Medical Exodus - Measures

5509POSTS

9 years ago

The new governor has a proposal to stop the exodus that will need to be voted on by the senate and house of representatives in PR.

About 2,422 doctors have left the island in the last 12 years or 347 annually. This has caused the lengtening of time to get an appointment and the deficit of specialists.

The proposal is to limit the tax contribution so a doctor making 250K or less pays no taxes and limits taxation at 4% instead of the 33% that they currently face,

More work will be needed in other areas like the contracts with medical plans where a doctor can be removed from the plan with no rime or reason. Also it is going to take some doing as the government does not currently pays all its bill making doctors and many others with contracts with the government to wait for their money.

While the government is trying to get parity into the amount of money provided by Medicare and medicaid, this is a big unknown, PR receives a lot less money from these programs and the government is looking to get Washington to provide funds equivalent to the amount states receive. However there is nothing in the wind that says that they are considering making changes to the current formulas.

We will need to wait and see if the above law proposal is passed and if it helps reverse the exodus.

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DonnaR Active member

49POSTS

9 years ago

Very interesting! I found a brief mention of this in an article in NuevoDia, do you have a link to where you found this more detailed information? Thanks!!

ReyP ViP

5509POSTS

9 years ago

Spanish: http://www.elnuevodia.com/noticias/loca … a-2279215/

ReyP ViP

5509POSTS

9 years ago

They just released it in English: http://www.elnuevodia.com/english/engli … s-2279320/

DonnaR Active member

49POSTS

9 years ago

Great, thanks! Sounds like Act20/22 for doctors!

Karenqc Guest

0POSTS

9 years ago

Hope they extend this to teachers, officers, etc as well.

ReyP ViP

5509POSTS

9 years ago

Unlikely

Marion-Olga Contributor

147POSTS

9 years ago

I have to say that I didn't experience a longer waiting time for doctors appointments yet.
Had to go to several doctors the last month ( dentist, eyes etc..) and I got the appointments pretty fast. I asked them if they want to leave the island and all the doctors said No, that they will stay because they love PR and that they earn good money here. Not as much as in the US but enough.

lgustaf Serial expat

401POSTS

9 years ago

Why not try recruiting medical professionals? Cubans can now come to the US, and Cuba has some damn good doctors and nurses. And unlike Cuba, Puerto Rico has internet.

Marion-Olga Contributor

147POSTS

9 years ago

#10

My former general doctor was from the Dominican Repuplik.

ReyP ViP

5509POSTS

9 years ago

#11

lgustaf wrote:
Why not try recruiting medical professionals? Cubans can now come to the US, and Cuba has some damn good doctors and nurses. And unlike Cuba, Puerto Rico has internet.

They could but I expect they will need to be certified.

lgustaf Serial expat

401POSTS

9 years ago

#12

Yes, I suspect as well. But I don't think they need certification to work in paramedical positions and pharmacies, which they can do until they receive a certification.

ReyP ViP

5509POSTS

9 years ago

#13

One possible twist on that, President Trump may change the arrangement with Cuba, so who knows. He could even close the embassy, but I am not in the know about how he feels about Cuba so he may or may not undu any of Obamas agreements with Cuba. Unlikely he will lift any sanctions in my opinion but I could be wrong.

adlin20 ViP

1057POSTS

9 years ago

#14

lgustaf wrote:
Yes, I suspect as well. But I don't think they need certification to work in paramedical positions and pharmacies, which they can do until they receive a certification.

Unfortunately or fortunately yes you do ned to have certification and pass a board for most medical positions. That includes becoming a paramedic and pharmacy tech. Just the same way you need to pass a certification in the states. Even for a nurse aid you need to have a license.
The problem with coming from other countries is that if the school you study at is not certified by the medical association your diploma is worthless in the continent. This had happened to a lot of physicians that goes to RD and Mexico to study. The schools lose their credentials for x or y reason and the students cannot apply for the boards in the mainland or in PR.
Since the island uses medicare funds it is regulated just like the states.

lgustaf Serial expat

401POSTS

9 years ago

#15

I still think it's something that should be investigated. There's a lot of talent there and PR has the market. I would think something could be negotiated.

Sitka Serial expat

953POSTS

9 years ago

#16

Adlin20 is correct, medical professionals in the USA must have a current valid license to practice or be employed as a nurse, pharmacist, dentist or physican in any state or the commonwealth of PR. This is a very necessary standard that protects patients from quacks and incompetent individuals.

Some of the lower level positions, like pharmacy techs or medical assistants only require some type of certification that is evidence of training and passing testing requirements, but these types of workers preform their work under the direct supervision of a licensed professional such as a pharmacist or M.D. The licensed professional is responsible that the work performed by the tech or assistant and meets required standards.

