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  • Writer's pictureThe San Juan Daily Star

A looming crisis in medicine

“To me, this is the most important press conference on our island currently, because we are talking about the health of our children and teenagers who are the future of our island, and pediatricians play a huge role in their development,” said Physicians and Surgeons Association of Puerto Rico President Dr. Carlos R. Díaz Vélez, second from left. (Richard Gutiérrez/ The San Juan Daily Star)

The Physicians and Surgeons Association leads an urgent discussion with a focus on pediatricians

By Richard Gutiérrez

A recent survey of more than 359 pediatricians around Puerto Rico showed that 75% of the physicians who practice that medical specialty in Puerto Rico are over the age of 50.

That is one reason why the Physicians and Surgeons Association of Puerto Rico (CMCPR by its Spanish initials) was joined by several other professional medical associations at a press conference on Tuesday to specifically discuss the current state of the pediatrics profession on the island.

“To me, this is the most important press conference on our island currently, because we are talking about the health of our children and teenagers who are the future of our island, and pediatricians play a huge role in their development,” said Dr. Carlos R. Díaz Vélez, a cardiologist and president of the CMCPR, which hosted the press conference.

Leading the forum along with Díaz Vélez were Dr. Yasmín Pedrogo, president of the Pediatricians Chapter of the CMCPR, Dr. Gerardo Tosca, president of the Puerto Rican Society of Pediatricians (SPP), and Dr. Nilka de Jesús, president of the American Pediatrician Academy (AAP).

“The Physicians Association is 100% united with regard to the claims made by all of our colleagues, which have been happening for years; however, we come back to the same spot, where we let things happen and we don’t act on time,” Díaz Vélez said, acknowledging that as pressing as the pediatrics crisis is, it is one aspect of a larger medical crisis on the island that involves all areas of medicine.

In addition to the result showing the average age of pediatricians on the island, the CMCPR president pointed out that the survey also shows that 47% of the pediatricians surveyed don’t have a structured retirement, which means they could be working far past the customary retirement age, and more than 50% of them believe that the biggest problem they face is health care plans.

“Health care plans have absolute control of health in general, and the government knows about it,” Díaz Vélez said.

The survey, which was directed toward general pediatricians, was created by the four organizations that took part in the press conference, along with the Western Medical Association of Pediatricians and the Eastern Medical Association of Pediatricians. Of the some 500 pediatricians in Puerto Rico, 359 answered the survey, which also revealed that around 60% of pediatricians surveyed are over the age of 60, and 39% of the pediatricians who responded have been doing general pediatric work for over 30 years. The average age that the pediatricians surveyed consider retiring is 67, while 28% of the pediatricians who responded work in two or more municipalities.

The pediatric associations believe that the situation has only gotten worse, and could have dire consequences in the future if it is not dealt with properly and immediately.

Pedrogo, of the Pediatricians Chapter of the CMCPR, discussed the fact that the Puerto Rican Pediatric Society published a study back in 2011 named “Profile of the Pediatrician.” That study pointed out that at that time there was already a significant reduction in pediatricians, and also exposed many situations such as the low remuneration of health care plans. Pediatricians who actively take part in a private pediatric practice have been facing the fact that for over 25 years they have had to continue paying health care plans at a rate that is not in line with today’s inflation. The effect of this on pediatricians is felt in terms of their personal spending as well as their office operations. Adding the fact that salaries are low in the public sector, and considering how demanding the job is without a limit on hours or days, pediatricians tend to burn out.

Pedrogo said such situations have contributed to a significant reduction in medical practitioners who provide care for the population between the ages of 0 and 21.

“Since 2011, pediatricians have been burned out with excessive work because a lot of them work in both the office and do shifts in separate hospitals, because in order to support their families and stay ahead of the curve in terms of inflation and maintain their respective office, they have to work excessively,” she said. “Eighty-five percent of the people who responded are active as general pediatricians and 74% of these are working full time. Here in Puerto Rico, pediatricians can’t have multiple pediatricians in the office to reduce the workload like in the U.S. Here, pediatricians have to work as much as they possibly can.”

“The fact that pediatricians don’t have money for retirement doesn’t help keep these medical practitioners on the island,” Pedrogo added. “I knew somebody who had to leave Puerto Rico because they did not have enough funds for retirement; once they left to the States, they were able to gather a certain amount of retirement funds.”

Another concern expressed during the press conference involves the fact that many hospitals are leaving the health of children in the hands of general physicians who are trained mainly to treat adults and do not possess the training necessary to handle health situations related specifically to children or teenagers. De Jesús, of the AAP, went into more detail regarding healthcare plans and how important it is to actively address the pediatrician crisis in Puerto Rico before it’s too late.

“It may seem obvious, but a child’s body is not the same as an adult’s body. Their hormones and structure are in development, therefore having specialized physicians that treat youths is very important,” she said. “A fundamental part of pediatric work is prevention; they observe if the child is being developed properly, if the child shows signs of autism, depression, or any other mental health-related issue -- pediatricians take care of these. The worst part is that a lot of healthcare plans don’t cover these prevention-based medical interventions and the ones that do cover them only cover about $5 of the procedure. If 75 percent [of pediatricians in Puerto Rico] are over the age of 50 and most of them are planning retirement by the age of 67, we are soon going to see a drastic cut in pediatricians around the island. We have to deal with this issue on time to make sure our children have their respective treatments so we can raise a future generation that is healthy and well-treated.”

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