Why Essential Workers Are Going Extinct

0:00 We're living through an age of job anxiety.

0:02 Every week there's a new headline warning

0:04 that artificial intelligence is coming for our livelihoods.

0:07 We're told it could reshape everything from office jobs

0:09 to creative work and even professions that once seemed untouchable.

0:12 And that fear isn't irrational.

0:14 Big technological shifts have always reshaped labor markets.

0:17 But while we're fixated on jobs that might disappear someday,

0:20 something far more concrete is already happening.

0:23 Countries around the developed world are

0:24 quietly running out of teachers and doctors.

0:26 These are some of the most stable jobs in the economy.

0:29 They don't vanish in recessions and societies

0:31 quite literally cannot function without them.

0:33 Yet across the OECD, the teaching workforce is aging fast just

0:37 as fewer people are coming in behind them.

0:39 Shortages have existed in education for a long [music] time,

0:42 but they were usually manageable.

0:43 Lately they haven't been.

0:45 According to UNESCO,

0:46 maintaining today's education systems alone will require

0:49 millions of new teachers [music] by 2030.

0:51 In healthcare, the picture is even starker.

0:53 The World Health Organization warns of a global

0:55 shortfall of around 11 million health workers by 2030,

0:58 driven by aging populations and medical

1:00 staff retiring faster than they're being replaced.

1:03 Everyone agrees this is a problem and [music] in practice

1:06 many developed countries have already leaned on the same solution.

1:08 Instead of training more teachers and doctors,

1:10 they've increasingly relied on immigration

1:12 to keep schools and hospitals running.

1:14 At first glance that seems like a win-win,

1:16 but this fix only works for as long as people stay and increasingly they don't.

1:21 So, as always we've got some important questions to answer.

1:25 Why are essential workers disappearing in the first place?

1:28 [music] Why can't migration continue to be the solution for this issue?

1:31 And what happens if this shortage becomes permanent?

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2:24 On paper, becoming a teacher or a doctor still

2:27 looks like one of the safest bets you can make.

2:29 Teachers tend to have stable contracts,

2:31 predictable career paths and regular hours with pay that often catches up

2:34 to or exceeds the national average wage over the course of a career.

2:37 In the UK, for example,

2:39 a qualified teacher's salary starts at about 32,916 pounds a year but can rise

2:44 to around 51,000 pounds or more

2:46 with experience with even higher scales in London.

2:49 By contrast, the median full-time UK worker

2:52 earns roughly 39,000 pounds a year before tax.

2:55 In other advanced economies, the pattern is similar.

2:57 Across the OECD, teachers earn statutory

2:59 salaries that cluster around 56,000 [music]

3:02 to 64,000 US dollars depending on the country

3:04 and the education level they teach.

3:06 That puts teacher pay around or slightly above the OECD's

3:09 average annual wage which sits at roughly 61,000 US dollars.

3:13 Doctors go even further.

3:14 By the time they are fully qualified,

3:16 physicians earn more than the average worker with strong job security,

3:19 global demand and skills that remain extremely difficult to automate.

3:23 [music] In the US, the average doctor earns roughly 230,000 dollars a year

3:26 with primary care physicians earning

3:27 less and specialists earning significantly more.

3:30 [music] Meanwhile, the average US worker earns around 69,000 dollars annually.

3:34 The same pattern holds across other high-income

3:36 countries even if the absolute numbers are lower.

3:39 According to the OECD, general practitioners typically earn two times

3:42 the average national wage while medical specialists

3:44 often earn two and a half times the average depending on the country.

3:47 Schools and hospitals are built on the assumption

3:49 that teachers and doctors will always be there.

3:52 Yet across rich countries,

3:53 that assumption is on a collision course with reality.

3:56 Despite all the apparent advantages,

3:57 schools and hospitals are finding it harder to stay fully staffed.

4:01 For most of the past century, the way rich countries supplied essential

4:03 workers followed a fairly predictable pattern.

4:06 Teachers and doctors were trained domestically,

4:08 usually through heavily subsidized public systems,

4:10 because governments understood these roles as core

4:12 national infrastructure rather than ordinary market jobs.

4:15 Each year a new cohort of graduates would

4:17 enter classrooms and hospitals while older workers gradually retired.

4:20 As long as the number coming in roughly matched the number leaving,

4:23 the system stayed in balance.

