🇺🇸 English

As a U.S. territory with a population of more than 3.18 million people, Puerto Rico continues to navigate the effects of clinician shortages, provider migration out of the island, and longstanding structural funding constraints. These pressures show up in delayed appointments, reduced specialty access, longer travel for care, and a healthcare system that asks too much of too few professionals on the island. In order to improve access efficiently, workforce planning must be part of the conversation.

The Puerto Rico Healthcare Workforce Study, commissioned by the Financial Oversight and Management Board, makes that point plainly: workforce gaps are a central part of the island’s healthcare challenge and must be understood if policy decisions are going to be grounded in reality. This is one reason the Physician Associate profession deserves more attention in Puerto Rico. PA-Cs are not a symbolic solution or a backup plan: they are trained medical professionals who strengthen care teams, improve capacity, and help health systems respond more flexibly to patient needs. In communities where access is already strained, adding qualified clinicians, such as bilingual PA-Cs, is essential. It is an effective way to increase the number of patients who can be seen, educated, and treated. That matters in primary care, in specialty settings, and in medically underserved areas where access gaps are often felt most.

Still, expanding a workforce should never mean lowering standards. If Puerto Rico is going to build more awareness and opportunity around the PA-C profession, that growth should be tied to clear quality expectations: 1) Board Certification Matters— The NCCPA certification process requires graduation from an ARC-PA accredited masters PA program before a graduate can sit for the national certifying exam. 2) Official PA-C professional representation matters— the profession should be informed by the perspective of those trained and practicing within it.

That said, Puerto Rico does have an existing licensure pathway for PA-Cs through its Department of Health under the médico asistente profession, which also includes IMGs within the same framework. This umbrella profession presents a distinct set of challenges for PA-Cs that warrants a separate conversation, but it demonstrates that PA-Cs are not a theoretical profession without any regulatory framework on the island. However, when potential candidates for the profession—as well as already credentialed PA-C professionals—do not see the field clearly represented, cannot identify clear pathways into it, or lack strong connections to training, scope of practice, and career opportunities, the island loses more than future clinicians—it loses local talent.

A stronger and accurate PA-C pathway in Puerto Rico along with the return of a physician associate program on the island could help build something durable: not just short-term workforce support, but a profession that Puerto Rican students can imagine themselves entering and using to serve their own communities. That is especially important in a place where retaining health professionals has been an ongoing challenge. Building awareness, partnerships, and recruitment pathways is not separate from access to care; it is part of how access is sustained over time.

Although Puerto Rico is part of the United States, it is often left out of national healthcare conversations until a crisis forces attention back onto the island. A better approach is to think proactively. If Puerto Rico faces documented workforce strain, recognized shortage designations, and ongoing access barriers, then it should be included in serious discussions about healthcare workforce expansion and support. Ignoring Puerto Rico in those conversations does not preserve the status quo; it deepens inequity.

None of this means PA-Cs are the only answer. Puerto Rico’s healthcare challenges are complex and will require action across financing, training, retention, public health infrastructure, and physician workforce support. But complexity is not an excuse to overlook practical solutions that can help now. A stronger PA-C presence on the island can be one part of a more resilient workforce strategy: one that values team-based care, protects professional standards, and expands opportunity for both patients and future clinicians.

Take Away

Puerto Rico needs greater visibility, integration, and development of board-certified PAs. It is a realistic step that could help strengthen care teams, improve access, and create meaningful opportunities and careers for Puerto Rican students and communities. If healthcare workforce planning is truly about meeting patients where the need is greatest, then Puerto Rico belongs squarely in that conversation.

🇵🇷 Resumen en Español

Puerto Rico continúa enfrentando desafíos significativos en acceso a servicios de salud debido a la escasez de profesionales, la migración de proveedores fuera de la isla y limitaciones estructurales del sistema de salud. Estas dificultades afectan directamente a las comunidades mediante largas esperas, acceso limitado a especialistas y una carga creciente sobre un número reducido de profesionales de la salud.

Este artículo explora cómo los Physician Associates/Assistants Certificados (PA-C) pueden formar parte de una estrategia realista para fortalecer los equipos de atención médica, ampliar el acceso a servicios y ayudar a retener talento local en Puerto Rico. También enfatiza que el crecimiento de la profesión debe mantenerse ligado a estándares claros de calidad, certificación y representación profesional adecuada.

Además, se discute cómo la falta de visibilidad, orientación y oportunidades claras dentro de la profesión puede limitar el desarrollo de futuros profesionales en la isla. Fortalecer las vías educativas y profesionales para PA-Cs no solo podría beneficiar a los pacientes, sino también crear oportunidades sostenibles para estudiantes puertorriqueños interesados en servir a sus comunidades.

El artículo concluye que los PA-Cs no son la única solución a los retos de salud en Puerto Rico, pero sí pueden ser una pieza importante dentro de una estrategia más amplia para mejorar el acceso, fortalecer el sistema de salud y promover una atención médica más resiliente y sostenible en la isla.