The government pays for the residencies of at least 95 percent of all Puerto Rican medical students, investing $35,000-$45,000 a year for each, Aponte said. Puerto Rico has four medical schools, and roughly 400 medical students graduate a year.
If the bill is approved, students would have to reimburse the government the cost of their residency if they leave before practicing medicine for the required time.
"Currently, they are disappearing from the scene because they go to the U.S., where they have received incredible offers," he said.
Tirado agreed: "Job offers rain down every day," he said. "It's a huge bombardment."
Family and general practitioners in Puerto Rico earn about $72,000 a year, while in the U.S. they earn about $180,000, according to 2012 statistics from the U.S. Bureau of Labor.
That's partly due to the lower standard of wages on the island, where the median wage is less than $28,000 a year, far below mainland income. Ibarra and Tirado say peculiarities in the island's health insurance system also force doctors to accept less income — or to leave.
Puerto Rican health care providers also get less reimbursement from Medicare for particular services than do those in any other U.S. state or territory, Pierluisi said. They get about 20 percent less than those on the U.S. Virgin Islands and the base rate for hospital patients is 14 percent less than on the U.S. mainland, he said.
Currently, more than 670,000 people in Puerto Rico use Medicare.
"It's a huge number of patients for doctors," said Pierluisi. "It's the best plan we have. It serves as the top plan. If Medicare is not paying our physicians well, the commercial insurers in the private sector will do the same."
While the U.S. government is scheduled to revise how Medicare reimbursements are determined next year, that won't stop doctors from leaving, Tirado said.
A recent study commissioned by the island's Association of Surgeons found the problem is aggravated by retiring doctors, and by the fact that fewer doctors are studying allergy, endocrinology, geriatrics and urology. The study also warned about a scarcity of specialists including cardiologists, anesthesiologists and orthopedic surgeons.
Flores said she is looking forward to not having to worry about scarcity of doctors once she moves to the U.S.
"I've already taken the decision to quit my job," she said. "It pays well, but my health is more important."
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