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Short abstract:

Ethnographic research with Puerto Rican physicians who have left for the mainland US, as well as among those who have stayed, forms the basis for an analysis of how coloniality informs the unprecedented loss of physicians due to migration, resulting in a crisis of care in the Caribbean archipelago.

Long abstract:

Puerto Rico faces an unprecedented healthcare crisis due to the accelerating migration of physicians to the mainland United States (US), leaving residents with diminishing access to biomedicine and excessively long provider wait times. While scholars and journalists have identified economic factors driving physician migration, this study analyzes the effects of place-based stigma within the broader context of coloniality as unexamined dimensions of physician loss. Drawing on ethnographic observations of Puerto Rican biomedical institutions and patients across the island and fifty (n=50) semi-structured interviews with physicians in PR (n=26) and the US (n=24), the research identified how colonial metaphors and stigmatizing meanings are attached to PR, its people, and its biomedical system, often deploying colonial notions of the island’s presumed backwardness, lagging medical technology, lack of "cutting-edge" technologies, and presumably inferior career opportunities. These notions, deeply rooted in US military-imposed colonial biomedicine, neglect the diverse history of Puerto Rican medical practices, including twentieth-century approaches to community-based medicine that were once models of care in the Global South. Post-Reforma restructuring of the medical system in line with metropolitan interests, intensified by environmental traumas and escalating debt, combine with colonial legacies that disparage island-based, anti-colonial practices to inform physicians' migratory decision-making. In addition to economically motivated policies that have dominated responses to the crisis, efforts to curb physician migration should address globally circulating ideas about PR, acknowledge their roots in coloniality, and valorize local resurgent responses to the crisis in danger of being lost to history.