Dave’s Blog: It’s Time For PA Practice In Puerto Rico


by Dave Mittman, PA, DFAAPA

I live in Florida but my soul is that of a New Yorker. It has been said that all New Yorkers are eventually a blend of each other. I believe that. That being said, NY is home to the largest population of people of Puerto Rican ancestry outside of the Commonwealth itself. When Hurricane Maria struck, I personally felt it. I know the people there. Obviously, my thoughts turned to healthcare and just who was going to provide it? Even the question of whether PAs could go down there to help? Let me explain…

If you don’t know, Puerto Rico has been experiencing a “brain drain” as physicians and nurses from there leave to make considerably more money on the mainland. Their economy has been hurting and the healthcare system had manpower shortages before the Hurricane. I can’t imagine that it will get better after. Imagine getting your degree, finishing residency and being able to make tens or even hundreds of thousands of dollars a year more for doing the same thing. It would be a challenge for any of us to stay. After Maria that challenge becomes something that can not be ignored.

Puerto Rico is the last place that is part of the USA that does not allow PA practice. Why? Most agree it is because of the pressure imposed by organized medicine. There are NPs there as they have legislation which is fairly new but they have problems also.

In a report issued January 2017 from the Health Policy Resource Center titled “Puerto Rico Healthcare Infrastructure Assessment”, this was said about PAs and NPs; “The health care provider shortage is exacerbated by a lack of midlevel providers like physician assistants (PAs) and nurse practitioners (NPs). PAs are not licensed to practice in Puerto Rico, and according to many respondents, physician groups have exerted ongoing pressure to maintain this arrangement. Some said that general practitioners worry about competition from PAs and the pressure this might create to further reduce reimbursement rates. By comparison, NPs face marginally better acceptance from the Puerto Rican medical community than PAs. Recently, Puerto Rico passed a law allowing NPs to practice, and several NP training institutions exist in the commonwealth. However, most graduates of these programs are either foreign students or Puerto Ricans intending to leave to practice elsewhere. Like physicians, bilingual nurses and NPs are in high demand on the US mainland and can earn significantly higher salaries there than in Puerto Rico”.

It’s time for PA legislation in Puerto Rico. It’s time to allow those that want to take some time and go down there to practice their profession the ability to do so. I know many of my PA friends over the years have wanted to, only to be told they were not wanted or needed. More than that let’s not settle for legislation that will tie our hands and not allow us to practice to the full extent of our education and clinical abilities. Let’s draft legislation for PA practice with OTP or as close to it as possible. We don’t need to hamper ourselves and this is a place that both needs and deserves PAs doing what we do best; providing medical care. Let’s look at what the NPs are trying to do and possibly work together and I hope all of us can team with the physicians there to provide the Island’s citizens with the healthcare they so desperately need.

It’s time for PA practice in Puerto Rico.


Dave Mittman has been a PA and later NP leader for thirty years. He co-founded the LIU PA Program student society, was President of the New York State Society of PAs from 1978-1979 and served on the American Academy of Physician Assistants (AAPA) Board of Directors from 1981-1983. Dave was also the first USAF Reserves PA permitted to practice. Dave spent 9 years in primary care in Brooklyn, N.Y. and left to begin a career in medical publishing with Physician Assistant Journal. Dave has also won the AAPA Public Education award for leading the march in Trenton NJ to establish PA practice. Dave left PA Journal to co-found Clinicians Publishing Group (1990) and Clinician Reviews Journal in 1991. Dave has authored papers in publications as diverse as “Chicken Soup for the Expectant Mothers Soul”, “U.S. Pharmacist”, “The British Medical Journal” and others. Dave¹s paper in the BMJ was the first internationally written paper written on PA practice. Dave and a few very close PA colleagues co-founded the PAs For Tomorrow”” in 2012 which is a new national professional organization representing and advocating for PAs in an different way. Dave as spoken at hundreds of NP and PA meetings and always has some interesting thoughts on the future of both professions. Most recently Dave has been busy launching another dream; Clinician 1, the first internet community for PAs and NPs. Dave is married to his sweetheart Bonnie for 32 years and has two wonderful children.

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