Those seeking a thoracic oncologist, for example, have to go to Florida, if they canafford it."It's truly catastrophic," he said. The exodus of doctors is part of a larger wave of professionals who have left the USisland territory in recent years, settling in states such as Florida and New York,where there is a big demand for bilingual workers, especially police and nurses.Many Puerto Ricans also seek to escape a wave of violent crime and higher cost of living. Almost a million more Puerto Ricans now live on the mainland than on theisland.Medical professionals say they expect the situation will worsen.President Barack Obama's new health care law means US states will soon seekmore doctors amid an influx of patients, said Dr Guillermo Tirado, an internalmedicine specialist in Puerto Rico."All states are preparing to cull a lot of doctors from Puerto Rico," he said. "If wehave a big exodus now, we're going to see it get worse ... There hasn't been arevolution yet because the escape valve is to buy a plane ticket to Orlando,"referring to the many patients who fly to the US for treatment if they can afford it.Puerto Rico currently does not meet federal recommendations on the number andtypes of doctors needed per capita, Tirado said. The island of 3.7 million people has no more than two paediatric neuro-surgeons,even though guidelines state there should be at least one paediatric neurosurgeonper roughly 80,000 people, he said.Puerto Rico also lacks 93 full-time primary care physicians to adequately cover themedical needs of the population, according to statistics from the US HealthResources and Services Administration, which tracks areas suffering from ashortage of health professionals. Of the island's 78 municipalities, 37 need morehealth care professionals, including the capital of San Juan and Ponce, the island'ssecond largest city. The island has roughly 7,000 primary care physicians, Ibarrasaid.At the same time, the island's medical tourism industry is growing, with two newhospitals being built in Manati and Bayamon, catering mostly to foreigners fromelsewhere in the Caribbean, and even some from the US mainland, said PedroPierluisi, the island's representative in Congress who has limited voting powers. "Ina way, it's inconsistent," he said. Tirado said U.S. patients seek mostly cosmetic procedures, while Caribbean patientsoften seek specialists not available on their islands, such as endocrinologists.