American hospitals turn to virtual healthcare workers - Rest of World

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By Michael Beltran and Jonathan Feakins

9 July 2026

U.S. hospitals are increasingly hiring Filipino workers for remote roles to address significant staffing shortages and for cost savings.<br>The virtual assistants monitor patients, and do a range of administrative tasks for a fraction of the pay received by nurses in the U.S.<br>The reliance on overseas virtual workers raises concerns about patient safety, and risks worsening healthcare shortages in the Philippines

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.”

Virtual healthcare assistants are helping fill a shortfall of nearly 80,000 registered nurses in the U.S. healthcare industry.

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...