We take pride in our ability to “MacGyver” solutions with the resources we have. We try never to say, “Just go away,” or “You’re not wanted here.” Our souls avoid imploding from frustration because we keep our access open and try our best to work with the tools we have.

What would you do when the entire system is bankrupt and defaulting on its entire financial framework? When the resources are not only scarce but the option of financial help doesn’t exist? Welcome to the challenges of our colleagues in Puerto Rico, where not only is the reimbursement to our members the lowest in the US health care system, recent reports have some stating the emergency departments are the cause of their health care financial crisis.

This was the case recently when, again, the emergency departments were accused in the Puerto Rico media of being poor stewards of the health care dollar. They continued to care for all patients who presented to them under their EMTALA mandate, then were blamed for dwindling resources. Our devoted leadership responded eloquently. Fernando Soto-Torres, MD, FACEP, the Puerto Rico ACEP Chapter president, was very passionate in pointing out that although limited access exists in American primary care, those barriers are even greater on his island. Given the financial challenges, follow-up access isn’t likely to improve in the immediate future. As long as alternatives to accessing care don’t exist, ACEP will not apologize for keeping ED doors open. He was quick to acknowledge that alternatives exist for non-urgent care, but many of our patients often lack the knowledge to know the difference when faced with an acute health challenge. The daily transfers to the emergency department from local physician offices and urgent care centers are similar to those on the mainland. If there were ever a set of colleagues we should be proud of in American health care, it’s our emergency colleagues in Puerto Rico.

So the next time you are working and you are frustrated by a lack of resources, be proud that you don’t throw up your hands and say, “If no one is going to help me, I quit.” There will always be a department, or even an entire territory, with fewer resources than you, and the patients won’t stop coming. We aren’t the problem. We are the soldiers looking for solutions. In Dr. Soto-Torres’ words, “If you think you’re having the symptoms of a medical emergency, seek emergency care.”