausting to work. That draining environment affects your relationship with… colleagues or coworkers negatively.”

Respondent L additionally exposed that one means to minimize the existence of drama is to limit oneself from taking the impressions and actions negatively demonstrated by workmates and rather choose to interact openly and cautiously, because

“Sometimes, your perception is your real opponent, not them. They’re not doing anything and it’s just in your mind that they are scary, but it turns out that they are kind [to talk to].”

Meanwhile, Respondent B explicated that he had collection of encounters with toxic people while working in USA, wherein such co-workers often portrayed behaviors of talking about other people’s businesses that were deemed unhealthy, hence Respondent B ensured to adapt the habit of distancing himself from such types of conversation and

“I make an effort to present myself well, okay, because you don’t want to contribute to the toxicity of the environment, it’s better to… just… be kind.”

He likewise figured that personal adjustments should be made with matters that are out of control in a workplace. Seeing lessened workplace drama as an opportunity, Respondent S viewed the differences owned by every worker in a manner that

“Having different perspectives helps you grow… that’s one of the good things and…to be honest, working with other cultures tends to be less toxic as it results in less crab mentality.”

Despite the diverse range of nationalities in the workplace, the participants attested to experiencing a nondiscriminatory work environment. This sub-theme explored how the participants fit in, despite differences in skin color and cultural background. The participants shared a common belief that cultural disparities did not hinder the camaraderie in the workplace. They received equal treatment and respect, regardless of any differences, promoting a harmonious and inclusive work culture. According to Respondent J, during his six months working in the United Kingdom,

“I have never experienced bad treatment, nor any racist or negative comments. Talagang… accepting sila.”

He further elaborated that people in his workplace did not judge individuals based on their skin color, and there he believes that they are approachable. Respondent L, who worked with individuals from disparate nationalities, shared a similar sentiment, noting no incidence of discrimination owing to their openness and welcoming nature. Similarly, Respondent D imparted the same story, expressing that she did not feel inferior to other races. She stated,

“Even though I was the second international that they have, and I was the only Asian that they had, it wasn’t quite as alienating, as I felt, as I thought it would be.”

Apart from the imperative of avoiding discrimination, the practices of Filipino occupational therapists had gained recognition and appreciation overseas. Respondent K, who collaborated with professionals from several nationalities in the United Arab Emirates, had noted that Filipino occupational therapists were in high demand. According to her,

“They [United Arab Emirates] prefer Filipino therapists… I noticed that they seem to… request Filipino therapists more.”

Presence of Career Progression

In the exploration of theme 4, the significance of career advancement emerged as an opportunity for empowerment and growth. It was divided into two sub-themes. The first thread, highlighted by mentorship and guidance of experienced professionals, emphasized the critical function of mentorship and supervision in fostering and polishing fundamental professional skills. This mutually beneficial partnership promoted individual growth and strengthened professional knowledge. Mentoring was portrayed as a beneficial resource for persons striving to advance in their careers. When looking for traits in a workplace. Respondent D expressed

“They offer the training that I need by providing internal training, they have communities of practice, they offer me the ability to broaden my horizons, and provide more to the participants that I see.”

The mentor-mentee relationship becomes beneficial, accelerating individual development while also contributing to the collective professional expertise. Supervision is equally vital, particularly for those starting out in their careers, as highlighted by Respondent J, given that it is a prime factor to improve clinical reasoning skills.

In pursuit of continuous growth and honing his skills, Respondent J added

“Not to brag but I feel like when I worked in pediatrics in the Philippines, I was able to achieve my highest skills so I went here for the goal of seeking mentorship.”

Collectively, these perspectives underscored the vital role of mentorship and supervision in shaping a fulfilling and supportive professional journey.

The second component introduced the concept of sustained education as a catalyst for personal skill development. Beyond personal development, this subtheme promises a greater influence, stressing knowledge gained to be shared with fellow Filipinos. Education was a cornerstone for personal and societal improvement, providing people with the information, abilities, and perspectives they need to succeed. With this, individuals could develop their expertise, discover emerging disciplines, and improve their professional competencies by taking advantage of the option for continuous education. Respondent J addressed about the potential for progress in the United Kingdom,

“If ever you want a certain seminar, no matter how expensive, whether these are seminars, trainings, or master’s degree, they will help you as long as you can answer the application or convince them to fund your master’s degree… there are also credentials, criteria to be met.”

Respondent J emphasized the Philippines' comprehensive education system, underlining its importance in promoting his professional success. He mentioned that all of the knowledge he gained during his academic path was instantly used in his professional experiences. Respondent L also noted significant differences between the school systems of the United Kingdom and the Philippines wherein

“‘OT lasts for 3 years only and there are no board exams, once you graduate you just need to pass some papers and you are automatically registered.”

To prove one’s self-capability became visible using the application of the accumulated knowledge gained through years of education and its effective execution within the practice of OT, particularly when showcasing its impactful contribution. Aspiring to establish one’s clinic or therapy center stood as a professional goal that had been a constant aspiration back in the Philippines and a current goal.

Respondent S mentioned

“I’m wondering about having a business rather than a profession… but my main goal now is to pursue a doctorate, perhaps opening my own clinic or practice where I would work independently.”

In line with this, Respondent J expressed his desire to establish his institution to assist patients in need. Contrasting these claims, Respondent L pointed out

“It is really hard to establish a clinic if you are not even present to manage it, although I have a family and sisters whom I can rely on to watch over my clinic, but I don’t want to risk it since they can’t understand my work in general… they don’t know OT and how to hire therapists, they will not know if they are right about the practice of OT because it is not their forte after all.”

Vast Resource Modalities

There are significant differences in the availability of resources between the Philippines and other countries. The vast resource modalities were embedded throughout participants’ responses across a range of topics. Theme 5 delved into the various modalities utilized by participants in their workplace, contributing to their effectiveness as professional occupational therapists. Within this theme, three domains were identified, which manifest and intertwined with vast resource modalities.

One of the primary considerations for occupational therapists when selecting a workplace was the availability of resources. A significant factor in this regard was the availability of a diverse range of assessment tools, which the workplace could provide. Several participants cited this as a critical requirement for their work. For instance, Respondent V, who worked in Australia, stated,

“Here, they have a lot of assessment tools, and in the Philippines, we also use assessment tools but it’s just FIM and MMT.”

In contrast, Respondent B mentioned that in the Philippines,

“If you don’t request the modalities, I mean even if you request it, they won’t be able to give it because it’s expensive… [In America] If you think the patient needs it… you will request it if it can be requested and they will definitely purchase the item.”

One key aspect that participants emphasized was the use of high-quality intervention modalities in their respective workplaces. These modalities varied from familiar techniques and tools to new and innovative methods, especially those employed in other countries. As an example, Respondent K mentioned that the OT field in the UAE utilized advanced technology, such as robotics, which appeared to be a novel approach to her. Furthermore, Respondent D mentioned that she was exposed to things that advanced her knowledge about intervention. According to her,

“I went for a math assessment, for sitting and mobility for OT, which I never had the opportunity to do in the Philippines. So, I was exposed to types of wheelchairs, like types of cushions to go under the wheelchairs, what modifications I can do to support things like pelvic obliquities.”

Respondent B supported this by comparing the availability and quality of modalities used by occupational therapists. He emphasized that in the Philippines, as long as the equipment was not completely broken and still somewhat functional, it would continue to be used. In contrast, in other countries,

“Here [in the US], when something starts to get a bit… broken, we obtain a new one.”

There existed an ultimate reality that several therapeutic modalities were not physically available in the Philippines compared to other countries. However, participants in the study expressed satisfaction regarding the resources provided by their workplace to perform OT services. They stated that there was an adequate budget allocation to fund the tools and materials required for the OT services. Respondent J shared his experience of being resourceful and unleashing his creativity while working in the Philippines due to lack of resources. He mentioned,

“In the Philippines, if you want to ensure quality, sometimes when there’s no budget for the patient you’re working with, you, yourself will have to sort out the money, here [current workplace] everything is well provided and free as it was government-funded.”

Respondent L, who worked in the UK, has also experienced the budget allocated by his workplace for training and other needs. Similarly, he stated that

“Every year, a budget of 1000 pounds is allocated to you, [and] if you want any training, you need to submit it to them because they will fund it.”

