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Editorial & Column
No Residents, No Physicians
By FRANCISCO JAVIER CIMADEVILLA
February 26, 2004
Puerto Ricos healthcare industryby far the best and most advanced in the Caribbean and possibly in all of Latin Americacould soon find itself in critical condition.
And it wont be because of a lack of facilities or equipment. On the contrary, we have on the island some of the most advanced medical technology available, equivalent to that found in most states on the U.S. mainland.
Rather, its our ability to generate and retain top-flight medical talent that could soon put us in a bind and force more and more island middle- to upper-income families to travel abroad for medical care. That would reduce the ability of medical specialists and hospitals to continue serving everyone with the quality medical service we have now.
Although local medical schools keep turning out a good number of graduates every year, fewer and fewer graduates are able to actually become physicians in Puerto Rico. That is because the number of residency programs and the number of positions in those programs are dropping precipitously. Since 1992, the number of local residency positions has been cut in halffrom 1,100 to about 550 in total.
For years, Puerto Ricos hospitals not only have offered residency programs in general medicine but have striven to offer more and more medical specialties and subspecialties, which has meant that locals dont have to travel stateside to get the most advanced specialty treatment. Now that trend is in reverse.
Although not the only reason, the government Health Reform implemented in 1993 has aggravated the problem. The gist of the reform was to get the government out of the business of directly providing health services by selling public hospitals and health facilities to the private sector and using the money saved to buy private health insurance for the indigent at low group rates.
As a result, Puerto Ricos needy can access the same quality healthcare available to those who can pay for private healthcare insurance.
But the otherwise beneficial Health Reform has had an unforeseen adverse consequence. Before most of the islands public hospitals were sold, 85% of the medical residencies were done there, with the remaining 15% done in private hospitals. And although the original intention was for privatized hospitals to continue having residency programs, it didnt happen.
One of the reasons was that the government stopped paying stipends to interns and residents at privatized hospitals, as it had been doing when those hospitals were in government hands. Instead, it chose to pay only residents at the remaining government-owned public hospitals. The other main reason for the dwindling number of residency programs is the problem of medical malpractice. While medical malpractice lawsuits against public hospitals are capped at $75,000 under local law, theres no limit on malpractice claims against private hospitals. As a result, many private hospitals have chosen to limit their residency programs, which typically command higher, and therefore more costly, malpractice insurance costs.
Medical malpractice reform is obviously an area that deserves prompt study and action on the part of the local government, to ensure it doesnt continue serving as a disincentive for private hospitals to have more adequate residency programs.
In the States, private hospitals are often affiliated with large universities with medical schools. In Puerto Rico, most private hospitals dont have the size to nurture large residency programs, in contrast to public hospitals, which get their residents stipends subsidized by the government and their malpractice liability capped.
As it is, we have already been feeling the pinch of physicians and nurses being attracted to better and better-paid working conditions in the States, resulting in a brain drain, which we must quickly staunch. Now we have the problem of not turning out enough physicians because we dont have enough medical residency programs.
Unless some of these issues are tackled posthaste, Puerto Ricos healthcare industry will soon suffer the consequences, and the many families that cant afford to go to the States for specialized medical care will suffer the most.
This Caribbean Business article appears courtesy of Casiano Communications.