Chaos in the Health System: Myth or Reality

«Chaos» is a word that when we hear it we think of disaster, usually caused by natural phenomena such as hurricanes, earthquakes, pandemics, etc.

While it is true that the island’s health ecosystem is out of balance, it may be premature to conclude that it is in chaos. According to the dictionary of the Royal Academy of the Spanish Language, chaos is synonymous with confusion and disorder. It is the erratic and unpredictable behavior of some systems, such as the health ecosystem.

By definition, we must conclude that there is no chaos in our health ecosystem, but an imbalance that disadvantages patients, limiting their access to health services and therefore affecting their treatment. Said imbalance is caused mainly by the gradual and organic decrease in the workforce of health professionals and the limited entry of new members. Especially from doctors. This undoubtedly impacts hospital operations, since physicians are the primary source of referrals to hospitals. The formula is simple: the fewer doctors, the fewer meetings and, therefore, fewer referrals to hospitals.

Unlike behavior that leads to chaos, what is happening is not erratic or unpredictable. Without a doubt, it is highly predictable and with countless alternatives to control it. The disease and the treatment are known for sure; what remains is to execute.
What are we up against? In Puerto Rico there are around 9,000 doctors licensed to practice. A very interesting detail is that most of the doctors, residents and students who have left the island in the past are the youngest. They left the island with professionals who have an average age between 55 and 60 years. Which means that, within five to ten years, most of them could be retiring, winding down their internships, or leaving the island for a quiet place to end their careers.

The migration of young general practitioners and specialists seeking a better quality of life versus the integration of new physicians into the ecosystem is undoubtedly what creates the imbalance in the ecosystem. A considerable number of resident doctors and medical students migrate each year, leaving the island with a limited number of professionals in the most needed specialties, such as General Surgery, Neurosurgery, Neurology, Ob-Gyn, Cardio-Thoracic Surgery, Urology and Orthopedics, among others. This vacuum that is created is not replaced at the same rate by new doctors. Which means that the medical workforce on the island is shrinking faster than it is being replaced. A bit scary, considering the number of people still on the island seeking and needing healthcare. Without a doubt, this situation is what could lead us to chaos.

What can we do? If the central axis of the problem is the workforce of health professionals, hospital institutions must develop aggressive and attractive recruitment programs so that new professionals consider Puerto Rico as an alternative to start their careers. The government should simplify and expedite the licensing process and insurers should do the same, when applicable, with the credentialing process, as well as the contracting process. On the other hand, the development of new education or residency programs is urgent. For this, a joint effort must be created by all the participants of the health ecosystem, in order to support hospital institutions, so that they become involved in this initiative.

In conclusion, the island’s health ecosystem, if its particular needs are not attended to immediately and accurately, could collapse in the future. Now, there is no doubt that we have good leaders, an educated country and a democratic structure that, with will, can trigger a stronger and more successful development of our health ecosystem. Let’s not fall into lethargy and conformism, let’s look for the necessary tools to promote the will of the government and the private sector. That is the key to success! Hospital institutions must develop aggressive and attractive recruitment programs so that new professionals consider Puerto Rico as an alternative to start their careers.

Link to Article: