This quarter’s issue explores what it truly takes to move our profession forward—where communication, clinical judgment, and access to care intersect. From the impact of bedside manner on patient trust and risk, to the critical importance of early recognition in high-stakes conditions, we examine how skill and awareness shape outcomes.

But even the most capable clinicians cannot close gaps alone—strengthening the PA-C workforce in Puerto Rico remains essential to expanding access and retaining talent. As part of this effort, AAMPR Scholarships for 2026 are now open, creating new opportunities for those committed to serving their communities and advancing the profession. Through the work of leaders already serving their communities, we see what that future can look like in practice.

And because sustainable progress requires more than action, we close by reflecting on the power of setting boundaries and leading with intention.

Let’s dive in.

→ Intro: From Bedside to Boundaries
→ Bedside Manner’s Correlation on Patient Satisfaction and Lawsuits
→ Avoiding the Misdiagnosis Minefield of Necrotizing Fasciitis
→ Expanding Access to Care in Puerto Rico: Why the PA-C Workforce Matters
→ Spotlight Stories
→ The Power of a Positive No
→ Updates & Quick Links

How clinicians communicate at the bedside plays a critical role in shaping patient satisfaction, trust, and even the likelihood of legal action.

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Takeaway: Strong bedside manner isn’t just good practice—it’s a measurable factor in patient experience and a key safeguard against malpractice risk.

Necrotizing fasciitis is a rapidly progressive, life-threatening infection that is often misdiagnosed in its early stages due to subtle or nonspecific symptoms. This article highlights key clinical red flags and emphasizes the importance of early recognition, prompt imaging when appropriate, and immediate surgical consultation to improve outcomes.

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Takeaway: Early suspicion saves lives. Recognizing red flags and acting quickly—before classic signs appear—is critical to preventing catastrophic complications and reducing medico-legal risk.

Puerto Rico has a PA-C licensure pathway, but gaps in representation, awareness, and training pipelines limit its impact. Strengthening and clarifying this pathway could improve access to care and retain local talent.

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Takeaway: Access to care depends on building clear, supported PA-C pathways. Without it, Puerto Rico risks losing both current and future clinicians.

Mariela Román is a Physician Associate practicing in urology in Puerto Rico, dedicated to providing compassionate, patient-centered care while serving her community on the island.

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Takeaway: Physician Associates play a vital role in expanding access to care in Puerto Rico—bringing expertise, trust, and continuity to the communities they serve.

The Power of a Positive No A Positive No reframes saying “no” as an act of purpose—grounded in a clear “yes” to what truly matters, delivered with respect, and followed by an openness to collaboration. In Puerto Rico’s healthcare landscape, this approach empowers PA-Cs/Asociados Médicos to set boundaries, protect their role, and advocate effectively without compromising relationships.

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Takeaway: Saying “no” with clarity and intention isn’t rejection—it’s how we protect our mission, strengthen our profession, and still move toward a meaningful “yes.”