CAGUAS, Puerto Rico _ Myladis Reyes, 26, fell in love with medicine by accident. She was a sophomore at the University of Puerto Rico studying chemistry seven years ago when she visited her aunt, a clinic internist, in New Jersey and witnessed the difference she made with patients.
"She was always smiling. She always made little jokes," Reyes said. "I just saw that and I thought, what better way to help?"
The experience showed Reyes a new way to harness her interest in science and directly improve people's lives. But after a fierce struggle to get into medical school, she foresees challenges in finding hands-on medical training _ known as a residency _ in Puerto Rico. And because of poor job prospects on the island afterward, she expects her career to steer her far from home.
Studying medicine is a popular option among young Puerto Ricans. Acceptance rates at the commonwealth's four medical schools are low and competition runs high. For example, Ponce Health Sciences University received 1,200 applications for its medicine program in the 2015-16 academic year. It accepted 180. Last spring, the Association of American Medical Colleges reported the island's schools graduated a combined 277 medical students.
But many of those graduates are leaving the island for better work opportunities, despite Puerto Rico's growing and urgent health needs.
In the Residency Match announced in March _ where students learn where they will continue training _ about half of students matched to the mainland, based on figures provided by officials at Puerto Rico's four medical schools.
That exodus is particularly alarming because the commonwealth's health care infrastructure is suffering from a shortage of trained physicians.
Physicians opt out of Puerto Rico for many reasons: Nearly 4 in 10 people in the commonwealth are insured through Medicaid managed care programs, but payments for doctors and hospitals are a third less than the average payments by Medicaid managed care organizations on the mainland. Most Medicare patients also use the private alternative _ Medicare Advantage plans _ but their reimbursements are well below mainland rates too.
The low payments are compounded by a $70 billion debt crisis in Puerto Rico. Last summer, Congress established an oversight board charged with saving the island's economy. Its fiscal plan released in March calls for more cuts to provider reimbursements and fewer benefits for Medicaid enrollees, adding pressure to an economic recession that has helped drive thousands of physicians off the island.
To cauterize the bleeding, Gov. Ricardo Rossello signed into law a measure that lowers physicians' income taxes to 4 percent if they complete 180 hours of medically related community service or compensated care to Medicaid patients.
For medical students Reyes and Rafael Cardona, the uncertainty presents a large risk in deciding where to seek their medical residency and become licensed physicians.
As they near the end of their academic training and weigh their options, both are struggling to find a reason to stay.
