Let’s talk about language barrier. You may ask.. “is Spanish a requirement to be a physician assistant in PR?”

Short answer… absolutely. When I applied for my job at the VA hospital in CT surgery no where on the application was there mention of speaking fluent Spanish. Even in my interview, which was conducted in English, there was no mention of Spanish being a requirement. One of the MDs on the interviewing panel did ask how my Spanish was, and as the good student that I am, I responded “estoy aprendiendo.” Estoy aprendiendo still holds true, even after 14 months of living in PR. There are a few things that make learning Spanish difficult on the island – the rapidity in which it is spoken by locals, the dialect, and the fact that most places you go in the Metro area you don’t need to speak it, or if you try to speak for practice you are responded to in English. But I digress…

I strongly believe that if I spoke more fluent Spanish I would absolutely connect better with my patients and their families, but I feel I would be more widely accepted and respected by my colleagues too. I have a bit of an advantage because at the VA hospital we are taking care of Veterans, and most of them speak English as a result of their time spent in the service. However this isn’t an absolute. I probably encounter roughly one patient a month that I struggle to communicate with. Luckily I can get by with a combination of my limited Spanish and utilizing the help of my nurse practitioner colleague, who is from PR. I couldn’t imagine working outside of the VA system with the amount of Spanish I know. It would be considered inappropriate and borderline negligent for me to take care of Spanish-only speaking patients. Even working at a federal hospital, where HR documentation, hallway signs, and emails are written in English, essentially everything else is conducted in Spanish. Multidisciplinary meetings, the time-out in the operating room, and educational webinars are conducted in Spanish. I’ve learned to perform heart surgery mostly in Spanish, asking for my instruments in Spanish, and following along with what the surgeon is doing in Spanish, but there are definitely moments where I still feel lost – if a patient is unstable coming off the heart/lung machine, the dialogue between the surgeon, the perfusionist, and the anesthesiologist is often lost in translation for me.

Take Away

My suggestion is that you should know at least conversational Spanish to work as a health care provider in Puerto Rico. Although jobs as a PA in the private sector are currently very limited, you can not rely on getting a federal job and knowing no Spanish. People will make adjustments to you, but I believe it is the overall expectation that you learn if you don’t already know. In fact, that was the only negative feedback I received in my annual review – I need to speak more Spanish. But, as we often say in Puerto Rico, “poco a poco.”