What inspired you to pursue a career as a Physician Assistant, especially after moving to the island?
During my fourth season with the orchestra, I realized I didn’t want to spend the rest of my life playing second oboe. It was a job where I had to play quietly all the time. Blending in has never been my personality, although I did love being part of a team! Ever since I was a little girl, I have always been interested in biology. When I first applied to colleges, I wanted to double major in biology and music, but my first oboe professor told me I couldn’t study both if I wanted to be competitive in music. In 2019, I got up the courage to start taking pre-med classes at the InterMetro while still working in the Sinfónica. I knew I wanted my second career to be medically related because I had an insatiable curiosity about medicine and a desire to serve my community. All the online career tests I took indicated physician assistant as the perfect match for my personality! I did extensive online shadowing, and every PA I heard made me more interested in the career. As a music professor, I found the educator component of the PA’s role very appealing. I also really liked how PAs worked as a part of a team and could have the flexibility to change specialties. However, when I started doing my prerequisite biology and chemistry classes, there was no PA school on the island. I thought I would study optometry or audiology instead. When San Juan Bautista opened the PA school, it was a dream come true for me!

Can you share your experience studying at San Juan Bautista School of Medicine and what drew you to this program?
San Juan Bautista was the only PA school I applied to because from the beginning my goal was to serve patients in Puerto Rico. While the program was advertised as being in English, we did have a few classes in Spanish, and of course, 99.9% of our patients speak Spanish in clinicals. This bilingual modality has made me completely comfortable practicing medicine in both English and Spanish. I’ve also learned more about the specific needs of the community during my rotations in various towns across the island.

How has living in Puerto Rico shaped your perspective on healthcare and your approach to patient care?
Since I’ve lived in Puerto Rico for 10 years, I’ve been a patient on the island for longer than I’ve been a PA student. As a patient, I’ve experienced prenatal care, a c-section, and pediatric care on the island. While Puerto Rico has long wait times both to get an appointment and then within the appointment (appointments are generally first-come-first-served regardless of your appointment time), there are some very positive qualities to healthcare in Puerto Rico. To begin with, MDs here are extremely devoted and highly educated. So even though it might take a while for you to get into your appointment, they will take the time to listen to your concerns and do a good focused physical exam. Something I’ve come to appreciate is the importance of parents being able to get medical care on a schedule that doesn’t require them to miss work. Since an appointment could easily take 5 to 6 hours between driving and wait times, you often have to miss a whole day of work. When you’re also a parent, you already may use all your sick days to go to your kids’ appointments. Therefore, if medical offices close at 4 pm, parents will often neglect their care to avoid problems with their employer. As a future PA, I would be interested in helping medical offices extend their hours to serve parents.

What are some challenges or opportunities you’ve encountered as a PA student in Puerto Rico?
One situation that has been both a challenge and an opportunity is that all our preceptors are MDs, and we are often their first PA students. Since they don’t distinguish our training from that of MDs, they hold us to the same standards as third-year medical students or interns. Although that might not seem fair, it has challenged me to study harder. Particularly, in my rotations at Pavia Hospital, I’ve had preceptors who “pimped” (for those not familiar with the term, this is where the doctor asks students tough questions while on rounds) relentlessly on details of pathophysiology and pharmacology that I never learned during didactic year. This has challenged me to go beyond what we need to know for end-of-rotation exams and learn as much as I possibly can. I’ve also had the opportunity to get input about my note-writing from excellent residents and interns.

What area of medicine or patient population are you most passionate about serving, and why?
To complete my patient care hours, I volunteered as a nurse assistant at two different nursing homes. During that experience, I observed firsthand how the elderly population in Puerto Rico often suffers neglect. Some elderly parents are abandoned when their kids move to the States for work, and along with the individuals who never had children, they experience intense loneliness in the last decades of life. Many of these elderly become bedridden after strokes or injuries due to a lack of PT and follow-up. Once they’re admitted to a nursing home, they lose control of their daily routine and may quickly slide into depression and even dementia. I feel a calling to care for this population because they deserve more individualized and compassionate care. On the other hand, I also absolutely adore working with children, so I could see myself working in family medicine eventually. It would be great fun to serve families across the entire lifespan!

Do you plan to stay and practice in Puerto Rico after graduation? If so, what type of setting or specialty do you envision working in?
I would love to stay in Puerto Rico and help patients with diabetes and heart disease live their best lives. During my surgery rotation, I assisted with limb amputations of diabetic patients who had never received appropriate nutritional counseling. In my hospital rounds, I’ve seen diabetic patients with single-digit eGFRs drinking huge bottles of sugary soda! All these experiences, along with my brief bout with gestational diabetes, led me to a passion for diabetes management. I believe PAs can fill the gap in Puerto Rico to effectively educate and challenge patients to live their best lives with diabetes. I’m fascinated by diabetes medications! It’s so interesting how we can personalize treatment for each patient by choosing medications that optimize glycemic control while also treating comorbid conditions like obesity, heart failure, or kidney disease. Additionally, I’m drawn to cardiology due to its musical nature. I would enjoy honing my ability to diagnose heart murmurs by sound quality.

How do you think PAs can help improve healthcare access and quality on the island?
I think PAs can best serve the island by assisting specialists and hospitalists. In Puerto Rico, we also have médicos generalistas, who are good at doing primary care work in family clinics and urgent care. So, I think as PAs, our niche in Puerto Rico will be to cut wait times for specialists. During my rotations, I’ve seen several patients with very suspicious skin lesions who must wait 5 months to be seen by a dermatologist! Many cardiologists and other specialists in PR are so overworked that they have simply stopped accepting new patients. Think of all a PA can do in a specialist office – we can take full histories, do complete physical exams, perform diagnostic testing, form a differential, do medication reconciliation, interpret lab results, chart the H&P on the EMR, give lifestyle counseling, and provide education about diagnoses and medications. When done properly, these tasks can take anywhere from 20 minutes to an hour. Within a couple of minutes, we can efficiently present the case to the MD so they can give a final diagnosis and prescription By saving the specialist that precious half hour, we can enable his or her practice to manage twice as many patients and cut the wait time in half for those patients. We can also manage routine follow-up appointments with very little input from the MD. Of course, if the law in Puerto Rico changes to allow us to prescribe medications, we could contribute in an even more efficient way.

Is there a particular experience or mentor that has greatly influenced your journey as a PA student?
My current preceptor, Dr. González Bóssolo, has pushed me to go beyond what we learn in PA school to do deep dives into drug mechanisms and pathophysiology. When I understand how things work, I feel more confident and don’t have to memorize as much for tests! I’m so grateful for the opportunity to study with every preceptor I’ve had on the island. MDs in Puerto Rico are incredibly committed, brilliant, and hard-working doctors who care about their patients!

What advice would you give to someone considering becoming a PA, especially those who might move to Puerto Rico?
Unfortunately, since the PA school at SJB is closing, I would advise pre-PA students who want to live in Puerto Rico to study in another state. The time will go by quickly and it will be well worth the sacrifice! For Puerto Ricans who for personal or family reasons don’t have the option of leaving the island, other options would include the Doctor of Nurse Practitioner (DNP) route, which currently has better scope of practice than PAs in PR, or becoming a médico generalista (an MD who does a one-year internship on the island instead of a full residency).