Under Puerto Rico law, provisions relating to regulation of physicians are provided under 20 L.P.R.A. § 31 through 20 L.P.R.A. § 56e. Every person wishing to obtain a license to practice medicine and surgery or of osteopathy must be of age and have resided uninterruptedly in Puerto Rico for a minimum of six months, excluding sporadic trips from the state for medical, business or pleasure purposes, and also excluding any trip from the country to study abroad in universities, colleges or medical schools[i]. The applicant must have completed all academic studies for a career as a physician, surgeon or osteopath from a university whose curriculum is accepted by and registered with the Board of Medical Examiners (board). In the case of educational institutions operating in Puerto Rico, said curricula must be previously authorized by the Council on Higher Education[ii]. The board shall not recognize the legality of a title as physician or osteopath in cases in which the aspirant has not taken at least the last two years of the school’s official curriculum in the school of medicine that issues it. The board shall not accept the legality of a diploma, certificate or title if the school, university or college that issues it excused the aspirant from any subject included in the curriculum which was accepted by and registered with the Board[iii].
The applicant must pass the revalidation examinations given by the board or the United States Medical Licensing Examination (USMLE), or any other equivalent examination. Provided that, subject to the other applicable provisions in 20 L.P.R.A. §§ 31-52d, the board shall establish, through regulation, the examinations that must be approved by the aspirants to obtain a surgeon’s or physician’s license who have taken their medical studies partially or entirely in a school that is not recognized by the board.
The board shall establish the requirements to be accepted to take the revalidation examination that comprises the basic sciences. Provided that the candidate for any part of the examination shall include a transcript of credits certifying that said candidate received a Bachelor of Science degree, a premedical course or courses equivalent to a premedical course as established by the board through regulation, with a grade point average of not less than two point five (2.5) or its equivalent[iv]. The board may waive the examination requirement for those who have obtained a license by passing an examination before the corresponding board in the States of the American Union with which the board has established a reciprocity relationship, and those physicians or surgeons who hold a diploma issued by the National Board of Medical Examiners of the United States of America or have passed the licensing examination of the Federation of State Medical Boards (FLEX).
The board may grant provisional licenses to physicians or osteopaths from other states who come to Puerto Rico to practice their profession in nonprofit medical hospital facilities, until said professionals have met the six-month residence requirement[v].
The applicant must offer evidence that after graduating from a medical school or college s/he has completed training as an intern or resident for not less than one year in a hospital approved by the board. Provided that the board shall accredit to every physician who served as an intern in the U.S. Armed Forces the time s/he served, in the same way, and with the same effect as if he had served as an intern in a hospital recognized by the Board.
The board may issue a provisional license to physicians or osteopaths of good national or international scientific reputation, who come to Puerto Rico to practice medicine. Such license may be for the term of one year, which may be extended for one more year. If these doctors or osteopaths wish to continue practicing their profession in Puerto Rico indefinitely, they must obtain a regular license, as established in 20 L.P.R.A. § 31-52d. The granting of regular license shall be approved, in each case, by two thirds of the total number of the members of the board. Provided, furthermore, that, in the case of foreign doctors, they must show evidence of having obtained the corresponding permits or visas from the Office of Immigration and Naturalization of the U.S. Department of Justice.
In addition, the applicant must have a good reputation, verified by a good conduct certificate issued by the Puerto Rico Police and any other credentials the board may establish by regulation[vi].
The physicians or osteopaths of the U.S. Armed Forces and the U.S. Public Health Service are exempted from the examination, and may practice medicine in Puerto Rico while they are in the active service of their official duties, for which they must obtain a special license issued by the board[vii].
The Board shall establish the requirements and mechanisms needed for re-certifying the professionals every three years, based on continuing education[viii].
The board shall have the power to refuse a license to practice the profession of a physician or osteopath to any person who has attempted to obtain it by means of fraud or deceit, does not meet the requirements established in 20 L.P.R.A. § 43, has been found mentally incompetent by a court of competent jurisdiction, is addicted to narcotic drugs or is a confirmed alcoholic, has been convicted of the unlawful practice of any profession regulated by law or has been convicted of a felony or a misdemeanor involving moral turpitude[ix].
