1) Physician Migration and its Implications for Puerto Rico’s Health Care System

Co-Principal Investigators: Professors Sheilla Rodríguez-Madera, Mark Padilla, and Nelson Varas-Díaz (all faculty in FIU’s Global & Sociocultural Studies).

Co-Investigators: Professor Kevin Grove (FIU’s Global & Sociocultural Studies); Professor Torsten Neilands, University of California, San Francisco.

External collaborators: Professors Alixida Ramos-Pibernus and Melissa Marzan, Ponce Health Sciences University; Professor Clemente Diaz, University of Puerto Rico Medical Sciences.

Summary: A new federal grant was awarded to Florida International University faculty members and Co-Principal Investigators, Professors Sheilla Rodríguez-Madera, Mark Padilla, and Nelson Varas-Díaz. Their team also includes FIU’s Professor Kevin Grove, a geographer and co-investigator on the project, and Professor Torsten Neilands, a statistician and co-investigator at the University of California, San Francisco. The four-year, $2.5 million grant is funded by the National Institute on Minority Health Disparities (NIMHD), a division of the National Institutes of Health, which focuses on research to address health disparities in the United States and internationally. The project will be administered by the Kimberly Green Latin American and Caribbean Center (LACC), and is a part of its newly established Program of Excellence, the Research Network for Health and Society (REACH), directed by Dr. Padilla. The grant will allow FIU’s investigators, all of whom are faculty members in the Department of Global & Sociocultural Studies within FIU’s Steven J. Green School of International & Public Affairs, to study the phenomenon of the emigration of Puerto Rican physicians from the Caribbean island – which has recently suffered from a combination of financial crisis and natural disasters – to the mainland United States. Due in large part to the concurrent crises, it is estimated that Puerto Rico will lose half of its already depleted physician workforce in the next decade. Until this grant, there had been almost no scientific research to study the causes, consequences, and potential policy responses for the loss of physicians in Puerto Rico. Using innovative methods of ethnographic mapping, geographic analysis, and a national survey of Puerto Rican migrant physicians, this grant will allow the FIU researchers to examine how the Puerto Rican health sector and communities are responding to the physician migration crisis, drawing on social science theories of migration, spatial stigma, and health care system resilience.

2) Reducing Serious Mental Illness and Suicide Stigma Among Medical Students

Co-Principal Investigators: Dr. Nelson Varas-Díaz (FIU’s GSS - LACC) and Dr. Eliut Rivera-Segarra (Ponce Health Sciences University).

Co-Investigators: Dr. Torsten Neilands – (University of California San Francisco), Dr. Lawrence Yang – (New York University) and Dr. Yovanska Duarté-Vélez – (Bradley Hospital/Brown University).

Consultants: Dr. Adriana Foster – (Florida International University), Dr. Guillermo Bernal – (University of Puerto Rico- Retired), Dr. Ronald Epstein – (University of Rochester) and Dr. José Torres – (Ponce Health Sciences University).

Activity dates: 09/04/2020 - 09/03/2023

Summary: People with serious mental illness (PSMI; i.e. Schizophrenia and bipolar disorder) die, on average, 25 years earlier than the general population. Suicide is a key factor for this disparity as it is the leading cause of unnatural deaths among this population. Latinxs are a particularly vulnerable group accounting for one of the highest rates of SMI and suicide ideation and attempt (SIA) among ethnic minorities in the United States. Health professionals play a key role in identifying SMI/SIA among patients; unfortunately, SMI/SIA stigma hinders this process. This is vital, as research has documented that half of PSMI who are suicide victims contact their physicians prior to their deaths. Furthermore, Latinxs seek SMI/SIA related services in general medical settings, rather than through mental health care. Thus, the National Action Alliance for Suicide Prevention’s Research Prioritization Task Force calls for effective SMI stigma-reduction interventions targeting health professionals in order to prevent SIA through early identification and increasing referrals for at-risk individuals. In light of this, the proposed R34 project aims to: Aim 1 - Develop the content of an intervention to reduce SMI/SIA stigma among medical students. Aim 2 - Determine the acceptability and feasibility of implementing the intervention among medical students by examining recruitment/screening procedures, participation/refusal/retention rates, and participant satisfaction. Aim 3 - Pilot test, via a small randomized controlled trial (RCT), the preliminary efficacy of the intervention in reducing SMI/SIA stigma among medical students by: increasing knowledge of SMI/SIA, reducing negative attitudes towards SMI/SIA, and increasing behavioral skills for providing healthcare to PSMI. The team will develop the intervention content based on their previous studies, recommendations from the Community Advisory Board and input from medical students via iterative focus groups (Aim 1). Afterwards, 126 medical students recruited in Puerto Rico and Florida will be randomly assigned to either the SMI/SIA stigma reduction intervention (n=63) or a time and attention matched controlled condition (n=63) to determine its acceptability/feasibility and test its preliminary efficacy (Aims 2 & 3). The team will examine the intervention’s efficacy in reducing SMI/SIA stigma via direct observation of: 1) interactions with Standardized Patient Simulations (n=126), and; 2) a subsample (n=40) of interactions with real-world patients. Following, the team will then examine students’ and patients’ views and attitudes regarding these real-world clinical interactions via qualitative interviews. If data from this study points to an efficacious intervention, the team will implement a fully powered Hybrid-I type RCT design examining the intervention’s effectiveness and implementation strategies. If successful, medical schools will have a powerful cross-cultural tool to train students on stigma-free skills impacting SMI/SIA prevention efforts with high-risk populations.