4:25 Schools remained staffed,

4:26 hospitals kept functioning and shortages were rare and usually temporary.

4:30 That model worked because the underlying demographic supported it.

4:33 Back then, populations were younger,

4:35 birth rates were high enough to guarantee a steady flow of future

4:37 workers and demand grew slowly enough for systems to keep up.

4:40 Training capacity didn't need to expand aggressively

4:43 because replacement was gradual and largely self-sustaining.

4:46 But now, the system is breaking down.

4:48 Across almost every high-income country,

4:50 populations are aging rapidly which puts pressure

4:52 on healthcare from two directions at once.

4:54 Many doctors are approaching retirement just

4:56 as the population itself is getting older.

4:59 In countries like Japan, Italy and Germany,

5:01 more than one in five people is already over

5:03 the age of 65 and that share continues to rise.

5:06 And older societies need more healthcare, not less,

5:09 because people live longer and spend a greater

5:11 share of their lives managing chronic conditions.

5:13 At the same time, birth rates across developed countries have

5:16 fallen well below the replacement level of 2.1 children per woman.

5:20 In countries such as South Korea, Italy, Spain and Japan,

5:22 fertility rates now sit closer to 1.2 or lower

5:25 and even historically higher fertility countries like the UK,

5:28 France and the Nordics have seen sustained declines.

5:30 [music] In practical terms, this means fewer young people entering the workforce

5:34 just as demand for teachers and doctors is accelerating.

5:37 So the obvious question becomes, why don't we train more of them?

5:41 The problem is that training new teachers takes years and training doctors

5:44 often takes a decade or more from university entry to full qualification.

5:48 That means the shortages visible today are not the result

5:50 of recent policy failures but of decisions made 10, sometimes 20 years ago,

5:55 like how many training sites to fund or how

5:56 much strain these systems could be expected to absorb.

5:59 When retirement waves arrive,

6:01 there is no way to accelerate the pipeline quickly enough

6:03 to compensate and the pandemic just made this timing problem worse.

6:07 COVID-19 didn't create the underlying shortage

6:09 but it experienced teachers and healthcare

6:13 workers into early retirement at exactly the moment demand was spiking.

6:17 And once those workers leave, they can't be replaced quickly enough.

6:21 But the deeper problem is that these shortages aren't just about timing,

6:24 they're about incentives.

6:26 While teachers and doctors earn above average wages,

6:28 in many countries they earn less than

6:30 other professions requiring similar levels of education,

6:33 responsibility and time investment.

6:35 Also, public sector pay structures tend to place

6:37 a ceiling on earnings over the course of a career

6:39 with defined salary bands that contrast with private sector

6:41 professions where pay can continue to scale with experience,

6:44 performance or market demand.

6:46 At the same time, getting into these professions has become

6:48 a longer and more expensive process with [music] higher student debt,

6:51 rising housing cost in the cities where the work actually is

6:54 and a payoff that comes only after many years of training.

6:56 [music] Day-to-day work has also become more demanding.

6:59 Long hours, administrative overload and high

7:01 responsibility have become normal particularly in healthcare

7:04 where staff shortages feed directly into heavier workloads for those who remain.

7:08 For many high-performing students,

7:09 private sector alternatives often offer faster financial rewards,

7:12 more flexibility and fewer constraints,

7:14 making teaching and medicine comparatively

7:16 less attractive despite their long-term stability.

7:19 So, the result is a slow compounding erosion.

7:22 Fewer people begin training, more leave earlier than expected and the workforce

7:25 ages faster than it can be replaced.

7:27 So, how have governments managed this problem until now?

7:30 Pay raises and retention policies have helped

7:33 but when faced with shortages they can't fix quickly,

7:35 most governments have reached for the same lever.

7:37 If you can't train enough teachers and doctors at home,

7:40 you bring them in from elsewhere.

7:42 Migration is a faster fix than expanding universities.

7:45 It's also cheaper than raising pay across the public

7:47 sector and far easier politically than long-term reform.

7:50 So governments redesigned their visa systems to compete for essential workers.

7:54 Doctors and nurses were fast-tracked with processing

7:56 times shortened compared with standard skilled visas.

7:59 In the UK, that led to tens of arrivals in a single year.

