Featured Doctor

ALMENAS, Dr Marina

Puerto Rico : family doctor

What work do you do now?

Over the past 17 years I have been the medical director of two Independent Physician Associations (IPAs), in Puerto Rico, one in the capital city of San Juan and another in Trujillo Alto. The public health system of Puerto Rico serves about 1.6 million of the inhabitants of the island through these IPA's. These offices group general practitioners and family physicians (the latter have done three years’ training in specialist residency programs), as well as paediatricians, internists, obstetricians & gynaecologists, all providing their services in one place. In addition to providing services to patients, my role is to continually improve the services and quality of the entire group of doctors for every audit of insurers and government, so that we can continue to have excellent results in preventing and treating chronic conditions.

I am also the medical director of two Management Service Organizations (MSOs), where with many other doctors, we offer services to ‘Medicare patients’ (elderly patients) - for prevention and treatment of chronic conditions. I am continually improving the services offered, because in recent years, each month Medicare rates the services provided. We provide ongoing care to these elderly patients for chronic conditions but also implement prevention of other conditions. The care is both outpatient and inpatient. I also offer medical services to patients on private medical plans.

What other interesting activities have you been involved in?

As past president of the Academy of Family Physicians in Puerto Rico and now the Puerto Rico’s delegate to the Congress of Delegates of the American Academy of Family Physicians (AAFP) for the past few years, I have set myself big goals for our specialty. Among the goals are: that the payment to our specialty equals other specialties; maintaining the monthly journal Continual Medical Education (CME); organizing an annual convention with more than 20 credits of CME and workshops attended by 500 doctors.

photo: Marina and WONCA North America region president, Dr Ruth Wilson promoting the 2015 Iberoamericano conference and WONCA, at the 2014 AAFP meeting.

I continuously work to ensure that our Association has its own headquarters where we get together monthly and organize activities for our members and for the community. It is where we also work to support our four Residency Programs in Family Medicine.

Working within the community has always been a passion of mine, leading me to be involved in some amazing activities. These include free health clinics to our population; and a poster contest where children and adolescents, of the private and public education system, get to be involved in health education directly. Some of these posters were: "If you love me don’t smoke", "For Your Health, MOVE", "Say YES to Your Family Health". Also I was involved in the creation of the Community Award for work, where I had the privilege of working with community entities such as "United Way", "Make a Wish", Youth at Risk and many others. This award recognizes the work of others and serves to promote to our doctors as early as our resident physicians, the idea of combining medicine and community.

What are you interest as a family doctor and also outside work?

My interest as a family doctor is that people should know more of our unique medical specialty. Although we have spent many years educating people about the family doctor, people still do not recognize the importance of having a family doctor. As we say “a family doctor for every family.” We created a 30-second video for radio and film, in English and Spanish, to educate the population on this issue. The first video was 10 years ago, and now our new video has been broadcast on our TV channels this year. We have managed to position ourselves at the same level as other specialties in universities, hospitals and insurance companies, but we still have lot of work to do.

Outside of my work I have much to do. I love community work, helping people come together to work for a better future. Besides the Family Medicine Associations in Puerto Rico, a few years ago I began to introduce Puerto Rico to WONCA - CIMF. I started as Vice President of the Mesoamerica Area where I began to educate on the importance of Family Medicine to countries of our region, such as the Dominican Republic, Costa Rica, El Salvador, Nicaragua, which still continue to work and develop family medicine. Afterwards as Honorary Treasurer, I continued to work and support family medicine throughout our region of Latin America in our conferences and summits. Being treasurer is a great responsibility especially in times like this where the economy is difficult, nevertheless we have always succeeded in all our activities.

Then there is my passion for my family. As a wife and mother I work every day for my family alongside my husband, also a doctor. My main triumph is my children; Lorenzo, a third year medical student in the U.S.; Janice, a first year law student; Franceska, a professional stylist and my two smaller children Marimyr and Gabriela, still high school students and future doctors.

Leading several companies and my family is only possible thanks to the support of my parents and in-laws. When we're not working or studying, my family’s shared passion is traveling the world and learning about other cultures. As a family we’ve has the privilege of sharing many stories from exotic cultures like Dubai, Australia, New Zealand and India. I must admit my favorite hobby is taking pictures, it is quite amazing to see the pictures and relive that moment.

What it be like a family doctor in Puerto Rico?

We are an important part of public and private system in our country. The family doctor is a specialist, who still despite all the years as an established specialty, have many goals to achieve. At academic, college, hospital, insurance company and government levels we have achieved a great many things. We still have many more to achieve not only for ourselves, but as advocates for our patients.

To have people understand that it is a specialty, which can provide services to both ambulatory patients and inpatients is one of our main goals. Those who are family doctors in Puerto Rico take great pride and care in our practice even if it is at times hindered - sometimes not being able to practice many of the procedures for which we have so meticulously trained. We are a small island, 100 by 35 miles (160 by 56 km), with many doctors including many medical specialties, and yet, despite that those that choose the path of Family Medicine exercise their practice with great satisfaction.