Puerto Rico’s shortage of specialists is pushing patients and families to seek care on the US mainland, while some mainland-based Puerto Ricans keep treatment on the island. Elba Pérez Morales, 58, of Juncos, who has pulmonary fibrosis and pulmonary hypertension, flew by air ambulance to AdventHealth in Orlando to await a double lung transplant. Her son and caregiver, nurse Jorge Antonio Fuentes Pérez, 27, went with her with no return date.
No surgery date is set, and recovery could take a year or more. She began her evaluation in 2024 and has seen pulmonologists in both places because of limited access to specialists in Puerto Rico. More than 200,000 Puerto Ricans have emigrated to the US since 2020, according to the Puerto Rico Institute of Statistics.
No exact figure exists for those leaving for care; some move permanently, others travel periodically for treatment. Jorge Rivera Peña and Imayrín Padua Sotomayor moved to Massachusetts in 2019 for care and schooling for their son Gabriel, who has severe autism. They found housing difficult, felt isolated, and were disappointed in the school.
Amaury Rijo Sánchez continued care in Puerto Rico because of high deductibles in the US. About 5,000 doctors have stopped practicing in Puerto Rico over 10 years, and 300 to 500 emigrate yearly, the Colegio de Médicos Cirujanos says. Its president, Carlos Díaz Vélez, cites low insurer payments, overwork and lack of government incentives.
Dr. Waleska Crespo Rivera, president of the Universidad Central del Caribe, said some doctors earn in two weeks in Florida what four weeks pay in Puerto Rico. A 2025 workforce study commissioned by the Oversight Board describes a structural health crisis.