Shakira Bou Rolón, MS3, San Juan Bautista School of Medicine
It is not a secret that we are experiencing a shortage of physicians in Puerto Rico, especially dermatologists. Many patients are waiting to be treated, and there are just a few doctors to treat them. For many reasons, including the low payment rates from health insurance companies, the financial crisis and the lack of enough residency spots, doctors decide to leave the island and move to the mainland, where they get better opportunities.1
According to the National Resident Matching Program, there were only three Postgraduate Year-2 dermatology residency positions available in Puerto Rico for 2022, and all were filled.2 The shortage of positions drives Puerto Rican physicians to move to residency programs in the United States. Once on the mainland, many physicians do not return to the island to practice medicine. The ones that do come back establish their private practice mainly in the urban areas of Puerto Rico, limiting access to their services for people who live in the island's rural areas.
The problem with the scarcity of dermatologists in Puerto Rico is the consequences patients must confront to receive medical services. First, no appointments are available for new patients with doctors who accept health insurance. Doctors have chosen to treat a limited number of people to control the high volume of patients. In other cases, when patients find a physician who would treat them, they have to wait more than a year to get an appointment. Waiting to obtain a medical visit can risk and worsen patients’ conditions, forcing them to either not treat their skin disease or to look for other alternatives, such as over-the-counter medication that would not necessarily benefit the condition.
Another option to get an appointment sooner is to pay for a private visit with a dermatologist who does not take health insurance. Because of the low and late payment fees from insurance companies, many doctors have decided to exit the insurance companies’ network.3 Now, they have an online website where you can book your appointment and pay with no refunds guaranteed. This is viable for some people who have the money, but the truth is that an initial visit can cost as much as $130, excluding the procedures and medication patients must also pay. That is why this option, although feasible for some, is not cost-effective for most Puerto Rican patients when seeking dermatologic services.
I recently saw a post on social media that motivated me to write this article. A mother posted about a lunch sale she had to collect funds for her daughter. She stated her daughter was suffering from Atopic Dermatitis, and she could not find nearby appointments with a dermatologist who took her daughter’s health insurance. To help her daughter, she was making the sale, and with the money collected, she could pay for a private visit with another doctor. This makes me wonder how many people on our island are doing the same to pay for medical treatments and makes me reflect on all the issues patients confront to receive health services.
Certainly, Puerto Rico needs to create new health policies, residency programs, or incentives to try to reduce the exodus of physicians and to attract other specialists to our island. It is true that Puerto Rico does not provide the highest pay rates for physicians compared to the United States.3 But what about the patients who cannot afford a doctor and only count on health insurance? Most of these patients do not have the resources to pay for a private visit to a dermatologist, and as a result, they choose not to seek treatment, and their conditions aggravate.
As an aspiring dermatologist, I would like to change the system and work towards better health policies for the benefit of not only physicians but for patients as well. My main purpose is to work along with the government in the development of new residency programs and incentives to give doctors, specially dermatologists, the opportunity to practice in the island under fair conditions, realizing there has been an increase in skin diseases that need to be addressed and that there is an urge for medical specialists in Puerto Rico.
References:
1. The exodus of Puerto Rico’s doctors has strained its health care system. NBCNews.com. Accessed January 28, 2024. https://www.nbcnews.com/news/latino/puerto-rico-s-exodus-doctors-adds-health-care-strain-dire-n783776.
2. Results and data - national resident matching program. National Resident Matching Program. May 2022. https://www.nrmp.org/wp-content/uploads/2022/10/2022-Main-Match-Results-and-Data-FINAL.pdf.
3. Why it can take longer than a year to see a doctor in Puerto Rico. Accessed January 28, 2024. https://www.reuters.com/investigates/special-report/usa-puertorico-healthcare/.
About the Author: My name is Shakira Bou Rolón, born and raised in Puerto Rico. I grew up in the rural area of the island, spending the majority of the time with my grandparents. After finishing high school, I decided to pursue medicine after falling in love with my biology class and the reproductive system. I attended the University of Puerto Rico at Bayamon, where I majored in Human Biology. I'm currently an MS3 at San Juan Bautista School of Medicine and hopefully will graduate next year, becoming the first doctor in my family and also the first person to finish college. I'm currently interested in Dermatology, Immunology and Infectious Diseases. My hobbies include watching crime shows, rom-com movies and exploring new eating places. I'm passionate about different cultures and the advocacy of shelter animals. Fun fact about me: I never learned how to swim and I'm allergic to dogs, but I have two; Venus and Kosmo are the light of my life. After medical school and residency, my dream is to travel the world and explore as many cultures and countries as possible, and to learn other languages.
About the Work: This essay provides an overview, from my perspective, of how the shortage of physicians and the healthcare system have impacted Dermatology in Puerto Rico and its consequences for patients.
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