Puerto Rico

[68WEMTto65DPAC]

Creating this thread to start the conversation about PA practice in my home country. I am currently outside of PR but have been following the profession closely. Interested in learning about other's perspectives on the trajectory of the profession on the island. Currently, the vast majority of Puerto Ricans are not familiar with the profession, from my perspective, the vast majority of physicians and other healthcare professionals aren't either, there's only 1 program (currently on probation), there aren't that many job openings since graduates from medical schools can work as PAs, and salaries are tragically low even for the island's economy (jobs within the $15-$25/hr).

I know this: PAs are one of the best things that can happen to the island's healthcare system. PAs are competent, economical (compared to their physician counterparts), and can help increase access to care significantly.

So, what do you all know about PAs in Puerto Rico? What are the current and/or most needed advocacy efforts? 

[68WEMTto65DPAC]

Update from the president of the Puerto Rico state chapter of the AAPA, Laura Juarez, PA-C, as of September 2023:

 

Quote

The short answer is- there are zero PA-C's licensed and working in Puerto Rico with an actual scope of practice. After Ley 71 was passed in 2017 we all got excited but it turns out it was a Trojan horse of sorts; it used the PA title to give foreign medical graduates a "license."  
To the best of our knowledge there are >1,000 FMGs using PA and there are 3 of us with the PR PA license that are actual graduates of ARC accredited programs who have passed PANCE.  
There are "one offs" with one of us in the Coast Guard, one at the VA who isn't allowed to do anything/assist in surgery/diagnose or prescribe. In 2020 we dissolved the AAPA special interest group called "PAs for Puerto Rico" and created the actual constituent organization (like the state chapters) called Academia de Asociados Médicos de Puerto Rico or AAMPR. We use that title instead of PR association because #1 it's in Spanish and #2 it uses the correct Spanish translation of the title of the profession Asociado Médico.  For more info on our current efforts with legislation and the PA program see our social media on facebook, Twitter, Instagram! 

 

[rev ronin]

On 1/3/2024 at 6:47 PM, 68WEMTto65DPAC said:

So, what do you all know about PAs in Puerto Rico? What are the current and/or most needed advocacy efforts? 

I've had the pleasure of speaking with Robert Smith on the topic. It sounds like the problems are somewhat similar to Texas: Very strong, physician dominated medical/regulatory apparatus that has no use for PAs that might threaten their grip on things.

[68WEMTto65DPAC]

8 hours ago, rev ronin said:

I've had the pleasure of speaking with Robert Smith on the topic. It sounds like the problems are somewhat similar to Texas: Very strong, physician dominated medical/regulatory apparatus that has no use for PAs that might threaten their grip on things.

I can see that being the case. Physicians in PR are very well respected (not that they aren't elsewhere) being such a small place and doctors still being the family physician, or the endocrinologist in town, etc. But if that's what's holding PAs back, it doesn't make sense and they probably don't know how to utilize PAs in practices. People have to wait months, sometimes a year, to get in with certain specialties precisely because there's only a handful of them in the country.

I do think that PAs being much more economical compared to physicians will make hospital groups want to hire PAs. But there's also the issue that graduates of foreign medical schools who are not able to obtain their medical license can practice as PAs and use the title of PA in Puerto Rico.

[rev ronin]

2 hours ago, 68WEMTto65DPAC said:

I do think that PAs being much more economical compared to physicians will make hospital groups want to hire PAs. But there's also the issue that graduates of foreign medical schools who are not able to obtain their medical license can practice as PAs and use the title of PA in Puerto Rico.

I think the federal government use of PAs (USCG/PHS, other uniformed services, VA) is the key. We need to send out a call for Spanish-speaking PAs to seek out these jobs and emigrate to PR, knowing they will have limited respect and working opportunities, knowing they have an uphill climb to open the island. And, when they've done that, the profession needs to support them professionally: mentoring, online advanced degree support, whatever it takes to make sure that when they go to PR to fight to open the territory to PAs, we have their backs.

[68WEMTto65DPAC]

2 hours ago, rev ronin said:

I think the federal government use of PAs (USCG/PHS, other uniformed services, VA) is the key. We need to send out a call for Spanish-speaking PAs to seek out these jobs and emigrate to PR, knowing they will have limited respect and working opportunities, knowing they have an uphill climb to open the island. And, when they've done that, the profession needs to support them professionally: mentoring, online advanced degree support, whatever it takes to make sure that when they go to PR to fight to open the territory to PAs, we have their backs.

That's what I most likely will do. Family matters will eventually take me back to the island inevitably, and more than likely I will seek employment with a federal agency to secure a decent salary and appropriate scope of practice since it seems to be the only way to do that in PR right now. I like to think I'm willing to take on the fight for the profession. But I'm not even a PA yet so we'll see. That's why I started this thread and keep up with the profession's progress. Chances are I'll be a PA in PR at some point in the next 10-15 years.

Edited January 5 by 68WEMTto65DPAC