Additionally, Respondent E, who worked in a home care setting in the UAE noted that “Here in UAE, we have a budget for toys.” However, she observes a similarity between working in the UAE and the Philippines that if the allocated budget is depleted

“You really have to buy with your own money.”

Individualized Gains

This theme delved into diverse perspectives of individuals as they navigated the concept of Individualized Gains, which pertained to the specific and personalized benefits or improvements that an individual underwent within a particular context. The theme was divided into four subthemes. The first sub-theme emphasized the distance of the workplace. Respondent L expressed that as he was choosing a working environment,

“When I transferred here [in the UK]… I lived across the street but before that, for the first two months when I came here, they gave us free accommodation but I had to travel 1 hour and then eventually I had to transfer to a new one that is nearer.”

This showed that the distance of the workplace could greatly affect an individual’s decision-making process and impact their overall satisfaction and work conduct.

As we navigated the intricacies of modern work environments, the role of connections in shaping professional routes became a compelling focal point. Respondent L highlighted the importance of considering one's colleagues when making decisions about a workplace,

“You need at least find some connection or you need to be shameless because you can’t avoid asking questions, you have to ask.”

As a fundamental aspect of both personal and professional growth, Respondent D mentioned

“What sort of happened was we developed this kind of connection. They taught me their slang, I taught them some of mine. So, I've learned a lot of Aussie slang and have started to become indoctrinated. They put such importance on the idea of making connections.”

This perspective underscores the social aspect of the workplace and how familiarity with colleagues can contribute to a positive and inclusive professional experience. In contrast with this, Respondent V from Australia, expressed he had a hard time building connections,

“It’s difficult to get along or become close with your coworkers if your focus is more on achieving your plans, [In the Philippines] we’re all in one place, having lunch together at the same time.”

The intricate realm of cultural influences encompassed the dynamic interplay of traditions, values, and shared experiences, molding the diverse pattern of human interaction and expression. Respondent E highlighted,

“You have to learn how to interact and socialize with others, especially with different nationalities because you will see cultural differences. You will also see their different approaches to socializing so you will learn how to be flexible.”

Supporting this claim, Respondent C who worked in the UK mentioned

“What I prepared for is more of a cultural aspect because, of course, being Filipino, you need to show them that you know what you are doing, and you’ll gain respect from them.”

This dual perspective from Respondent E and Respondent C exemplified the nuanced and adaptive nature required when navigating cultural influences in professional settings. Additionally, Respondent D illustrated the evolving awareness and inclusivity within their company regarding various types of disabilities as the culture,

“Now that I see more people, more types of disabilities and how easy it was to access…in my company, that’s the culture. We strive for growth. We…just don’t say “that’s okay, someone else can do it,” not that. You say “maybe you could help me.”

Exploring the dynamics of professional and personal choices, the influence of family members emerged as a significant and enduring force. From career choices to personal aspirations, the influence of a family member formed a compelling backdrop against which individuals navigate their professional journeys. Respondent V, from Australia, expressed

“My father was the one who pushed me to go to Australia… our long-term goal is to bring my family with me.”

This illuminates the profound and lasting impact that familial influence can have on the direction and purpose of one's professional journey shaping not only individual aspirations but also broader, interconnected life objectives. In addition, Respondent B from the USA expressed that

“Initially it’s actually…my wife…who has to go here first…So that kind of influenced my…decision to go here, so like knowing that she’ll go here eventually, kind of bragging to myself, okay I have to take my masters and all those things just so I can work here as well.”

Political Apathy

Politics often served as a significant push factor for individuals to leave their home country. Some people chose not to engage in political activities, despite the ongoing political turmoil in their nation. This theme underlines the political apathy or disengagement of participants who have left their home country due to heightened “political conflict.” One subtheme that emerged from this is the occurrence of election campaigns. Respondent K shared that her decision to practice OT abroad was influenced by the political climate in the Philippines. While practicing as an occupational therapist in the Philippines, she aspired to work abroad. However, due to concerns regarding the election's outcome and its impact on her ability to leave, she decided not to wait. She affirmed that,

“Because of the supporters, I have a feeling of who will win. Then it’s like maybe if I wait for the election, it might be even harder for me to leave.” She further explains that “Originally, this wasn’t really the country in my plans but the availability here is fast.”

