Concern about the lack of doctors in Puerto Rico has existed for many years but was particularly sparked by the effects of Hurricane Maria in 2017. Within a year after the disaster, Puerto Rico had already lost around 15% of its medical staff. Since then, we have seen a gradual increase, however, the number of healthcare professionals is not nearly proportionate to the population. This has severely impacted locals, forcing the sick to endure long wait times or travel far to receive proper care.
The loss of medical workers can be mostly attributed to the low pay standards for these positions in Puerto Rico. The average hourly wage for doctors in Puerto Rico was less than half the wage in the United States in 2016. Many doctors were incentivized to move to the mainland US in order to receive a higher salary. This is perpetuated by the fact that Puerto Rico’s Medicaid program is severely underfunded by the US government, leading to lower wages in the healthcare industry. The Federal Medical Assistance Percentage (FMAP) is used to calculate how much funds should be allocated to each state for Medicaid based on the average poverty rate in that state. However, in 2016, Puerto Rico only received 55 cents for every dollar it spent on Medicaid even though the poverty rates are far higher than Mississippi which received almost 3 dollars for each dollar spent. The former Trump administration cut additional funding from Puerto Rico, leading to further harms to their Medicaid program. The Biden-Harris administration addressed the historic underfunding of the Puerto Rican Medicaid program, ensuring that Puerto Rico will receive an additional 3 billion dollars per year for the program, which will hopefully decrease the doctor exodus over time.
Puerto Rico especially felt the brunt of the exodus during the height of the COVID-19 pandemic. Despite having high vaccination rates and strictly-enforced vaccine mandates, Puerto Ricans were still subject to the highly contagious omicron variant. High hospitalization rates caused serious problems for healthcare officials because they were simply not prepared for the influx of patients. Hospitals were already understaffed due to the doctor exodus that was exasperated by Hurricane Maria, and in addition to that, many doctors were fatigued and even sick. Patient outcomes were significantly affected by this, as they were not able to receive the quality care they needed. This not only affected COVID-19 patients but also forced other patients to have delays in their care which created long-term health issues that surpass the pandemic.
The doctor exodus is still threatening Puerto Rico. With doctors rapidly leaving for more desirable wages in the mainland US, Puerto Rico needs a fast solution. Professor Edwin Park of Georgetown University suggests Medicaid reform as a possible solution, stating that improving Medicaid is the best way to most effectively use federal money to help Puerto Rico’s healthcare system. Others disagree, suggesting that the ideal solution would be improving Medicare Advantage plans which are offered by private companies supported by Medicare. Puerto Rico has a high enrollment in these plans, and there are currently benchmarks that dictate how much the government should pay insurers per person. In 2022, these benchmarks were around 41% lower than the average Medicare benchmark in the US. This is a problem as the costs of procedures and medicines are the same in Puerto Rico as they are in the mainland US, however, insurers are paid far less money and cannot afford them. Puerto Rico’s Resident Commissioner Jenniffer González-Colón (NPP, R) introduced a bill to Congress along with various other legislators that would ensure that the benchmarks would stay above a certain level and the bill has received bipartisan support. Should it become law, it could be the first step to improving healthcare in the territory.
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