Forty Percent (Dis)Solution

I read the following statement about a month ago:

"About 40% of the medical school graduates in Puerto Rico leave the island."

Forty. Percent.

Four out of every ten would-be doctors decide that staying in Puerto Rico is not a viable option. The culprit, according to majority opinion, is the fact that doctors can make more money in the U.S. than here. But let's take a closer look.

About 28% of the local (Puerto Rico-based) doctors are graduates from medical schools that are not in Puerto Rico or the U.S. (Mexico, Spain and the Dominican Republic, mostly.) Although statistics are very hard to find, the general observation is that these doctors have substantially less student-related debt when they finish than Puerto Rican-based med students do. It makes sense, since almost all of them have to pay their way to complete their studies, unlike local students, who rely on Federal grants and loans.

Is the difference substantial? In a brief survey of 23 foreign-educated doctors versus 27 locally (Puerto Rico or U.S.) educated doctors, the average debt of the foreign-educated group was $62,000, mostly in the form of personal loans and/or second mortgage's, usually on their parent's home. For the locally-educated, the average debt was $171,000, almost all of it in government loans.

Look at those numbers again. Assign a 20% margin of error and you still have the potential for a $74,000-$127,000 debt-ratio. My "survey" was certainly far from methodical, but it quickly showed a huge gap between the two groups.

And there was another: Of the 27 locally-educated doctors, 21 said they were either planning on going to the States (11) or were already making that transition (10; about 40% of the group.) Of the foreign-educated group, only 7 said they were thinking of moving (5) or already moving to the States (2). (One said she was moving to Guatemala to work in an isolated clinic; I didn't count her as a Stateside-transitioner.)

Is it money that makes doctors leave the island? Yes, partially. If you have about $170,000 of debt that you must pay back to keep your license valid, you will seek better pay. It's natural. That Puerto Rico doesn't offer that "higher pay standard" is sad, but then again, there's something even sadder: That these doctors run up such huge debts in the first place.

Foreign-educated students have no government largesse in their favor. Most of the ones I spoke to never received a penny from Uncle Sam. On the other hand, of the locally-educated group, some bragged about how they "cheated" to get their studies paid for up to 100% by Uncle Sam. The ones that cheated were, invariably, children of doctors or licensed professionals (lawyers, engineer and pharmacists. Often both parents were licensed professionals.)

So it isn't necessarily that Puerto Rico is "devoid of opportunities" for these doctors, but rather, that they "price" themselves out of the opportunities that naturally exist here...if they were actually pursuing knowledge instead of cash.

There are other factors, such as social class (children of professionals have a much better chance of securing a spot in a local medical college); work loads (most of the foreign-educated students started medical school at an older age because they had to work while completing their undergraduate degrees); educational costs (can be lower in other countries, including living expenses) and language (most of the foreign-educated group indicated that their English was weak, even though to become doctors, they had to pass the Boards, which are in English.) To the locally-educated, many of whom come from privileged backgrounds, private schools and intensive English exposure, moving to the States is easy, or at least easier than to the foreign-eductated.

But We--or rather, I--still come back to the original point: money. If My informal survey is close-to-reality (and many of the doctors feel it is), then what We have is not an economic "crisis" but a moral one.

Here's why: I shot the breeze with these doctors, especially about their college years. And I quickly noticed an enormous difference in the kinds of experiences each group had. The foreign-educated spoke about immersing themselves in another culture, making new friends, tackling new ways of seeing Life and spending time in service to poor or marginalized communities. They certainly had their fun, but they focused more on what they shared with others.

The locally-educated group spoke more often about the new SUV or sport car that they bought with the loan money as their graduation gift (and entrance to medical school.) Some spoke about their apartment or house, filled with the latest and the greatest. Many of them spoke about trips to Europe, skiing trips during Spring Break and the fabulous wedding they had, most of this financed by Uncle Sam. Only two mentioned providing service to poor or marginalized communities and both complained that they had been grossly underpaid. One of them actually became bitter at the memory of his one week in "poverty hell."

One week. Though he spent 11 weeks in Europe in a four-year period.

Yes, 40% of our medical school graduates leave the island. Yes, there are major differences between types of medical students. But I feel that the doctors that leave are not better than those that stay. More "successful" at tracking money, yes. But if that were the criteria for better doctors, politicians would be miraculous faith healers.

Doctors leaving isn't because of a new pursuit of money: it's simply a continuation. Hounded by debt they eagerly chased, now they are chased by it. And that's another difference I noticed: the foreign-educated doctors seemed more satisfied, more content with their lives than those educated locally. They shared practically the same lifestyle in terms of house, cars, education for their children, etc., but whereas those who earned their way were "happier," those who "bought" their way seemed stressed.

I could be wrong. But I'm pretty damn sure I'm not.


The Jenius Has Spoken.