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A study on the healthcare workforce in Puerto Rico conducted by FTI Consulting for the Financial Oversight and Management Board found numerous problems.
The study, whose results were unveiled Tuesday, was commissioned because, the oversight board said, addressing the challenges facing Puerto Rico’s healthcare workforce is crucial for improving the health and quality of life of its residents, as well as fostering economic growth. FTI partnered with IMPACTIVO to carry out the research.
The study identified a significant misalignment between the demand for and supply of healthcare workers across various categories. Misalignment is defined as either supply significantly exceeding demand or, conversely, demand significantly exceeding supply.
The extent of the misalignment varies based on several factors. The first is patient demographics, since older people living in Puerto Rico face greater challenges in accessing healthcare services compared to younger residents.
The second factor is geography. People living in rural areas of Puerto Rico, which are less populated and farther from major population centers, have more difficulty accessing services than those in urban areas.
The third factor was the category of service. Certain healthcare professions, including endocrinology, gastroenterology, geriatrics, nephrology, oncology, orthopedics, physical therapy and psychology/psychiatry, exhibit the greatest misalignment. There is also a notable shortage of clinical support staff, such as physical therapists, who are essential for managing an aging population and patients with multiple chronic conditions.
The concentration of healthcare practitioners in urban regions creates significant accessibility issues for residents in rural areas. Additionally, many healthcare professionals are aged 65 and older, leading to fewer available doctors.
The study found that existing laws and regulations in Puerto Rico act as barriers to expanding and developing the healthcare workforce. For example, practitioners operating outside of Puerto Rico are unable to provide telehealth services to patients within the territory.
The licensing and credentialing processes for healthcare practitioners rely heavily on outdated paper-based methods, which can take months, and in some cases over a year, to complete. This is further complicated by the fragmentation of the system, requiring practitioners to work with multiple payers to secure individual credentials.
The often-discussed 4 percent tax incentive for certain healthcare providers seems to have resulted in recipients reducing their hours of operation while maintaining the same level of net income. Additionally, an increase in Government Health Plan (GHP) reimbursement for certain providers has led practitioners to prioritize GHP members over those covered by other health insurance programs.
Funding constraints and misalignment — specifically the disparities in Medicaid and Medicare funding between Puerto Rico and U.S. state jurisdictions — are well-documented and recognized as a major driver of workforce shortages. More fundamentally, those issues contribute to the unavailability of critical health and human services in the territory, the study noted.
The report from the FTI study recommended implementing initiatives that have been shown to improve population health and promote more optimal utilization of healthcare professionals and support resources, all at relatively low cost and in a short timeframe. It also suggested initiatives to manage workforce supply and information effectively.
