Doctors are twice as likely to migrate as nurses because wage differentials are greater, and because most nurses are women and men are often the primary decision-makers regarding migration (Brown and Connell 2004). A growing shortage of skilled workers in the region has also contributed to increased intra-Pacific migration, with workers migrating to countries offering better work conditions and salaries, such as Samoan nurses moving to American Samoa and tourism workers to the Cook Islands, and various skilled workers going to Nauru (including health workers from Tonga). There is some weekly commuting from Samoa to American Samoa.