Physician Migration and its Implications for Puerto Rico's health care system

医生移民及其对波多黎各医疗保健系统的影响

基本信息

批准号：
10225635
负责人：
MARK B PADILLA
金额：
$ 61.58万
依托单位：
FLORIDA INTERNATIONAL UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-07-29 至 2024-02-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10225635
关键词：
Address Affect Appointment Area Categories Characteristics Country Destinations Deterioration Economics Educational workshop Ethnography Event Face Federal Government Fostering Funding Geography Health Health Facility Administrators Health Policy Health Professional Health Services Accessibility Healthcare Healthcare Systems Hispanics Hospitals Hurricane Infrastructure Interview Island Left Methods Migrant Modeling Morbidity - disease rate Natural Disasters Nonmigrant Not Hispanic or Latino Outcome Patients Pattern Physicians Policies Policy Maker Politics Population Process Puerto Rican Puerto Rico Recommendation Reporting Research Role Sampling Science Shapes Site Specialist Structure Surgeon Surveys System Technology United States United States National Institutes of Health Work base career cognitive interview design health disparity medical attention medical specialties migration mortality recruit resilience social social stigma theories trend

项目摘要

Project Summary/Abstract Puerto Rico (PR) is facing a major existential crisis fostered by a 70 billion dollar external debt and recent natural disasters that have fostered the deterioration of the health infrastructure.1,2,3,4 These events fuelled the mass migration of physicians to the US mainland, and it is estimated that PR will lose half of its already depleted physician workforce in the next decade.20 We propose to explore, from a multi-level perspective, how the PR health care system responds to this physician migration crisis using a conceptual model informed by theories of migration, spatial stigma, and health care system resilience. We propose the following aims: Aim 1: Document the role of push and pull factors, as well as the potential role of spatial stigma, on fostering and/or mitigating physician migration from PR to the mainland US by richly describing the characteristics of their current and previous work contexts and settings. Aim 2: Document the geographical migratory patterns of physicians who have moved from PR to the US mainland in the last decade (2009-2019) as a consequence of the territory's ongoing economic crisis and the recent natural disaster. Aim 3: Determine the impact of physician migration on PR's health care system functioning and resilience through systematic ethnographic observations of sites affected by physician migration. Aim 4: Develop science-based policy recommendations for the local/federal governments to mitigate physician migration in PR using findings from Aims 1-3 and input form stakeholders in the health care system. We will implement a multi-stage mixed methods design. During Stage 1, we will recruit a random sample of physicians (total N=560) equally divided between migrants and non-migrants. They will complete: a) in-depth qualitative interviews (n=50) to gather rich descriptions of the factors behind the decision to leave or stay, b) cognitive interviews for survey refinement (n=10), and c) a brief survey (n=500) to gather information about the push/pull factors that foster/mitigate migration and the geographical migration patterns of those who have left (Aims 1 & 2). The survey will allow us to analyze the geographical impact of this phenomenon using Arc-GIS technology. During Stage 2, we will carry out institutional ethnographic observation/mapping in settings impacted by physician migration in PR (Aim 3). We will carry out semi-structured qualitative interviews with a theoretically-driven sample (total N=100) of: health facility administrators (n=20), health policy makers (n=20), health care professionals (n=30), and patients (n=30) to understand the impact of physician migration on the health care system's resilience and patient's access to care. In Stage 3, we will develop policy recommendations to mitigate physician migration, conduct participatory ethnographic workshops with key stakeholders in the health care system, and implement a targeted dissemination plan. Results will allow us to assist the local/federal governments in developing strategies to address physician migration.

项目概要/摘要波多黎各 (PR) 正面临着由 700 亿美元的外债和最近的自然灾害加剧了卫生基础设施的恶化。1,2,3,4 这些事件加剧了医生大规模移居美国本土，估计PR将失去一半的收入未来十年医生队伍将耗尽。20 我们建议从多层次的角度探讨如何 PR 医疗保健系统使用以下概念模型来应对这一医生移民危机：移民、空间耻辱和医疗保健系统复原力理论。我们提出以下目标：目标 1：记录推力和拉力因素的作用，以及空间耻辱的潜在作用通过详细描述，促进和/或减少医生从波多黎各移民到美国大陆他们当前和以前的工作环境和环境的特征。目标 2：记录从波多黎各移居美国的医生的地理迁移模式过去十年（2009-2019），由于香港持续的经济危机和最近的自然灾害。目标 3：确定医生移民对 PR 医疗保健系统功能和弹性的影响通过对受医生移民影响的地点进行系统的人种学观察。目标 4：为地方/联邦政府制定基于科学的政策建议，以缓解使用目标 1-3 的调查结果和医疗保健系统利益相关者的意见进行 PR 中的医生迁移。我们将实施多阶段混合方法设计。在第一阶段，我们将随机招募一名医生样本（总数 N=560）在移民和非移民之间平均分配。他们将完成：a) 深入的定性访谈（n=50），收集关于离职或离职决定背后因素的丰富描述停留，b) 用于细化调查的认知访谈 (n=10)，以及 c) 用于收集信息的简短调查 (n=500) 关于促进/减缓移民的推/拉因素以及移民的地理移民模式已离开（目标 1 和 2）。该调查将使我们能够利用以下方法分析这一现象的地理影响： Arc-GIS 技术。在第二阶段，我们将在以下地区进行机构民族志观察/绘图受 PR 医生迁移影响的环境（目标 3）。我们将进行半结构化定性访谈理论驱动的样本（总数 N=100）包括：卫生机构管理者（n=20）、卫生政策制定者 (n=20)、医疗保健专业人员 (n=30) 和患者 (n=30) 了解医生迁移的影响医疗保健系统的弹性和患者获得护理的机会。在第三阶段，我们将制定政策建议减少医生移民，举办参与性民族志讲习班，重点关注卫生保健系统中的利益相关者，并实施有针对性的传播计划。结果将使我们能够协助地方/联邦政府制定解决医生移民问题的战略。