My recent meeting included a session with the Deans of Puerto Rico's four medical colleges. As we discussed diversity and inclusion, they presented an unexpected issue. Because Puerto Rico is a US territory, its medical schools are accredited by the same groups as those on the mainland. Their students must take the MCAT, National Boards, and Specialty Boards that mainland students do.
These exams are only offered in English.
That means only truly bilingual students can hope to get into medical school and eventually qualify to practice. For the urban population and wealthier people, this is not a huge problem. For the bulk of the island, that level of English fluency is difficult. Medical school thus becomes primarily an upper-class option, perhaps even more so than on the mainland United States.
Then, if you have that sort of fluency, training on the continent provides more options than the island. Once you move to train, it becomes tempting to stay, leading to major brain drain for Puerto Rico.
My school's problems seem less weighty now.
By the way, San Juan is a lovely city. You can visit the Caribbean without a passport. All of your appliances, including your cell phone, will work. OK, some Verizon customers had issues with voice calls, but my AT&T phone worked just fine. No plug adapters required. There's history, tropical beauty, and the ocean. You will eat more rice, beans, and plantains that you imagined possible, but the food is delicious. So is the rum.
So go; you can thank me later.