8:03 In 2022 alone, over 73,000 health and care workers were sponsored

8:07 on skilled visas and the number continued to rise into early 2023.

8:11 So in the short term, visa changes did what they were meant to do.

8:15 Over the past decade,

8:16 this approach allowed schools and hospitals in developed countries to keep

8:19 running without sudden spikes in class cancellations and hospital waiting lists.

8:23 Even as some countries expanded training

8:25 opportunities or experimented with retention bonuses,

8:27 migration remained the fastest way to relieve pressure in the short term.

8:31 The problem is that migration doesn't create new workers,

8:33 it just moves them around.

8:35 So when high-income countries recruit teachers and doctors trained abroad,

8:38 they're often pulling talent out of places

8:40 that already have shortages of their own.

8:42 In theory, that should at least protect developed countries from shortages,

8:45 but in practice it rarely does for long.

8:48 Migrant professionals are less tied to a single system

8:50 and more willing to move again once better opportunities appear,

8:53 which means migration can keep filling gaps

8:55 but it struggles to build a stable workforce.

8:58 You can see this clearly in the UK.

9:00 For decades, the NHS has relied heavily

9:02 on foreign trained doctors to plug staffing gaps.

9:04 Today, around 1/3 of doctors working in the UK were trained

9:07 abroad and roughly a quarter of NHS nurses are non-UK nationals,

9:11 making their health service one

9:12 of the most internationally dependent in the OECD.

9:15 Many arrive, gain experience and do essential work.

9:18 But a significant share doesn't stay.

9:20 Once they've built skills and credentials,

9:22 some move on to better paying systems like

9:24 the US or Australia where salaries are far higher.

9:27 So, the UK becomes a stepping stone rather than a destination.

9:31 In the end, new doctors arrive and others

9:33 move elsewhere which leaves the underlying shortage largely unchanged.

9:37 So, why not fix the problem at the source?

9:39 Because the alternatives are politically and economically hard,

9:42 so many policy makers are opting to just

9:44 hit the snooze button on this problem for now.

9:46 [music] Governments can raise pay for teachers and doctors,

9:49 but that strains public budgets and risks

9:50 backlash from voters who don't benefit directly.

9:53 Expanding domestic training is another option,

9:55 but that takes years and requires sustained funding long before results show up.

9:58 The UK government's NHS long-term workforce plan, for example,

10:02 is backed by more than 2.4 billion pounds in investment

10:04 and aims to expand training and recruitment over the next 15 years.

10:08 But a medical student who starts training today won't fully

10:10 relieve pressure on the system [music] for a decade or more.

10:13 So, for politicians, the costs arrive immediately,

10:15 but the benefits come far too late for an election cycle.

10:18 That's why migration keeps being asked

10:20 to do more than it can realistically deliver.

10:22 It's the only tool that works quickly, [music] but it comes at a price.

10:26 It shifts shortages across borders, increases turnover,

10:29 and delays the deeper reforms needed

10:30 to make education and healthcare workforces sustainable again.

10:33 And this is where the real risk sits.

10:35 When shortages stop being temporary, systems adapt in ways that look functional

10:39 on the surface while slowly degrading underneath.

10:42 In education, it starts with class sizes creeping up.

10:45 Once that happens, individual attention drops,

10:47 and schools quietly narrow what they can realistically teach,

10:50 especially as less experienced teachers are asked to carry heavier loads.

10:54 At first, the impact can seem manageable.

10:55 [music] Students still graduate, and schools are still open.

10:59 The real cost only shows up years later because weaker

11:01 skill formation today means lower productivity decades down the line.

11:06 [music] In fact, World Bank research shows that the quality of education,

11:08 so how much students actually learn,

11:10 matters [music] far more for long-term economic

11:12 growth than how long they stay in school.

11:14 Countries where students leave school with stronger

11:16 skills end up far richer over time,

11:18 while those that fall behind on learning lock in lower growth for generations.

11:22 Healthcare moves faster, so the consequences are even harder to ignore.

11:25 When staff become chronic, waiting times grow and diagnoses are delayed.

11:29 Once this happens, outcomes worsen for conditions that are otherwise treatable.

11:33 In England, for example,

11:34 long waits in A&E have become so severe that the BBC reports there

11:37 are 250 preventable deaths every [music]

11:39 week among patients waiting to be admitted.

