Mexican ENT Doc Trying to Work in Puerto Rico

[Woodsman8307]

Hi,

My fiance, who is a fully licensed ENT doc in Mexico and has been practicing at a public hospital system there for the past five years, is trying to get a job in Puerto Rico. I am American and we are looking to move there once we get married. I've read how it's basically impossible for foreign doctors to be able to get a job in the mainland US but I read somewhere it might be a little easier in Puerto Rico given the shortage of doctors there and the fact that it's a US territory with slightly different rules and regulations. It's been tough to find much information online though.

Does anyone know the licensing requirements in Puerto Rico for foreign docs? Do they have to redo residency like in the mainland US or just pass the boards? Are there any good resources you could direct us to so we can learn more?

Thank you so much for your help and any recommendations are great appreciated.

Best,
Ryan

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[theKingLT]

Unfortunately this side of the forums gets little to no attention, but your question intrigued me so I did a little bit of research. The most I could find at first glance was a PA propaganda piece pushing for PA licenses in PR while saying that "Puerto Rico allows foreign medical school graduates who are ineligible to practice on the mainland to practice as generalist physicians called “generalistas.”, however the sources for the article talk nothing of the generalistas so I'm not sure where they got that info. I asked a friend of mine from PR about it and he claims that there are people who don't get into the Puerto Rican med schools, so they go to Mexican or Caribbean schools that are "accredited", and then come back to work in PR as generalistas (basically GP's or PA type roles working under a supervising resident trained physician). Some U.S. states have similar programs such as in Missouri where foreign graduates are allowed to work in a PA type supervised position in rural general practice without a U.S. Residency. He's not sure if the accreditation refers to the broad list of schools worldwide that the ECFMG uses, or a narrow list of schools specifically approved by the Puerto Rican Medical Board (Junta de Licenciamiento y Disciplina Médica). He also mentioned that they recently passed new legislation to allow PA licenses in PR and reading up on the new law it appears that the PA license option will be extended to medical students who fail their accreditation in PR, so it appears the PA lobby are moving in hard and already have a lot of success trying to replace the current generalistas in PR (I even found a chang.org petition recognizing this very issue that intends to open up residency availability for generalistas so that they don't end up jobless with the PA enroachment). This combined with already low salaries and job availability due to their current funding issues (Puerto Ricans Brace for Crisis in Health Care), means I would recommend that your fiance not pursue any sort of generalista type position which ignores their residency training and essentially considers them a mid-level practitioner. They'd be better off staying in Mexico as a specialist or finding another type of healthcare job in the states (or outside healthcare all together). Whether or not they make exceptions to allow specialist work for those who already completed residency outside the U.S./PR is unclear, so you may still want to look further into that. I'd recommend having your fiance or yourself if you know spanish to look through their licensing law (http://www.bvirtual.ogp.pr.gov/ogp/Bvirtual/leyesreferencia/PDF/Juntas/139-2008.pdf) or some of the other documents on this site (Médico Cualificado (Ley 60-2019) - All Documents). I'm a little swamped right now but if I find time I'll check that stuff out myself and let you know if I find anything.

Also keep in mind that from a financial perspective your fiance would most likely be better off repeating residency in the states than working in PR, even if the laws do allow them work as a full-on ENT, the long term salary differences will make up for the reduced pay during residency , not to mention the better job opportunities you personally would have in most fields stateside. Matching into residency as an FMG is hard but your fiance has a pretty big advantage over the rest if they are already successful in their field and if you will be married (meaning they will not require a Visa sponsorship). If they end up having to pass the step exams anyways to practice in PR, might as well apply for residency in the states to give more job opportunities and pay in the future (plus residency pay will still be much better than what they are making now in Mexico).