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On leaving: Coloniality and physician migration in Puerto Rico

Author

Listed:
  • Varas-Díaz, Nelson
  • Rodríguez-Madera, Sheilla
  • Padilla, Mark
  • Rivera-Bustelo, Kariela
  • Mercado-Ríos, Claudia
  • Rivera-Custodio, Joshua
  • Matiz-Reyes, Armando
  • Santiago-Santiago, Adrián
  • González-Font, Yoymar
  • Vertovec, John
  • Ramos-Pibernus, Alíxida
  • Grove, Kevin

Abstract

Puerto Rico (PR) has a growing physician migration problem. As of 2009, the medical workforce was composed of 14,500 physicians and by 2020 the number had been reduced to 9,000. If this migration pattern continues, the Island will not be able to meet the recommended physicians per capita ratio proposed by the World Health Organization (WHO). Existing research has focused on the personal motivations for movement to, or permanence in, a particular setting, and social variables that encourage physicians to migrate (e.g., economic conditions). Few studies have addressed the role of coloniality in fostering physician migration. In this article we examine the role of coloniality and its impact on PR's physician migration problem. The data presented in this paper stem from an NIH-funded study (1R01MD014188) that aimed to document the factors associated with physician migration from PR to the US mainland and its impact on the Island's healthcare system. The research team used qualitative interviews, surveys, and ethnographic observations. This paper focuses on the data from the qualitative interviews with 26 physicians who had migrated to the USA and ethnographic observations, which were collected and analyzed between September 2020 and December 2022. The results evidence that participants understand physician migration as a consequence of three factors: 1) the historical and multidimensional deterioration of PR, 2) the idea that the current healthcare system is rigged by politicians and insurance companies, and 3) the specific challenges faced by physicians in training on the Island. We discuss the role of coloniality in fostering these factors and how it serves as the backdrop for the problem faced by the Island.

Suggested Citation

  • Varas-Díaz, Nelson & Rodríguez-Madera, Sheilla & Padilla, Mark & Rivera-Bustelo, Kariela & Mercado-Ríos, Claudia & Rivera-Custodio, Joshua & Matiz-Reyes, Armando & Santiago-Santiago, Adrián & González, 2023. "On leaving: Coloniality and physician migration in Puerto Rico," Social Science & Medicine, Elsevier, vol. 325(C).
    • Handle: RePEc:eee:socmed:v:325:y:2023:i:c:s0277953623002459
    DOI: 10.1016/j.socscimed.2023.115888
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    References listed on IDEAS

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    1. Arah, O.A. & Ogbu, U.C. & Okeke, C.E., 2008. "Too poor to leave, too rich to stay: Developmental and global health correlates of physician migration to the United States, Canada, Australia, and the United Kingdom," American Journal of Public Health, American Public Health Association, vol. 98(1), pages 148-154.
    2. Huish, Robert, 2009. "How Cuba's Latin American School of Medicine challenges the ethics of physician migration," Social Science & Medicine, Elsevier, vol. 69(3), pages 301-304, August.
    3. Lena Dohlman & Matthew DiMeglio & Jihane Hajj & Krzysztof Laudanski, 2019. "Global Brain Drain: How Can the Maslow Theory of Motivation Improve Our Understanding of Physician Migration?," IJERPH, MDPI, vol. 16(7), pages 1-13, April.
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