11:41 And a less healthy population is a less productive [music] one.

11:44 Fewer people are able to work consistently, more leave the labor force early,

11:48 and healthcare systems end up treating preventable problems

11:50 instead of preventing them in the first place.

11:53 If you zoom out far enough, you can even see how shortages

11:55 in schools and hospitals quietly reshape the economy.

11:58 On one side, growth slows as skills and health erode.

12:01 At the same time, access to education and healthcare becomes more

12:04 [music] unequal because those who can afford private alternatives opt out,

12:07 while everyone else waits longer and gets less.

12:10 Globally, the same dynamic plays out between countries.

12:13 When high-income countries pull essential workers from abroad,

12:16 lower-income countries lose the very professionals they need

12:19 to build their own education and health systems,

12:21 making future shortages even harder to escape.

12:24 In Ghana, for example, roughly seven out of 10 doctors [music] trained during

12:27 the 1990s were working overseas just a few years after graduating.

12:31 The country invested [music] in their training,

12:32 but the benefits were largely realized elsewhere.

12:35 Something similar happened in Kenya,

12:37 where it's estimated that the immigration of just 167 doctors

12:40 represented a loss of around $86 million in training investment alone,

12:44 money that could have gone towards

12:45 starting hospitals and expanding care at home.

12:47 The truth is that North America and Europe employ roughly 2/3 of the world's

12:51 health workers despite carrying only about

12:53 1/5 [music] of the global disease burden.

12:56 Africa, by contrast, bears nearly a quarter of the disease burden

12:58 with only 3% [music] of the global health workforce.

13:01 This is the long-term result of health workers moving from systems

13:04 that need the most to systems that can pay more.

13:07 So, shortages affect everything from inequality to growth,

13:10 but there's also evidence that this dynamic

13:12 can be slowed and, in some cases, reversed.

13:15 In countries where pay, working conditions,

13:17 and training capacity were adjusted earlier,

13:19 shortages have been easier to contain.

13:21 Portugal, for example,

13:22 spent two decades steadily expanding medical school capacity,

13:25 [music] eventually reaching around 5.8 doctors per 1,000 people,

13:29 one of the highest ratios in Europe and well above countries like the US,

13:32 which sits closer to 3.5 doctors per 1,000.

13:35 With this approach, Portugal reduced its reliance on foreign

13:38 inflows and helped stabilize staffing in primary care.

13:41 Romania followed a different path.

13:42 After heavy outflows in the 2010s,

13:44 it raised pay, expanded training, and improved working conditions.

13:48 Doctor immigration fell sharply,

13:49 from around 1,500 a year in 2012 to fewer than 500 by 2021.

13:55 This allowed the system to retain more

13:56 of its own graduates and rebuild capacity from within,

13:59 which tells us something important.

14:01 Outcomes depend on policy choices.

14:03 Where workloads are kept manageable and career paths remain attractive,

14:06 systems are far better at holding onto the workers they train.

14:10 Technology could help ease these shortages, too,

14:12 but only if it's used in the right way.

14:14 AI shouldn't be a replacement for teachers and doctors, but a force multiplier.

14:19 By reducing administrative work, speeding up routine tasks,

14:21 or freeing professionals to focus on the parts of the job only humans can do,

14:25 it can make these careers more sustainable rather than hollowing them out.

14:28 In the end, the real danger isn't that society

14:30 suddenly wake up one day without teachers and doctors.

14:33 It's that the system stop treating understaffing

14:35 as a temporary problem to be solved.

14:37 Once we start slowly accepting understaffing as the norm,

14:40 the cost doesn't stay confined to classrooms and hospitals.

14:43 It shows up in slower growth, weaker skills, poorer health,

14:45 and a society that gradually loses the ability

14:48 to replace the workers it depends on.

14:50 And that brings us back to where we started.

14:52 We're living through an age of job anxiety.

14:54 In many parts of the economy,

14:55 people are worried that technology won't just change jobs,

14:58 it might eliminate them entirely.

15:01 So, what happens in sectors where technology might make humans less necessary?

15:05 If you want to push that original question further

15:07 and see what happens when capitalism doesn't need workers anymore,

15:09 we made an entire video exploring that exact thought experiment.

15:13 You should be able to click to that on your screen now.

15:15 Thanks for watching, mate.

15:17 Bye.