On leaving: Coloniality and physician migration in Puerto Rico.
On leaving: Coloniality and physician migration in Puerto Rico.
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离开时：波多黎各的殖民和医生移民。
DOI：
10.1016/j.socscimed.2023.115888
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Grove,
中科院分区：
文献类型：
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作者：
Varas-Díaz,Nelson;Rodríguez-Madera,Sheilla;Padilla,Mark;Rivera-Bustelo,Kariela;Mercado-Ríos,Claudia;Rivera-Custodio,Joshua;Matiz-Reyes,Armando;Santiago-Santiago,Adrián;González-Font,Yoymar;Vertovec,John;Ramos-Pibernus,Alíxida;Grove,
波多黎各（PR）的医生移民问题日益严重。截至2009年，医务人员由14 500名医生组成，到2020年，这一数字已减少到9 000人。如果这种移徙模式继续下去，该岛将无法达到世界卫生组织（卫生组织）建议的人均医生比例。现有的研究集中在迁移到特定环境或在特定环境中停留的个人动机，以及鼓励医生迁移的社会变量（例如，经济条件）。很少有研究解决了殖民地在促进医生迁移中的作用。在这篇文章中，我们研究了殖民地的作用及其对PR医生迁移问题的影响。本文中提供的数据来自美国国立卫生研究院资助的一项研究（1R01MD014188），该研究旨在记录与从PR到美国大陆的医生迁移相关的因素及其对该岛医疗保健系统的影响。研究小组使用了定性访谈、调查和人种学观察。本文的重点是对2020年9月至2022年12月期间收集和分析的26名移民到美国的医生的定性访谈和民族志观察数据。结果表明，参与者将医生迁移理解为三个因素的结果：1)PR的历史和多维恶化，2)当前医疗保健系统被政客和保险公司操纵的想法，以及3)岛上培训医生面临的具体挑战。我们讨论了殖民主义在助长这些因素方面的作用，以及它如何成为该岛屿面临的问题的背景。
Puerto Rico (PR) has a growing physician migration problem. As of 2009, the medical workforce was composed of 14,500 physicians and by 2020 the number had been reduced to 9,000. If this migration pattern continues, the Island will not be able to meet the recommended physicians per capita ratio proposed by the World Health Organization (WHO). Existing research has focused on the personal motivations for movement to, or permanence in, a particular setting, and social variables that encourage physicians to migrate (e.g., economic conditions). Few studies have addressed the role of coloniality in fostering physician migration. In this article we examine the role of coloniality and its impact on PR's physician migration problem. The data presented in this paper stem from an NIH-funded study (1R01MD014188) that aimed to document the factors associated with physician migration from PR to the US mainland and its impact on the Island's healthcare system. The research team used qualitative interviews, surveys, and ethnographic observations. This paper focuses on the data from the qualitative interviews with 26 physicians who had migrated to the USA and ethnographic observations, which were collected and analyzed between September 2020 and December 2022. The results evidence that participants understand physician migration as a consequence of three factors: 1) the historical and multidimensional deterioration of PR, 2) the idea that the current healthcare system is rigged by politicians and insurance companies, and 3) the specific challenges faced by physicians in training on the Island. We discuss the role of coloniality in fostering these factors and how it serves as the backdrop for the problem faced by the Island.