In considering the potential return to the Philippines to work as occupational therapists, the majority of respondents indicated no intention of resuming work there. Instead, they cited various personal and professional reasons for their decisions. Respondent L stated,

“For now, I consider going back to the Philippines as a tourist or for vacation purposes. My goal now is dual citizenship here [United Kingdom].”

Similarly, Respondent D expressed contentment with her life abroad and her intention to obtain Australian citizenship. Respondent B noted,

“If I want to go back to the Philippines, I would want to focus on income-generating business opportunities.”

Furthermore, Respondent R emphasized the importance of being realistic about working as an occupational therapist, particularly when comparing life in the UAE to that in the Philippines.

DISCUSSION

This descriptive study delved into the motivational factors driving Filipino occupational therapists to depart their home country and pursue opportunities abroad. In addition to the conventional financial incentives and personal reasons documented in other researches, this study highlighted several distinctive factors propelling Filipino occupational therapists towards international work.

The migration of healthcare professionals from the Philippines was notably driven by discrepancies in compensation, unmet benefits, variations in hazard pay, and insurance reimbursement delays within the healthcare sector. Pull factors enticing these professionals abroad included higher salaries, improved working conditions, advanced technologies, and job opportunities arising from local shortages.¹⁷ Our research findings (Theme 1) revealed that participants chose to work overseas due to perceived robust labor provisions in the host country, ensuring access to comprehensive employment benefits and a structured work environment conducive to achieving a sustainable worklife balance. Additionally, the allure of increased salaries remains a significant factor influencing their decision to seek employment overseas, as supported by our findings (Theme 2). Furthermore, Filipino occupational therapists' pursuit of international employment is rooted in the quest for enhanced remuneration and superior salary prospects, with earnings typically surpassing those available in the Philippines.

Moreover, the strong aspiration for cohesive organizational camaraderie (Theme 3) notably impacted their career choices. Occupational therapists favored work environments that cultivated harmonious relationships among colleagues, devoid of discrimination, and where their expertise was valued, creating a less toxic work environment.

In addition to factors like salary increments, improved lifestyle, and travel prospects that attract healthcare professionals to work abroad, career advancement stands out as a significant motivator for such migration.¹⁸ Our research findings, as exemplified in Theme 4, underscored how career development plays a crucial role in the decision of Filipino occupational therapists to seek opportunities overseas. Participants highlighted their enthusiasm for professional advancement, citing the value of continuous educational initiatives like seminars and mentorship programs offered by employers, fostering a sense of potential career progression.

Validating these data, one research showed that low wages are a major factor for the resignation and migration of Filipino nurses. Medically accredited nurses are paid PhP 33,575 (US$ 670) monthly in public hospitals and PhP 8,000 (US$ 160) in private hospitals which is grossly inadequate to cover the cost of living in Metro Manila, estimated approximately at PhP 50,798 (US$ 1,080). Also, many healthcare providers, including registered nurse personnel, work without sufficient compensation even more so in the COVID-19 pandemic, further contributing to staff burnout and turnover intentions. Moreover, the desire for higher salaries, improved working conditions, and advanced technologies abroad are significant pull factors. Filipino healthcare workers, including occupational therapists, seek opportunities in countries offering better labor provisions, comprehensive employment benefits, and structured work environments conducive to achieving a sustainable work-life balance. The appeal of increased salaries remains a significant factor influencing their decision to work overseas.¹⁹

Healthcare facilities in the Philippines face challenges due to the inadequate availability of essential equipment, technology, and infrastructure, impacting the quality of care delivered.²⁰ Upon investigating the resources accessible to occupational therapists, substantial gaps were revealed when compared to other nations. The research findings (Theme 5) indicated a variety of modalities employed by occupational therapists in their workplaces, emphasizing how these resources enhance their professional efficacy. This study underscored the critical role of resource availability in influencing the effectiveness and job satisfaction of occupational therapists, emphasizing the necessity for equitable access to resources across various settings.

