Impact on health for the emigration of doctors
Surely he will have heard of the "brain leakage". Due to multiple factors on our island, we currently suffer the mass exodus of scientists and health professionals such as doctors. For example, I recently called a doctor specializing in a hospital and they notified me that unfortunately she had gone to the United States after the passage of Hurricane Maria. Many patients in Puerto Rico happened in the past months. This made me reflect on how many doctors have left our island and what are the factors that motivate this decision, in addition to how this will affect our health services.
This problem is not new, already in 2012 the dr. Eduardo Ibarra, former president of the College of Surgeons, described in the magazine Galenus the increase in the emigration of doctors . It is estimated that from 2009 to 2014, the number of doctors on the island decreased from 13,452 to 11,088, which is equivalent to an average loss of 472 doctors per year or 1.29 doctors per day. This is equivalent to a decrease of 17.5 percent according to Custom Research Center Inc., In December 2014. However, the so -called escape of doctors, according to the migrant profile in 2016, was completed with the game of 382 doctors . The case of nursing professionals was more dramatic with a total of 1,376 that left the island. In addition, some indicators, such as the movement of passengers at airports, show high migratory trends in the general population. It is established, for example, that last year 281,000 more individuals left the island of those who arrived (Cortés 2018). Most of this movement of people occurred in the months that followed the passage of Hurricane Maria. In an article published recently it is revealed that in the last three years 6 out of 10 general doctors have left the island (Parés 2018). During that period 8,143 more specialists left and the trend has increased slightly in the last year.
This has caused a lack of medical specialists in areas such as immunopathology, neuropathology and nuclear radiology, motivating patients to move outside the country in search of services. This situation negatively affects patients, who in addition to suffering delays in waiting rooms in the face of a greater volume of patients, also suffer the problem of getting appointments with specialists who could take years. For example, "an appointment with a geneticist can take up to two years," said DR. Víctor Ramos, president of the Surgeon College. This lets us see the seriousness of the situation when looking for specialists.
The causes are diverse, among these, the payments of the insurers. According to the Geographic Practice Index (GPCI), which governs the payments that galenos receive for their services to patients from Medicare and Medicaid, the Puerto Rico index is the lowest in the United States, this includes the Virgin Islands and Guam . Therefore, this disparity aims to be the core problem, added to the high cost of living on our island, which has promoted the emigration of doctors. The doctor. Ibarra indicated in the magazine Galenus, that this entity conducted a scientific study to identify the causes of the increase in emigration of these professionals . The study revealed that the difference in payments for its services was the first reason. The second cause was the dramatic difference in the time and way in which doctors receive their payments. To this is added how difficult it is to exercise the profession in an environment where the doctor has become a health worker. Regard. Ibarra. This was confirmed by DR. Víctor Ramos, president of the College of Surgeons, who pointed out that “dilemmas with medical plans for late or denied payments and difficulties in achieving approval for procedures to patients, appear to be the main reasons for emigration."In addition, the aforementioned study indicated that an alarming 60 percent of our doctors have considered emigrating . How could we solve the health problems of our people without 60 percent of the medical class? Truly, this is something worrying that we must think about how to improve the health system and stop these problems.
On the other hand, there is the indebtedness factor for the race. At the beginning of medical practice the hiring of medical insurance can take up to eight months, as explained by the DR. Humberto Guzmán, who is orthopedic. This causes that doctors in medicine cannot work during this time for not having a supplier number, however, in the United States they are hired and fast they begin to work, said the DR. Guzmán. Many newly graduated doctors are urgent to work, because they accumulate debts of up to $ 250,000 in student loans that are charged as soon. This factor limits the doctor to exercise and be able to pay their loans in Puerto Rico and increases the number of doctors that decides to emigrate.
Some young doctors, who suffer from this problem, confirm the challenges set forth above. The doctor. Odrick Rosas said that the emigration of doctors has increased and that the cause is the problems with the pay by medical insurance. However, he wishes to exercise medicine in Puerto Rico, although he does not deny that he has thought to leave the country. On the effect that this can have on medicine on the island, he mentioned that one of the negative effects on the patient is the long wait to obtain a health service, due to the lack of specialists. In addition, another consequence is the increase in the deterioration of a patient before obtaining the first medical evaluation, said the DR. Rosas.
