MIAMI — In 1991, Carlos Domínguez, a family doctor in one of Havana's poorest neighborhoods, bought a boat for 12,000 pesos — the equivalent of saving his entire paycheck for three years — to escape the government that had trained him to be an international doctor.
The boat was old and needed to be outfitted with the transmission from a 1952 Ford, one of the many American cars that still cruise the streets of Havana. The mechanic warned him there was no reverse gear. The boat could only go forward.
"Perfect," Dr. Domínguez, now 46, said he replied. "I don't plan on coming back. From now on, I'm just going forward."
And so, armed with his grandfather's World War II compass, he left Cuba and made his way to Miami, rowing the last seven hours after the gasoline ran out. He was 28 years old and ready to resume his life as a doctor.
But first he needed to pass four exams given only in English, and then put in several years of training as a hospital resident.
Dr. Domínguez, who had been taught Russian in his military school in Cuba, knew no English. Still, he passed one exam before failing the second by a few points. Already married and saddled with family responsibilities, he put away his medical school books, and signed up for a program to become a nurse in one year. Since 2001 he has worked as a hospice admissions nurse, a job that allows him to work with patients while avoiding the hurdles that doctors have to overcome to practice medicine in the United States.
While the rest of the country is suffering from a shortage of primary care physicians, Miami is awash with Cuban doctors who have defected in recent years. By some estimates, 6,000 medical professionals, many of them physicians, have left Cuba in the last six years.
Cuban doctors have been fleeing to South Florida since Fidel Castro seized power in 1959, but the pace intensified after 2006, when the Department of Homeland Security began a program that allowed Cuban medical personnel "who study or work in a third country under the direction of the Cuban government" to travel to the United States legally. The program has effectively turned a crowning achievement of Cuba's foreign policy on its head.
In the 50 years since the revolution, Cuba has sent more than 185,000 health professionals on medical missions to at least 103 countries. About 31,000, most of them doctors, are in Venezuela, where they work in exchange for cheap oil and other trade benefits for the Cuban government.
And more are in the pipeline. Cuba's official news agency reported that more than 25,000 health professionals graduated this year, "the largest graduation ever."
But many doctors on the island are now vying to be tapped for an international mission, in part because they know that no matter where they are sent, they will be one step closer to a visa to the United States.
The missions have earned Cuba much recognition, goodwill and bargaining power. President Obama told reporters at the end of a recent hemispheric meeting in Trinidad that he found it "interesting" to learn from Latin American leaders "about the thousands of doctors from Cuba that are dispersed all throughout the region, and upon which many of these countries heavily depend."
Yet for many Cuban doctors, who earn the equivalent of $25 a month, the lure of a life of freedom and opportunities in the United States is too strong to resist. And so these children of the revolution, educated by a Communist regime to reject capitalism and embrace socialism, have ended up in Miami, often tending to elderly Cubans who fled the island before the doctors were born.
Ana Carbonell, chief of staff for Representative Lincoln Diaz-Balart, Republican of Florida, said more than 2,000 Cubans had already settled in the United States under the parole program.
"It brings to our community highly qualified professionals at a time of great need," Ms. Carbonell said. "They work alongside U.S.-trained doctors, and they enhance any practice or wherever they work."
Many have been able to obtain licenses and practice medicine. Others have chosen to settle for careers in the medical field but not as physicians, and some work in fields that have nothing to do with medicine.
"I know neurosurgeons who are working in warehouses or factories or as gas attendants," said Julio César Alfonso, 40, who graduated from medical school in Cuba in 1992 and works as a clinic manager in Miami. "But I know many more who are working as nurses, medical assistants and technicians."
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