Shrinking Physician Workforce Threatens Access To Primary Medical Care in Puerto Rico

FOR IMMEDIATE RELEASE: Thursday, January 16, 2020

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Shrinking Physician Workforce Threatens Access To Primary Medical Care in Puerto Rico


WASHINGTON, DC — At a time when the need for greater access to primary medical care has escalated, Puerto Rico is hemorrhaging primary care doctors. Not only is Puerto Rico’s primary care physician workforce older than the U.S. national average, it’s failing to retain new family physicians trained in residency programs there.

That’s the finding in “A Shrinking Primary Care Workforce in Puerto Rico,” a Graham Center Policy report in American Family Physician. Graham Center researcher Elizabeth Wilkinson and her co-authors examined multiple data sources from the American Medical Association and the Centers for Medicare and Medicaid Services to identify physicians in direct patient care. They then focused on family medicine residents to determine how well Puerto Rico was retaining primary care physicians.

Results showed Puerto Rico’s retention rate for new family physicians is among the lowest in the United States. At the same time, the data showed that the territory’s primary care physician workforce is older than the national average.

“The findings indicate that the primary care physician (PCP) workforce in Puerto Rico is aging and leaving the island more rapidly than they are being replaced,” Wilkinson and her colleagues write.

Puerto Rico’s four family medicine residency programs graduated 111 family physicians between 2011 and 2017. However, a year later, only 45 remained on the island to practice. Of recent family medicine residency graduates across the United States, only five moved to Puerto Rico to practice.

“Overall, Puerto Rico experienced a total retention and recruitment rate of only 45% (50 out of 111) of the family medicine residents it trained, the lowest rate in the nation,” the researchers write. “…Meanwhile, in 2018, the median age of PCPs in Puerto Rico was 60 years, compared with 53 years nationally. The median age of family physicians in Puerto Rico was 57 years, compared with 52 nationally.”

These workforce data come at a time when the territory continues to struggle with the aftermath of Hurricane Maria, which caused both widespread damage and an exodus of health care professionals. At the same time, Puerto Rico’s health care system is facing severe federal budget cuts for its health care system.

“Interventions to encourage family physicians to stay or migrate to Puerto Rico are necessary to address the escalating health care needs of the island,” Wilkinson writes. “This includes funding to sustain an adequate health care infrastructure and to incentivize retention of physicians.”

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About the Robert Graham Center

The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.

Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP.