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Physician Migration and its Implications for Puerto Rico's health care system

Award Number: R01MD014188
ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 07/29/2020
PERIOD OF PERFORMANCE END DATE: 02/28/2025

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Physician Migration and its Implications for Puerto Rico's health care system - Project Summary/Abstract Puerto Rico (PR) is facing a major existential crisis fostered by a 70 billion dollar external debt and recent natural disasters that have fostered the deterioration of the health infrastructure.1,2,3,4 These events fuelled the mass migration of physicians to the US mainland, and it is estimated that PR will lose half of its already depleted physician workforce in the next decade.20 We propose to explore, from a multi-level perspective, how the PR health care system responds to this physician migration crisis using a conceptual model informed by theories of migration, spatial stigma, and health care system resilience. We propose the following aims: Aim 1: Document the role of push and pull factors, as well as the potential role of spatial stigma, on fostering and/or mitigating physician migration from PR to the mainland US by richly describing the characteristics of their current and previous work contexts and settings. Aim 2: Document the geographical migratory patterns of physicians who have moved from PR to the US mainland in the last decade (2009-2019) as a consequence of the territory's ongoing economic crisis and the recent natural disaster. Aim 3: Determine the impact of physician migration on PR's health care system functioning and resilience through systematic ethnographic observations of sites affected by physician migration. Aim 4: Develop science-based policy recommendations for the local/federal governments to mitigate physician migration in PR using findings from Aims 1-3 and input form stakeholders in the health care system. We will implement a multi-stage mixed methods design. During Stage 1, we will recruit a random sample of physicians (total N=560) equally divided between migrants and non-migrants. They will complete: a) in-depth qualitative interviews (n=50) to gather rich descriptions of the factors behind the decision to leave or stay, b) cognitive interviews for survey refinement (n=10), and c) a brief survey (n=500) to gather information about the push/pull factors that foster/mitigate migration and the geographical migration patterns of those who have left (Aims 1 & 2). The survey will allow us to analyze the geographical impact of this phenomenon using Arc-GIS technology. During Stage 2, we will carry out institutional ethnographic observation/mapping in settings impacted by physician migration in PR (Aim 3). We will carry out semi-structured qualitative interviews with a theoretically-driven sample (total N=100) of: health facility administrators (n=20), health policy makers (n=20), health care professionals (n=30), and patients (n=30) to understand the impact of physician migration on the health care system's resilience and patient's access to care. In Stage 3, we will develop policy recommendations to mitigate physician migration, conduct participatory ethnographic workshops with key stakeholders in the health care system, and implement a targeted dissemination plan. Results will allow us to assist the local/federal governments in developing strategies to address physician migration.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = -$17,847 )
2025	2023	FLORIDA INTERNATIONAL UNIVERSITY	11200 SW 8TH ST	MIAMI	FL	33199	MIAMI-DADE	USA	Minority Health and Health Disparities Research	000	4	7/25/2025	NON-COMPETING CONTINUATION	-$17,847
														Subtotal = -$17,847

Issue Date FY: 2023 ( Subtotal = $618,960 )
2023	2023	FLORIDA INTERNATIONAL UNIVERSITY	11200 SW 8TH ST	MIAMI	FL	33199	MIAMI-DADE	USA	Minority Health and Health Disparities Research	000	4	2/7/2023	NON-COMPETING CONTINUATION	$618,960
														Subtotal = $618,960

Issue Date FY: 2022 ( Subtotal = $609,492 )
2022	2022	FLORIDA INTERNATIONAL UNIVERSITY	11200 SW 8TH ST	MIAMI	FL	33199	MIAMI-DADE	USA	Minority Health and Health Disparities Research	000	3	2/4/2022	NON-COMPETING CONTINUATION	$548,541
2022	2022	FLORIDA INTERNATIONAL UNIVERSITY	11200 SW 8TH ST	MIAMI	FL	33199	MIAMI-DADE	USA	Minority Health and Health Disparities Research	001	3	4/29/2022	NON-COMPETING CONTINUATION	$60,951
														Subtotal = $609,492

Issue Date FY: 2021 ( Subtotal = $615,761 )
2021	2021	FLORIDA INTERNATIONAL UNIVERSITY	11200 SW 8TH ST	MIAMI	FL	33199	MIAMI-DADE	USA	Minority Health and Health Disparities Research	001	2	3/15/2021	NON-COMPETING CONTINUATION	$61,577
2021	2021	FLORIDA INTERNATIONAL UNIVERSITY	11200 SW 8TH ST	MIAMI	FL	33199	MIAMI-DADE	USA	Minority Health and Health Disparities Research	000	2	2/2/2021	NON-COMPETING CONTINUATION	$554,184
														Subtotal = $615,761

Issue Date FY: 2020 ( Subtotal = $664,019 )
2020	2020	FLORIDA INTERNATIONAL UNIVERSITY	11200 SW 8TH ST	MIAMI	FL	33199	MIAMI-DADE	USA	Minority Health and Health Disparities Research	000	1	7/29/2020	NEW	$664,019
														Subtotal = $664,019

Grand Total All Awards = $2,490,385

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Physician Migration and its Implications for Puerto Rico's health care system

Award Number: R01MD014188

ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 07/29/2020

PERIOD OF PERFORMANCE END DATE: 02/28/2025

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