Doctors call for a state of emergency to be declared in the health system

For some, it is a life or death situation, and others see their health deteriorate as they do not have access to medical services due to late appointments with specialists and subspecialists, which can take up to more than a year. And it is that the country’s medical class has been reduced by half – to about 9,000 – in the last 13 years due to the flight of these professionals in search of better salaries and benefits.

This is part of the painting presented yesterday by the Doctor Carlos Diaz Velezpresident of College of Surgeons of Puerto Ricowho stated that the governor Peter Pierluisi has the power to declare a state of emergency due to the precarious situation in which the country’s health system finds itself.

“There are many causes, but they are mainly linked to greed and kidnapping, in full view of the government, carried out by insurance companies against doctors and other health professionals,” said Díaz Vélez.

I urge the legislative presidents and the governor to open their eyes, stop lukewarm cloths and stop dragging their feet in the face of the unprecedented crisis that the country’s health service delivery system is going through “said the cardiologist, who warned that while this is happening many die or worsen their health conditions.

As an example, he warned that, while in the United States Medicare It is the medical plan with the lowest outlays, in Puerto Rico, it is the one that pays the most, while the payment of private plans is lower. Medicare is coverage administered by the federal government for people who are 65 or older or disabled.

Díaz Vélez urged the Legislature to manage projects that help prevent the flight of doctors, retain recent graduates and encourage the return of those who have left.

Dr. Carlos Díaz Vélez, president of the College of Medical Surgeons, stated that it is urgent to work on retaining the country's doctors.
Dr. Carlos Díaz Vélez, president of the College of Medical Surgeons, stated that it is urgent to work on retaining the country’s doctors. (Carlos Rivera Giusti)

Approximately 60% of the (doctors) who graduate (in Puerto Rico) leave. And with fewer resident slots, fewer are graduating”, said the doctor, noting that, before, about 20 could graduate from a residence, and now four or five do.

Data from Accreditation Council for Graduate Medical Education (ACGME, in English) reflect that, in the 2021-2022 academic year, nine hospitals and three medical schools in Puerto Rico offered 41 residency programs and 34 fellowships in which 831 residents and 141 fellows participated.

The situation, warned Díaz Vélez, has also led to patients seeking services and treatments abroad that are no longer available on the island.

“If you get an appointment with a specialist, it’s for six months. In some specialties, appointments are already offered for 2023 ″, he lamented.

The doctor remembered that the Law of Incentives for the Retention and Return of Medical Professionalsapproved in 2017 to establish a fixed rate of income tax of 4%, is stopped by court order after a request from the Fiscal Oversight Board (JSF) for its alleged fiscal impact, as well as four other measures that sought to retain the country’s medical class.

“We do not ask for that 4%. He came to shut our mouths”, he said, commenting that some 3,000 doctors in Puerto Rico took advantage of this tax benefit, which requires the doctor 15 years of service on the island and 180 hours of community work a year.

On July 27, the graduate Jaime El Kourylegal advisor to the Board, sent a letter to the executive director of the Financial Advisory Authority and Fiscal Agency (Aafaf), Omar Marrero, in relation to the procedures aimed at granting incentives to medical specialists or subspecialists to attend medical emergencies in the public health centers of Puerto Rico. In the letter, El Koury warns that the government seems to have no intention of stopping its application, despite its supposed fiscal impact.

In the document, the entity that controls public finances also gives the government until August 12 to report on the decrees granted, among other data. On this particular, Marrero told this medium, in writing, that they will meet the deadline.

“The government has to document where it has the resources to give the incentives. We asked him (to separate) from the area of ​​the film industry about $40 million for medical incentives. The Secretary of the Treasury has also identified resources from other places as well, but nothing (happens)”, said, for his part, Díaz Vélez.

He warned that the Legislature should be summoned to an extraordinary session to seek solutions to the critical state of the health system. He also stressed that the people should not rule out throwing themselves into the street in defense of these services. “We cannot lower our guard. Health has a supreme priority. If we have to throw ourselves into the street, we do it. If they say it’s against monopoly law, it doesn’t matter. We are in a crisis, and we have to work now. There are things that can be done immediately, ”she stressed.

Díaz Vélez, along with several members of the College Board and Jaime Plá, director of the Hospital Association, listed 15 possible solutions to stop the flight of doctors and encourage the return of others.

Here is the college proposal:

1- That the Board of Licensing and Medical Disciplines grant a medical license to those who graduate and comply with the three parts of the revalidation or USMLE. That facilitate and speed up the process with the minimum document requirements.

2- That private insurers, Medicare Advantage and the Vital Health Plan grant a provider number to recently graduated doctors, in the first 30 days of finishing their studies and having a medical license. That the documents required by insurers in this process be standardized and minimized.

3- That they do not pay personal and/or corporate contributions in the first three years of the medical career.

4- That they do not pay municipal patents during the first three years.

5- That in the first three years of the doctor’s career they be granted medical malpractice insurance coverage, free of charge, by SIMED.

6- That a family medical plan be provided at a special and lower cost to newly graduated doctors in their first three years.

7- That the mandatory courses required by the Board of Licensing and Medical Disciplines be eliminated. Leave it to the doctor’s discretion to select the courses they need for the 60 continuing education credits as part of their professional license recertification every three years.

8- Not paying the Medical College fee for three years to recently graduated doctors.

9- Equalize the rates of all services and procedures of private medical plans with that of Medicare.

10- Establish that payments be issued within a maximum period of 15 days for services rendered and billed to insurers. If the payment is made between 16 to 30 days after billing, the payment is doubled. And if it exceeds 30 days, a 25% fine is added.

11- Help in the payment of medical student loans.

12- Increase the places in residency programs through a trust that receives public and private health funds. The trust could be established under the law of the Academic Medical Centers that consist of the four medical schools of the country.

13- Give support to the Licensing and Medical Disciplines Board through the creation of an information center in the Medical Association where all documents are kept and protected to send them to the institutions that require it from doctors.

14- Grant the Medical College the function of certifying Continuing Education, which today falls under the Licensing and Medical Disciplines Board, to speed up the license renewal process.

15- Grant a tax incentive to all doctors in the country of at least 10%, with certain obligations and responsibilities for services rendered.

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