Puerto Rican physiatrist: I've been here for two years, and I can't take it anymore.

How can you say goodbye to your family, your home, your island, for the second time?

There is no script to follow. The reality of returning to Puerto Rico as a subspecialist physician to have to leave again after two years carves a big hole in my heart.

My story is one that you have heard many times before, but from other mouths, and other professionals. I was born and raised in Puerto Rico. I did my undergraduate and medical studies in the University of Puerto Rico system and then my specialty in Physiatry at the Veterans Hospital in San Juan. I had the opportunity to do two additional years of subspecialty training in neuromuscular medicine and clinical research in muscular dystrophy at UCLA and Johns Hopkins, respectively. And after 14 consecutive years of study and clinical experience, I decided to continue my academic career and practice in neuromuscular physiatry at different medical schools in the United States.

My situation is just a symptom of an ailing health care system, which is not prepared to help either health professionals or patients, writes Elba Gerena.

Nevertheless, I always had the intention of returning to my island, to be able to offer my services as a neuromuscular physiatrist to the Puerto Rican people. And so, in 2020, during the most challenging phase of the COVID-19 pandemic, my husband, my daughter and I moved from Miami, Florida, to Ponce, Puerto Rico.

It is difficult to summarize my experience these past two years trying to navigate the island's healthcare system. I have encountered a myriad of barriers to establishing my practice as a subspecialist physician and practicing my profession with dignity and excellence. There are no guides to overcome all the obstacles that come your way. Moreover, it is disappointing when you know you have met all the requirements to open a successful private practice and see no response from the local and state agencies that have the power to assist in this process. Between the difficulty and time it took to reactivate my Puerto Rican medical license, obtain all the other pertinent licenses for the practice, and obtain and negotiate the contracts with the insurance companies, two years passed without me being able to see a penny in profits.

By comparison, my experience in the different states in which I have worked in the United States, after 2-3 months, I had my medical licenses and contracts with the insurance companies, and I could start working as a subspecialist physician in the corresponding state.

I must emphasize that during all this arduous journey I had a good experience, and that was the opportunity to work with the team of professionals of SER de Puerto Rico. At the SER clinic in Ponce, I was able to provide my services to the pediatric and adult populations of the central and southern areas of the island. But this work was not full-time, but a time that I took out of my week to help the neediest population of the island.

I end this column by mentioning that no matter how much mental and economic preparation I had before returning to the island, after two years of struggling daily with a broken system, I have had to make the decision to return to the United States. My situation is just a symptom of an ailing healthcare system that is not prepared to help either healthcare professionals or patients. At the end of the day, the Puerto Rican people are the ones who must decide if this is the system they want to continue to support or if they will listen to all the voices that have warned them that the system is in decline. I say goodbye to my island with pain in my soul, knowing that my near future will be in another land far from here.

This piece was originally published in Spanish in El Nuevo Día.

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