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

• 批准号: 10052974
• 负责人: MARK B PADILLA
• 金额: $ 66.4万
• 依托单位: FLORIDA INTERNATIONAL UNIVERSITY
• 依托单位国家: 美国
• 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/10052974
• 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

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.

项目摘要/摘要 波多黎各（PR）面临着由700亿美元外债造成的重大生存危机 自然灾害促进了卫生基础设施的恶化。1,2,3,4这些事件助长了这一事件 医师大规模迁移到美国大陆，据估计，PR将损失一半 在接下来的十年中，医师的劳动力耗尽。20我们建议从多层次的角度探索如何探索 公关医疗保健系统使用由概念模型告知的医师移民危机 移民，空间污名和医疗保健系统的弹性理论。我们提出以下目标： 目标1：记录推送因素的作用，以及空间污名的潜在作用， 通过丰富的描述 其当前和以前的工作环境和设置的特征。 目的2：记录已经从公关转移到美国的医师的地理迁移模式 在过去十年（2009- 2019年）的大陆，由于该领土的持续经济危机和 最近的自然灾害。 目标3：确定医师迁移对PR的医疗保健系统功能和弹性的影响 通过对受医师迁移影响的地点的系统人种学观察。 目标4：为地方/联邦政府制定基于科学的政策建议减轻 医师在PR中使用AIMS 1-3的发现和卫生保健系统中的利益相关者的发现。 我们将实施多阶段混合方法设计。在第1阶段，我们将随机招募 医师的样本（总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），以收集有关离开或 留下，b）调查改进的认知访谈（n = 10），c）简短的调查（n = 500），以收集信息 关于促进/减轻迁移和地理迁移模式的推送因素 离开（目标1和2）。该调查将使我们能够使用 ARC-GIS技术。在第2阶段，我们将进行机构民族志观察/映射 受PR中医师迁移影响的设置（AIM 3）。我们将进行半结构化定性访谈 卫生政策制定者的理论驱动样本（总n = 100）：卫生机构管理员（n = 20） （n = 20），医疗保健专业人员（n = 30）和患者（n = 30）了解医师迁移的影响 关于医疗保健系统的韧性和患者的护理机会。在第3阶段，我们将制定政策 建议减轻医师迁移，用密钥进行参与式人种志研讨会 医疗保健系统中的利益相关者，并实施目标传播计划。结果将使我们能够 协助地方/联邦政府制定解决医师迁移的战略。