In his job as a nurse and healthcare administrator, Chris decided on appropriate treatments for patients, and checked their vital signs. Sometimes, he monitored up to 10 patients in intensive care — and he did it all from Manila, thousands of miles away from the U.S. hospital he worked for.
Chris, who asked to go by a pseudonym because he is bound by nondisclosure agreements, moved through a dozen remote nursing jobs in U.S. hospitals between 2020 and 2023. When he noticed drastic changes in blood pressure, or saw that a nurse had not logged whether they’d given a patient their medication, he would ping the on-site staff through the nurses’ station, he told Rest of World.
“We’re not nurses — more like nursing aides,” said the 37-year-old, who now works full time in the Philippines. “We didn’t make the decisions for care, we just informed [on-site nurses] that the blood pressure was high. It was up to them to give the meds.”
Thousands of nurses and aides in the Philippines, employed as independent contractors by U.S. healthcare companies, do a range of tasks including monitoring patients in intensive care, checking insurance eligibility, filing medical records, processing transfers to other facilities, and calling patients to remind them of their appointments. They represent a relatively new class of workers: virtual healthcare assistants who are helping fill a shortfall of nearly 80,000 registered nurses in the U.S. healthcare industry.
Some U.S. employers use local third-party agencies to hire Filipinos with nursing experience, while others insist on American nursing licenses. But for many virtual healthcare assistants, including telesitters, a degree in any medical field will do. The remote nurses, who usually work the graveyard shift at night from their homes or offices in the Philippines, earn between $5 and $10 per hour, compared to the average pay of more than $45 an hour for registered nurses in the U.S.
Top source of nurses
The Philippines has been one of the world’s top sources of nurses since the 1960s, and Filipino nurses make up more than a quarter of immigrant registered nurses in the U.S. currently. Now, as artificial intelligence threatens the business process outsourcing sector, and visa restrictions make it harder to move, more Filipinos are turning to the virtual healthcare sector.
The Philippines’ outsourced health sector employed about 210,000 full-time personnel in 2025, bringing in revenue of $4.5 billion, according to the Healthcare Information Management Association of the Philippines. Nearly 30% of these workers were nurses and other medical professionals.
The country has grown into a “clinical process outsourcing powerhouse … [and] a premier global hub for supporting overstressed international healthcare systems,” JL Botor, president of HIMAP, told Rest of World.
U.S. hospitals and clinics can save up to 70% in labor costs by hiring Filipino workers, said Botor, who expects the industry to expand due to the chronic labor shortage, as well as the growing use of AI. Companies will automate easier tasks such as note-taking, and lean more heavily on human oversight for other tasks, he said. He declined to name the U.S. hospitals and clinics that outsource work to the Philippines, citing confidentiality agreements.
210,000 The number of full-time workers in the Philippines’ outsourced health sector.
The outsourcing of work to virtual assistants runs across different functions in the healthcare industry. Alice, a licensed Filipino nurse in Quezon City, used to earn about $100 per month at a Philippine hospital. In 2019, she started working as a care coordinator at a California-based telehealth company that offers mental health and substance abuse treatment in California and New Mexico.
After patients consult with doctors and therapists over video calls, Alice — who used a pseudonym because she is not authorized to speak to the media — schedules their appointments and matches them with specialists, she told Rest of World. She earns $5 an hour, or five times more than her old job.
“We have this virtual clinic that functions like a lobby where patients check in, and then we traffic or triage them and send them to each of the providers’ personal Zoom room,” Alice said. The entire operation is remote, and the majority of the virtual staff is Filipino, apart from several Latino employees who handle Spanish-speaking patients, she said.
It’s hard to gauge the size of the remote healthcare industry in the U.S., Sarah Matt, physician and the author of a book titled The Borderless Healthcare Revolution, told Rest of World. Medical facilities may “white-label” them as their own employees, and many U.S.-based companies are also wary of pushback for hiring staff overseas, she said.
“So if places are utilizing folks from other countries, they may not be as transparent about it,” Matt said.
Claire landed a job through the hiring platform Upwork as a clinical intake coordinator for MD at Home, an Illinois-based company providing home-based primary care for the elderly. After a day of watching company training videos, Claire — who used a pseudonym because she is not authorized to speak to the media — began working from her home in Davao, earning $7 an hour, she told Rest of World.
On some days, Claire was calling up to 27 new patients in Chicago to ask them about their medical histories, insurance policy, and determine what kind of physician they needed for a house call, she said.
MD at Home did not respond to requests for comment.
An “imperfect” tool
The Covid-19 pandemic worsened staff shortages in the U.S. healthcare industry, with workers reporting feeling exhausted, burned out, and frustrated. To help deal with the shortfall, more than a dozen U.S. states introduced bills to recognize gig nursing platforms, with on-demand healthcare providers such as Clipboard Health, Kare Technologies, Nursa, and ShiftKey growing in popularity.
The workers are often recruited without interviews, detailed background checks, or training, raising concerns about safety, according to a recent report from the think tank AI Now Institute. Yet this model is growing worldwide, including in countries such as India, Colombia, and Mexico.
Following the Covid-19 pandemic, more U.S. hospitals and clinics embraced virtual care, Ksenia Gorbenko, a medical sociologist at the Icahn School of Medicine at Mount Sinai Hospital in New York, told Rest of World.
“It’s an imperfect tool, but the shortage of hands is significant enough” to maintain its appeal, said Gorbenko, who conducted a pilot study on virtual nursing at Mount Sinai. With virtual nurses, hospital staff on site reported “a perceived reduction in administrative burden, uninterrupted completion of clinical tasks, and felt their overtime was reduced,” the study found.
But the benefits to U.S. healthcare workers and patients come at a cost. Filipino nurses taking on more virtual positions is worsening the shortage of medical professionals in the Philippines, Nico Uba, secretary-general of the national group Filipino Nurses United, told Rest of World.
“If they can’t go abroad, remote nursing is the next best thing because local wages are so low,” Uba said. “Then local hospitals are left understaffed and overworked.”