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Physician Migration and its Implications for Puerto Rico's health care system

医生移民及其对波多黎各医疗保健系统的影响

基本信息

批准号：
10225635
负责人：
MARK B PADILLA
金额：
$ 61.58万
依托单位：
FLORIDA INTERNATIONAL UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-07-29 至 2024-02-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10225635
关键词：
Address Affect Appointment Area Categories Characteristics Country Destinations Deterioration Economics Educational workshop Ethnography Event Face Federal Government Fostering Funding Geography Health Health Facility Administrators Health Policy Health Professional Health Services Accessibility Healthcare Healthcare Systems Hispanics Hospitals Hurricane Infrastructure Interview Island Left Methods Migrant Modeling Morbidity - disease rate Natural Disasters Nonmigrant Not Hispanic or Latino Outcome Patients Pattern Physicians Policies Policy Maker Politics Population Process Puerto Rican Puerto Rico Recommendation Reporting Research Role Sampling Science Shapes Site Specialist Structure Surgeon Surveys System Technology United States United States National Institutes of Health Work base career cognitive interview design health disparity medical attention medical specialties migration mortality recruit resilience social social stigma theories trend

项目摘要

Project Summary/Abstract Puerto Rico (PR) is facing a major existential crisis fostered by a 70 billion dollar external debt and recent natural disasters that have fostered the deterioration of the health infrastructure.1,2,3,4 These events fuelled the mass migration of physicians to the US mainland, and it is estimated that PR will lose half of its already depleted physician workforce in the next decade.20 We propose to explore, from a multi-level perspective, how the PR health care system responds to this physician migration crisis using a conceptual model informed by theories of migration, spatial stigma, and health care system resilience. We propose the following aims: Aim 1: Document the role of push and pull factors, as well as the potential role of spatial stigma, on fostering and/or mitigating physician migration from PR to the mainland US by richly describing the characteristics of their current and previous work contexts and settings. Aim 2: Document the geographical migratory patterns of physicians who have moved from PR to the US mainland in the last decade (2009-2019) as a consequence of the territory's ongoing economic crisis and the recent natural disaster. Aim 3: Determine the impact of physician migration on PR's health care system functioning and resilience through systematic ethnographic observations of sites affected by physician migration. Aim 4: Develop science-based policy recommendations for the local/federal governments to mitigate physician migration in PR using findings from Aims 1-3 and input form stakeholders in the health care system. We will implement a multi-stage mixed methods design. During Stage 1, we will recruit a random sample of physicians (total N=560) equally divided between migrants and non-migrants. They will complete: a) in-depth qualitative interviews (n=50) to gather rich descriptions of the factors behind the decision to leave or stay, b) cognitive interviews for survey refinement (n=10), and c) a brief survey (n=500) to gather information about the push/pull factors that foster/mitigate migration and the geographical migration patterns of those who have left (Aims 1 & 2). The survey will allow us to analyze the geographical impact of this phenomenon using Arc-GIS technology. During Stage 2, we will carry out institutional ethnographic observation/mapping in settings impacted by physician migration in PR (Aim 3). We will carry out semi-structured qualitative interviews with a theoretically-driven sample (total N=100) of: health facility administrators (n=20), health policy makers (n=20), health care professionals (n=30), and patients (n=30) to understand the impact of physician migration on the health care system's resilience and patient's access to care. In Stage 3, we will develop policy recommendations to mitigate physician migration, conduct participatory ethnographic workshops with key stakeholders in the health care system, and implement a targeted dissemination plan. Results will allow us to assist the local/federal governments in developing strategies to address physician migration.

项目总结/文摘