The majority of the doctors that have left the island are specialists, so the ones that remain have long waiting lists for appointments.
The quality of all medical services in PR is the same as in the states, however some things are not done the same, for example, if a family member ends up in the hospital you are expected to bring blankets and be a principal care taker of your love one by fetching things, raising lowering bed and other things that a nurse typically does in the states.