Dr Yussef Galib-Frangie Fiol, president of the Puerto Rico Medical Association (PRMA), the oldest medical association on the island, discusses solutions for the current shortage and burnout of physicians in Puerto Rico. Galib-Frangie Fiol also wants to see the Association act as a facilitator for dialogue between government, academia and industry on pressing health issues on the island.
Please introduce yourself and the association.
I am an internal medicine specialist at two hospitals in San German, Puerto Rico. One of them is the Hospital de la Concepcion which is one of the oldest hospitals in the western hemisphere founded in 1511. Also, I am an assistant professor at Ponce Health and Sciences University. My involvement with academia is also practical, as I am in charge of the internal medicine program at the Hospital de la Concepcion to train resident doctors. Lastly, I am the 92nd president of Medical Association here in Puerto Rico, which is the oldest medical association on the island.
The Puerto Rico Medical Association was founded in 1902. Its main purpose it’s to strengthening the medical knowledge on the island. We aim to fortify our bond with other medical associations within the US system. The PRMA is a voluntary association with a growing membership of more than 400 members. We have been affiliated to the American Medical Association (AMA) since 1912 and are currently the representatives of the American Council of Continued Education (ACCE) for Puerto Rico. Apart from these representative responsibilities, we are the association that licenses other providers for education credits. Every physician in Puerto Rico has to undergo re-accreditation every three years and they do it through us. Lastly, we produce the Boletín de la Asociación Médica de Puerto Rico which we have been publishing since 1902. It is a peer-reviewed and net line index publication, which we are very proud of.
We have different committees that deal with legislative matters, as we get referrals to which we analyse the projects, before they get enacted into law. Additionally, we are involved in the cultural aspect of medicine as well. We have one of the largest historical medical libraries here in Puerto. The Association is also involved with the industry and we have met with many of the different stakeholders to work collaborate in different initiatives.
What are your main priorities and objectives heading the Puerto Rico Medical Association?
There are 3.1 million people in Puerto Rico and only around eight to nine thousand physicians, meaning there is a shortage on the island. I am very involved in the prevention of the island’s physician burnout. It is important to take care of our physicians and make sure they have enough time to rest. I am currently working on an initiative with Puerto Rico’s insurance companies to credential young physicians, so they can stay in Puerto Rico and deliver their care here. The PRMA is the ideal vehicle to bring together all the stakeholders such as government, private sector and academia, so we can discuss pressing issues for medicine here in Puerto Rico.
After a long period of hibernation, we are transforming the association to become the go-to point for physicians around the island. We have met with all the stakeholders individually to start the conversations and bring them together for dialogue.
Membership of the Puerto Rico Medical Association is completely voluntarily. How do you ensure that your membership is growing and what are some of the benefits of being a voluntary association?
It takes a lot of work and presence. We are participating in all sorts of radio and television programs to have exposure. The association also has a committee that is looking into opportunities that will put the association into the public spotlight so our voice can be heard.
There are some benefits of being a non-compulsory association. We have the opportunity to be part of the AMA, which gives us access to events like their annual congress, but also interactions with the different medical associations from each state. There are around 47 states which their associations are part of the AMA.
What are the main challenges that your members face today?
The main challenge that our members face is the workload. We have way more patients and we do need to take better care of our patients at the primary care level. I am a hospitalist and I should not see the number of patients that I am seeing. Many of the patients come with a diagnosis that is easily preventable and treatable by primary care or complications that should not have developed with proper care. We need to be able to recruit more physicians, particularly amongst the younger generation. The association is working on initiatives to have prevention campaigns throughout the island to avoid physician burnout.
Many Puerto Rican physicians have left the island for the US mainland in the last few years. Is there anything that the Puerto Rico Medical Association could do to incentivize those professionals to come back?
We are working on different initiatives, to not only bring back some of those professionals that left, but also prevent the talent that is here from wanting to leave. The Association is working in collaboration with the insurance companies on an initiative to have them recruit the graduating physicians with the right incentives, so they stay and work with their patients.
R&D investment levels of big pharmaceutical companies here in Puerto Rico have been on the rise. Does that offer an incentive for physicians to change gears and work for the industry?
Puerto Rican physicians are constantly thinking about the patients, so the relationship with the industry has been shaky. Many misconceptions need to be taken care of. There has not been much dialogue between the pharmaceutical industry and the physicians, so we are not aware of what they are working on or how we can contribute. In the insurance industry, however, this has changed, and more dialogue has been taken place, making sure that our voice is heard and we can work together.
What would you like to achieve during your tenure here as president of Puerto Rico Medical Association?
Firstly, we would like to see an increase in membership. Secondly, we want to have the association as the node of conversion between all the stakeholders for dialogue. We have the space and the desire here in the association to make this happen. Thirdly, I want to see more representation from AMA here in Puerto Rico. We are working to have their President come to the island and meet the physicians that are working on the island. This will help to propel Puerto Rico to the next level in terms of medical leadership. Lastly, we need to empower physicians in medical leadership as we are lacking in this aspect and we should more leaders.
What is your final message?
It is important to recognize that medicine in the Americas started in Puerto Rico. The first physician that set foot on the new continent land was here in Puerto Rico. Since 1508 we have uninterrupted medical services being provided to our population. For more than five hundred years we have been treating patients and we are eager to enter the global stage. The new generation of physicians wants to take Puerto Rico to the next level in terms of medical leadership.
