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It's hard to get medical care in Puerto Rico. More than 50,000 residents leave the U.S. territory each year for the mainland, many of them doctors. It's estimated at least one doctor abandons Puerto Rico every day, creating vacancies that are hard to fill. And that leads to waiting lists for patient care. NPR's Greg Allen reports.
GREG ALLEN, BYLINE: If you want to find out why so many doctors are leaving Puerto Rico, a good place to start is in Florida.
ANTONIO PERAZA: Welcome to our little home in here.
ALLEN: Dr. Antonio Peraza is in Miami now. He specializes in internal medicine and for nearly 14 years at a private practice in Bayamon, Puerto Rico. He recently made a wrenching decision to close his practice and take a job offer in Florida.
PERAZA: And I wish you could have seen my patients. My patients - the day I told them I was going to close my office, they cried. I felt like I was betraying them.
ALLEN: For decades, long before Obamacare, Puerto Rico has had a government-run health care system that provides coverage for nearly everyone on the island. It offers generous benefits but has never been adequately funded. Nearly two-thirds of the island's residents are covered by Medicaid or Medicare, but both of those programs cap payments to Puerto Rico at levels far below what the States receive. And in the last few years, Peraza says, Medicare payments, already low, have been cut further.
PERAZA: What they have been doing, unfortunately, is taking these Medicare cuts and passing it along to providers and to patients, which we are the weakest link of the chain.
ALLEN: Faced with a declining income, Peraza decided to move to Florida and sell his office building and practice in Bayamon. But so far, he says, he hasn't found a doctor interested in buying him out.
PERAZA: Because most of them are in the same plan as I am doing. Maybe they are a little behind, but plan B is you have to leave the island because there's no other way. There's no choice.
ALLEN: Congress is working on a plan to help Puerto Rico fix its economic problems and avoid defaulting on its more than $72 billion debt. Puerto Rican officials are hoping the plan will also include an increase in Medicare and Medicaid funding. In the meantime, the exodus of doctors, nurses and other health care professionals is making it hard for hospitals and clinics on the island to fill vacant positions. Puerto Rico already had a shortage of specialists. Domingo Cruz Vivaldi, vice president of San Jorge Children's Hospital in San Juan, says with so many doctors leaving, it's getting worse.
DOMINGO CRUZ VIVALDI: To see a adult rheumatologist right now, today, the waiting period, it can be four to five month. And some of them are moving out. And then to replace those physicians, it takes a decade.
ALLEN: The outlook is no better for young doctors just starting their careers. At the University of Puerto Rico, one of four medical schools on the island, Manuel Rodriguez is doing a residency in orthopedic surgery. He says, of his friends, only about one in five plan on staying in Puerto Rico to practice.
MANUEL RODRIGUEZ: I would love to stay here, but seeing the reality that we live every day here with the resources that the hospital has, the resources that the government has, it's difficult to think that we're going to stay here in Puerto Rico.
ALLEN: After his residency, Rodriguez says he'll look for fellowship on the mainland. Fourth-year medical student Milagros Lopez says opportunities and pay are better there, but Puerto Rico is home.
MILAGROS LOPEZ: There's a huge economic incentive to stay away, which is a sad, sad truth. But the thing is, we are a different group of people. This has our home, our family, our language. So I think there is an attachment that's kind of unavoidable there.
ALLEN: Lopez says she hopes to come back to Puerto Rico after completing a fellowship on the mainland but knows life might intervene. Her brother left for a surgical fellowship in the States five years ago, she says. Today, he's married, has two kids and lives in Detroit. Greg Allen, NPR News, Miami.
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