The board has the power to deny, suspend, or cancel a license if the applicant violates the rules by revealing data identifying a patient obtained during the course of a doctor-patient relationship without the patient’s prior authorization, except when such data is necessary or pertinent to the doctor’s allegations in answer to a malpractice suit for damages filed against him, and except when it is legally required or authorized. Similarly, if the physician acts beyond his/her capacity or guarantee unconditionally to the patient that he will be cured with his medical services or advertise his/her practice by false or deceitful means, such physician may be subjected to disciplinary action. Other prohibited activities include preparing or prescribing the use of controlled substances for weight loss, athletic activities or for purposes other than those accepted therapeutically, or soliciting or receiving compensation for professional services that have not been performed. It is also illegal to cause the personnel under one’s direction and supervision to be guilty of illegal activities or perform unauthorized medical acts, to harass, abuse or intimidate patients, to withdraw his services from a patient without notice or to deny or impede a patient’s access to his/her medical records on request[x].
The disciplinary sanctions that may be imposed by the board include an order placing the physician or osteopath on a probationary period for a definite period or requirement to submit to periodic review of professional practice or to undergo additional professional training. In addition, the board may suspend or revoke the license of the physician and require the health care institution, if any, where the physician renders services, to suspend or revoke the privilege of practicing his profession at such health facility, or to suspend or revoke any other privileges related to the practice of the profession that may have been granted to him/her. The board may otherwise restrict or limit the physician’s or osteopath’s practice[xi].
The board specifies penalties for the illegal practice of medicine. Accordingly, every person convicted of illegally practicing medicine or surgery, or osteopathy, shall face a felony charge, and upon conviction, shall be punished by imprisonment for a fixed term of three years[xii]. The sentence may be reduced to a minimum of two years and may be increased to a maximum of five years in the event of aggravating circumstances. The board may also file a suit to restrain a person engaged in the illegal practice of medicine[xiii]. A physician is deemed to have engaged in the illegal practice of medicine and surgery or osteopathy in the following situations:
- Writes, drafts or publishes a notice or advertisement purporting to be legally qualified to practice medicine or osteopathy;
- Without a valid license, purports to be qualified to examine, diagnose, treat, operate on or prescribe for any disease, pain, lesion, deformity or physical and/or mental condition, or performs or offers by any means or method to examine, diagnose, treat, operate, or prescribe for any illness, pain, lesion, deformity or physical and/or mental condition whether or not he receives remuneration for such services.
- When a physician, duly licensed by the Board, knowingly and in concert and common accord, accepts a contract with persons who are not licensed to practice medicine and surgery or osteopathy in Puerto Rico. However, medical students registered in medical schools duly authorized to operate in Puerto Rico by the Council on Higher Education, and some foreign medical students, domiciled in Puerto Rico may perform examinations of human beings, assist in operations, administer anesthesia, perform minor surgery and attend childbirth cases as part of their studies, while they attend medical school.
- The use of the title “Doctor of Medicine” or the abbreviation M.D., used by itself or together with other terms, by an unlicensed person with the purpose of soliciting patients.
- To advertise as a specialist or practice as such without being duly licensed by the board.
- To contract or employ any person as a physician or osteopath without being duly licensed by the Board, or when his/her license has been suspended, revoked or cancelled.
- To submit false or fraudulent documents to the Board with the purpose of obtaining a license as physician or osteopath or a certification as a specialist[xiv].
[i] 20 L.P.R.A. § 43.
[vi] 20 L.P.R.A. § 43.
[vii] 20 L.P.R.A. § 44.
[viii] 20 L.P.R.A. § 52c.
[ix] 20 L.P.R.A. § 52.
[x] 20 L.P.R.A. § 52.
[xi] 20 L.P.R.A. § 52a
[xii] 20 L.P.R.A. § 39.