Theme 6 delineated the intricate array of factors influencing personal and professional decision-making processes. It underscored the pivotal role of personal, social, and cultural elements in shaping individual gains within professional spheres, stressing the significance of adaptability and respect within diverse work environments. Conversely, Theme 7 acted as a significant driver prompting individuals to leave their home countries notably in response to political unrest. This theme shed light on the phenomenon of political apathy among expatriates compelled to leave due to escalating political discord, underscoring the profound influence of political instability on the decision-making processes of those seeking opportunities abroad.

Supporting these findings, a study highlighted that inadequate compensation and poor working conditions in the Philippines are significant push factors, leading healthcare professionals to seek better opportunities abroad. The allure of higher salaries, better working conditions, and professional growth opportunities in other countries further entices them to migrate. They also emphasized that political instability and dissatisfaction with the local socio-political environment contribute to the migration decisions of healthcare workers. Professionals seek more stable and supportive work environments that offer a structured and sustainable worklife balance, which is often lacking in their home country due to political unrest and ineffective policies.²¹

Aligned with the study's outcomes, the migration patterns of Filipino occupational therapists were guided by a blend of push and pull factors rooted in their experiences as healthcare professionals, mirroring findings from prior research. Nonetheless, the study's distinguishing feature lay in its thematic focus, highlighting the Philippine employment system as the primary impetus for the migration of Filipino occupational therapists, diverging from other studies that emphasized salary considerations. By delving into the disparities between working domestically in the Philippines and overseas, the study aimed to illuminate the nuanced realities of professional practice environments, veering away from a binary analysis of the pros and cons of working abroad. The study sought to elucidate the motivators underpinning migration decisions while ensuring that all participants were actively engaged in OT roles within their respective destination countries.¹¹

The researchers acknowledged that this study offered a distinct perspective by deeply examining the interplay between the Philippine healthcare employment system and the migration of occupational therapists. Unlike other literature that primarily focuses on salary and working conditions as isolated factors, this study provided a holistic view, incorporating organizational culture, resource availability, and political stability into the analysis. This comprehensive approach not only highlighted the multifaceted reasons behind the migration but also underscored the systemic issues within the Philippine healthcare system, offering valuable insights for policymakers and healthcare administrators to address these challenges effectively. The study's unique contribution lies in its ability to paint a broader picture of the migration phenomenon, moving beyond conventional narratives to reveal deeper, systemic influences driving Filipino occupational therapists to seek opportunities abroad.

CONCLUSION

These findings shed light on the motivations, aspirations, and challenges faced by Filipino occupational therapists, with each having diverse experiences, skills, and perspectives that influenced their decision to migrate. Healthcare systems are widely structured that encompass a range of organized frameworks, regulations, and provisions. These systems are put in place to effectively administer healthcare services wherein such exposure not only enhances their professional development, but also allows them to contribute their skills and knowledge to the field in a broader context. By migrating, they could gain exposure to different healthcare systems, and advanced technologies. Filipino occupational therapists, in particular, exhibited no inclination or intentions to return to the Philippines, as they perceive their present location to provide a superior quality of life. Each individual's circumstances and aspirations may have differed, leading to unique motivations for migration.

Recommendations

Based on the summary and conclusions of the study, the following recommendations are herein endorsed.

• To reduce the likelihood of Filipino occupational therapists from emigrating, policy makers should use the contributing factors for migration as a framework to develop effective and appropriate measures.

• The national government should prioritize implementing changes to the employment system for occupational therapists, rather than solely addressing salary complaints to promote overall improvement on working standards.

• Institute monitoring and evaluation systems within workplaces of Filipino occupational therapists to identify crucial needs and concerns that must be addressed consistently to facilitate work satisfaction.

• The researchers suggest that students should investigate added factors that could assist Filipino occupational therapists in remaining employed domestically, instead of seeking opportunities in an international context.

• For future researchers, a similar study with an in-depth analysis examining the underlying factors that influence the decision by Filipino occupational therapists to pursue employment overseas.

Statement of Authorship

All authors certified fulfillment of ICMJE authorship criteria.

Author Disclosure

All authors declared no conflicts of interest.

Funding Source

This study was funded by the authors.