On the other hand, the Dra. Jinetsy Rivera said that she has also observed a rise in the emigration of her medical colleagues. She agrees that among the causes for this are the various problems with medical insurance, among these "that are delayed to pay, denote visits, consultations, and procedures to patients". Also, Dra. Rivera mentioned that economic factors such as "lower pay, less benefits and less flexible schedules" make the landscape in Puerto Rico not very encouraging to exercise medicine in contrast to the United States. At the same time, the sacrifice of time and money invested in academic preparation is overwhelming for the medical class. For example, to exercise medicine it is a requirement "to have eight years of studies and a minimum of three years for residence (specialty), and a student loan debt is assumed of a minimum of $ 200,000", said the DRA. Rivera. On her desire to remain in Puerto Rico, she indicated that she does it for her family and because she believes that more endocrinologists are needed on the island. However, she mentioned that she has thought of multiple occasions to go to the United States to work. On the impact of the emigration of doctors on the health of the Puerto Rican people she said that "less specialist doctors, equivalent to more waiting time for appointments". Another negative impact, "is the problem of medical plans that are every so often denying medications or studies, which is equivalent to diagnoses, monitoring, treatment or other medical processes that expand …, in short, a suboptimal medical management (which It does not go with our responsibility or duty as a doctor) and makes some preventable or diagnosed disease early, ends in a full of complications including death, ”concluded the DRA. Rivera. This restlessness is genuine in health professionals, because they are limited in their exercise of medicine and show their concern about serving their patients with excellence.
It is important to stop emigration and keep our specialists on the island. Government’s initiatives, such as Law 14 of Incentives for the Retention and Return of Medical Professionals, have tried to stop without success that more doctors decide to leave. It is necessary to tackle the problems that these professionals confront and can be achieved through initiatives that promote improving the payment by medical insurance, developing bills that accelerate permissions procedures to establish their offices and measures that allow them to reduce their debts of Student loans.
Given the need for more doctors on the island, in the Fajardo enclosure of the Inter -American University of Puerto Rico. In Puerto Rico there are not enough opportunities for medical internships in hospitals for the number of students who want to have this experience. Therefore, the enclosure offers a medical internship (shadowing) such as the intermediate Shadowing Program of the Department of Sciences and Technology. The initiative began in 2016 and the goal is to help students obtain the necessary experiences to request in a medical school. The program consists in exposing them to the clinical area with specialists from various areas.
Students make rotations in areas such as gynecology and obstetrics, surgery, emergency room, gastroenterology, internal medicine and pediatrics among others. During the shadowing they go hand in hand with specialists and internal doctors, and observe surgical procedures, patient evaluations, medical consultations, physical exams, among other tasks performed by the staff.
References
- Cortés Chico, R. (2018, June 24). The new great exodus of Puerto Ricans to the United States. The new day. Recovered from https: // www.the new day.com/news/premises/note/elNuevographranexode-struggles states-2430577/
- Ibarra, e. (2012). Health professionals to the United States. Galenus magazine. 34 (6), 14. Recovered from http: // www.Galenusrevista.com/leak-of-professional-of-la-salud.HTML.
- Law no. 249 of 2018. To amend article 41.090 of Law No. 77 of 1957, Puerto Rico Insurance Code. Published in Lexjuris, of December 3, 2018. Puerto Rico.
- Pares Arroyo, M. (July 23, 2018). The escape of doctors threatens health. The new day. Recovered from https: // www.the new day.com/news/premises/note/lafugademedicosamesalud-2436908/
- OR.S. Centers for Medicare & Medicaid Services. (2011). National Physician Fee Schedule and Relative Value Files. [Web Document]. Recovered from https: // www.CMS.GOV/APPS/Physician-FeE-SCHEDURE/DOCUMENTATION.ASPX
- Velázquez, a. (2018). 2016 migrant profile. [Web Document]. Recovered from https: // statistics.PR/Files/Publications/PM_2016_1.PDF
- [Image: C: USERSMAYRA LIZ CASTRODOWNloadSFB_IMG_14915797300.JPG]
- Students of the First Shadowing Program
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