PAs' & Puerto Rico: Are we there yet?

       It’s hard to believe that PAs were not allowed to practice in Puerto Rico until recently. But more importantly that Puerto Ricans have been deprived of improved access to quality & affordable medical care for the past 5 decades.

I, like many other continental Puerto Rican & non-Puerto Rican PAs, found this myopic partisan political barrier personally and professionally deplorable and downright unacceptable from a Public Health & moral standpoint of view. Especially when the PA brand has demonstrated to the world that we have historically shown many benefits derived from our utilization when meeting the medical needs of the patient community across the globe. In fact, the PA concept is thriving in many countries outside the USA. For example, PAs can be found in Canada, The United Kingdom, The Netherlands, and India just to name a few. 

So with this industry-proven track record why is it that Puerto Rican leaders and their physician community were so reluctant to lift the PA legislative barriers for PA practice? Let me be clear: It was basically to protect their economic interests. In other words, It was about the “partisan political protectionism” of the “ruling class” (some elite empowered physician groups) who felt threatened by our brand. Let me tell you, overcoming this mindset was the biggest part/root of the problem at the local level. Another pervasive sad fact was that there was always comfort in the status quo from a psychological perspective in the mindset of all infrastructure stakeholders overseeing the Puerto Rican healthcare system dating back decades.  

Fortunately, this came to pass recently with the enabling of an introductory bill/legislative act known as Ley (law ) #71 in The Commonwealth of Puerto Rico recognizing and authorizing the integration of PAs into their inefficient local healthcare system.

        One unanticipated significant catastrophic factor that may have played an enormous role in finally lifting the hardened entrenched PA restrictions was hurricane, Maria. This natural disaster not only accentuated the inept, broken archaic healthcare system but augmented greatly the lack of physician providers when the massive exodus took place and many fled the island to the continental US for better practice environments and standards of living for their families.

        So this unintended consequence literally paved the way for the reversal of attitudinal barriers among political leaders when it came to their national conscience. Their short-sighted inter-professional mindsets and political derailers were removed thus eliminating the industry's longstanding anti-PA sentiment.

        While this enacted legislative act is considered far from ideal due to some of its restrictive caveats, it certainly is a step in the right direction. It definitely represents the dawn of a new era for PAs in Puerto Rico. More importantly, a great milestone for our PA community is when the first PA program in Puerto Rico opens its inaugural class in the fall of 2023. Perhaps slower than we would have liked, but obviously we're getting "there"!