Physician shortage is a global phenomenon that significantly impacts Puerto Rico. From 2014 to 2019 the number of active doctors in Puerto Rico decreased by 17.5%; from 13,452 to 11,088. Medical exodus has been associated with this, estimating 365 to 500 physicians have left the Island, over the last decade. Additionally, 28% of actively practicing physicians are aged 60 or older, which would place them in retirement age in the next three years. This reduction is particularly alarming given Puerto Rico’s higher incidence of chronic diseases, and lower physician to population ratios compared to the mainland United States. This study investigates the phenomenon of physician shortage and migration in Puerto Rico through meta-analysis, physician self-reported surveys, and operational data from outpatient clinics from the private and public sectors. Preliminary findings indicate that the medical exodus, and physician shortage is driven by high operational costs, low physician wages, insurance reimbursement delays, licensing challenges, and limited post graduate training infrastructure. These have been associated with Puerto Rico receiving less federal funding for healthcare and Medicare reimbursement than any other state. Access to physicians is further limited by geographic distribution, appointment availability, and limited acceptance of medical insurance plans. Despite policy interventions such as Law 14 of 2017, which offers tax incentives with the goal of medical retention, projections suggest a continued decline in specialist availability. In conclusion, public health policies and healthcare practices need to be reformed urgently to ensure physician retention and provide timely services to the patient population.