The medical and nursing boards in every state regulate licensing and ensure (to the extent possible) that consumers / patients receive appropriate care that actually helps to improve health of patients.

ReyP ViP

5509POSTS

9 years ago

#17

Looks like MCS and Triple S are trying to get any loses from the doctors instead of writing it off.
Makes no sense to me. They are apparently also not raising the Medicare payments that were agreed.
http://www.elnuevodia.com/english/engli … s-2284351/

ReyP ViP

5509POSTS

9 years ago

#18

Seems insurance companies are under investigation. http://www.elnuevodia.com/english/engli … n-2284696/

ReyP ViP

5509POSTS

9 years ago

#19

Funny how some in PR wants PR to become a state and some in California want California to become independent. a Group "Yes California Independence Campaign" is trying to collect 660,0000 signature to put it in their ballot for year 2018 election. If they were to win it would likely result in Civil war. But they been trying for several years now. Not sure how popular the movement is.
http://www.yescalifornia.org

adlin20 ViP

1057POSTS

9 years ago

#20

Rey, I am in California now and I hear more about the movement in the national news than locally. With the cost of living here I don't know how they can afford it. On the other hand, I'm sure many local businesses are not happy with the Trump immigration changes since they depend heavily in illegal workers here.

ReyP ViP

5509POSTS

9 years ago

#21

Maybe they can then sell the state back to Mexico

Sitka Serial expat

953POSTS

9 years ago

#22

ROTFLMAO - but can they afford it? The peso is way down!

lgustaf Serial expat

401POSTS

9 years ago

#23

The US didn't buy California from Mexico.It was spoils of war. Many provisions of the treaty signed have been violated since gold was discovered.

The idea of California seceding has been batted around for decades, but it won't get any traction.

Puerto Rico has a much better chance of being admitted as a state than California has of secession.

It is a shame that medical talent is leaving the island.

ReyP ViP

5509POSTS

9 years ago

#24

Maybe Sweden will buy them, not sure if California is liberal enough for them.

ReyP ViP

5509POSTS

9 years ago

#25

lgustaf wrote:
The US didn't buy California from Mexico.It was spoils of war. Many provisions of the treaty signed have been violated since gold was discovered.

The idea of California seceding has been batted around for decades, but it won't get any traction.

Puerto Rico has a much better chance of being admitted as a state than California has of secession.

It is a shame that medical talent is leaving the island.

I know but I thought it was funnier that way, Sitka liked it.

adlin20 ViP

1057POSTS

9 years ago

#26

Texas is calm now that Trump won. They won't leave now.....at least until the next election.

lgustaf Serial expat

401POSTS

9 years ago

#27

Huh?

ReyP ViP

5509POSTS

9 years ago

#28

Some in Texas also been talking about separating from the US, that is what Adlin was refering too.

Sitka Serial expat

953POSTS

9 years ago

#29

Remember, Texas was an independent nation prior to their voluntarily joining the union. They are quick to point it out when the topic comes up.

adlin20 ViP

1057POSTS

9 years ago

#30

Now that the republicans are in power Texas is quiet about recession, last year it was all over the news. Now is time for California to play the game since it is a major democratic hub.

Sitka Serial expat

953POSTS

9 years ago

#31

Purely anecdotal, but we know a few physicians here on the island socially. A couple have indicated that the are only here on the island working to be close with older parents. Once family obligations are complete they will move to the states to practice.

I know that compensation for medical professionls on the island is low relative to USA averages, not sure why?

ReyP ViP

5509POSTS

9 years ago

#32

Ask them Sitka.
Salaries for doctors in the states are 2 to 3 times what is in PR as I been told.

Sitka Serial expat

953POSTS

9 years ago

#33

Well, that may be a bit inflated, but not much, I know from experience that pay is lower. ( but some specialities may be more) At any rate, I'm still puzzled why? Is the supply of docs and nurses greater than demand here?

I haven't looked at any per capita data, might be interesting.

However, the costs for medical services to the public seems to be about the same as the states. And I bet the insurance coverage rates are not lower.

adlin20 ViP

1057POSTS

9 years ago

#34

I am not sure in the bigger cities, but in towns like mine, most local doctors are there because of the low pase. It is very hard and costly to start a new practice, it takes time to establish a reputation and a patient load. We have 3 local physicians in my town, they come from local families, one of them is the daughter of a long time doctor and she inherited his practice when he retire. I spoke with both of then recently since one of then went to school with me. For the most, they rather stay in town than go to the mainland and have to start all over. The office cost is way less and if they move over most likely they will have to start with a group or work for a hospital. Not that appealing when you're already set. Unfortunately the ones that are willing to move are the young ones that we need for the future.
But I believe it is all a cycle, I meet a lawyer on my last visit that spent years working on the mainland, he was tired of all the hustle, decided to open a small office in my town and left the big city behind.