Puerto Rico has been short of medical professionals for years. The fiscal oversight board just commissioned a survey to find out just how bad the situation is.
Supply and demand
The report says, in perfect report-speak, “Our modeling suggests there is significant misalignment between demand and supply across multiple healthcare workforce categories.” In other words, there is a serious shortage of healthcare professionals in Puerto Rico. We already knew this, but the researchers went on to enumerate the details of the major issues.
The report calls out significant shortages in certain specialties:
- endocrinology (hormones, diabetes, thyroid health)
- gastroenterology (stomach issues)
- geriatrics (health for aging people)
- nephrology (kidney health)
- oncology (cancer)
- orthopedics (muscles and skeleton health)
- physical therapy
- psychology/psychiatry
- urology (urinary system and men’s reproductive system)
These specialties are particularly important in Puerto Rico for two reasons. First, the population is aging, and second, the level of chronic diseases is unusually high. These two things are not unrelated, but they mean that the specialties listed above are in high demand. Since they are also in low supply, many people in Puerto Rico do not get the help they need.
One piece of information that has not been discussed much in the past is the fact that many of the health professionals in Puerto Rico are, like the overall population, over the age of 60. For examples, 49% of cardiologists in Puerto Rico are over 60. As these people retire, the shortage will become even worse.
Geographic issues
The metro San Juan area, which includes San Juan, Bayamón, Guaynabo, Cataño, Canóvanas, Caguas, Toa Alta, Toa Baja, Carolina and Trujillo Alto, is home to about 76% of the population of Puerto Rico. One study suggests that about 54% of the doctors in Puerto Rico practice in San Juan.
Rates of chronic diseases are higher in the west of the Island, however. Rural people have fewer doctors, more difficulty with transportation, and therefore less access to health care. The report found highest levels of supply and demand misalignment in Mayaguez, Arecibo and Ponce.
Compared with states
“There was considerable agreement among stakeholders interviewed and surveyed that the financial imbalance that Puerto Rico faces in its federal healthcare programs vis-à-vis states has created a negative impact in the population’s health conditions and an increase in demand for services,” the researchers concluded. That is, the lack of access to ongoing healthcare and preventive services caused people more often to end up in emergency rooms or hospitals.
The report referenced research from the National Hospital Ambulatory Medical Care Survey published by the Centers for Disease Control and Prevention (CDC). This data showed that emergency room use in Puerto Rico is 12% higher than in the states, and that 47% of the visits to emergency rooms are estimated to be non-emergent — that is, not actually emergencies. This supports the idea that people go to emergency rooms because they don’t have access to more appropriate options for their medical care.
The financial imbalance they’re talking about is the fact that Puerto Rico does not receive the same federal funding for healthcare that states receive. Puerto Rico’s poverty level is much higher than that of any state, so nearly half the population is eligible for Medicaid. Nonetheless, Medicaid is funded differently in Puerto Rico and the territory receives much less in federal funding for the program than any state. The funding received is in the form of a block grant. In states, the amount is reimbursed, and depends on the needs. In Puerto Rico, though, there is a cap and any needs not covered by the block grant just aren’t covered at all.
Territory status may also be implicated in some of the other factors affecting healthcare in Puerto Rico. For example, the high rates of diabetes and high blood pressure are discussed in the report. In both cases, genetic predisposition is suggested as a contributing factor, but so are poverty, obesity, and lack of physical activity. Access to healthy food choices is affected by socioeconomic challenges as well as the widespread reliance on imported foods. The Island imports about 85% of the food eaten. The prosperity which inevitably accompanies statehood for territories which are admitted would probably make a difference in these factors.
Finally, working conditions for healthcare professionals in Puerto Rico are poor compared with the states, and moving to a state is always an option for healthcare professionals in Puerto Rico. The report showed that healthcare workers surveyed made many complaint about overall working conditions, but also mentioned the lack of administrative support and other types of support such as nurses, technicians, and physical and respiratory therapists. Doctors in the territory do not have the kind of support doctors have in the states. In fact, 52% of the doctors in the survey said that they were considering moving to a state.
The future
The future of healthcare in Puerto Rico does not look good — assuming it remains a territory. Statehood would make a significant difference. Federal funding for healthcare would increase, overall prosperity would have positive effects on health for many residents, and reimbursement rates for physicians would improve. The researchers proposed that Puerto Rico work on improving the overall health of residents to reduce demand for healthcare workers, while also trying to improve working conditions in an effort to increase the supply.
We believe that statehood would have these desirable effects. Reach out to your congressional representatives today and let them know that you, as a voter and a constituent, care about Puerto Rico’s status, and that you want to see the United States add Puerto Rico as the 51st state.
Read the full report:
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