A Bitter Pill : Foreign-Born, Foreign-Trained Latino Doctors Frustrated by Barriers to Practicing Medicine Here


What if you’re Rigoberto Flores Garcia from Puebla, Mexico, and you have dreams of nice homes and new cars?

You come across the border into Southern California with $500 in your pocket and start a succession of low-paying jobs. First you scrub pots and pans at a Carl’s Jr. in Los Angeles. Then you try waiting tables at a Mexican restaurant. You switch to flipping burgers for a living. Finally you lose that job.

Typical immigrant pipe dream gone sour? Well, this 34-year-old newcomer happens to be Doctor Flores, a licensed Mexican physician who once delivered 12 babies in one night.

“It was my dream and my mother’s dream that I become a physician,” Flores said. “I didn’t know it would be this difficult, or this expensive.”


Flores and hundreds of other highly educated Latinos living here--some without legal immigration status--are finding themselves in economic limbo after spending years earning medical degrees. They left Mexico or other Central American countries fed up with their governments’ chaotic economies and low wages, and now they find themselves among Southern California’s unemployed or underemployed because they lack the language skills and the money to take courses and exams necessary to obtain licensing here.

“My God, we keep hearing about the lack of Latino doctors in this country for our Spanish-speaking communities and here Flores was washing dishes for a living,” said Enrique Zuniga, a bilingual counselor at Fullerton College.

Zuniga and counselors from other Southern California colleges are trying to create inexpensive English courses for Latino doctors that concentrate on medical terminology.

He also helped organize a group called the Consortium of Physicians from Latin American, which now includes more than 35 doctors from Los Angeles and Orange counties. The group hopes to help raise scholarship money for foreign doctors, and help with post-graduate programs.

“We need any kind of help right now,” Zuniga said. “Money or leads for jobs that some of the doctors can get, such as health assistants, to keep them from abandoning their plans.”

Jorge Lopez Espana, 33, graduated from the medical school at the University de San Carlos in Guatemala, where he was ranked 86th out of 500 students. At the Hospital at San Juan de Dios near Guatemala City, he performed appendectomies, removed bullets, delivered babies, and conducted autopsies.

Today, he is a health educator handing out brochures and conducting AIDS awareness seminars at a Latino community center in Santa Ana. He’s one of the fortunate--he has a job in a health-related field.

Alfonso Sandoval, 33, who practiced two years after graduating from the medical school at the University of Morelia in southern Mexico, is now driving a vegetable truck for an Anaheim company.


The problem is that foreign-trained doctors must climb through a maze of state Medical Board restrictions that can take three to five years, and sometimes longer, to complete and can cost thousands of dollars.

In addition, these doctors, who must support themselves and their families, are finding the transition from Third World economy to Southern California’s full-throttle materialism very tough.

For example, Sandoval earns $7.50 an hour driving a truck. His wife, Carolina, who was a third-year medical student in Morelia when they met, later became a physician and worked for a company specializing in medical examinations. She now works in an Anaheim assembly plant making aircraft parts for $6 an hour.

“Our biggest problem right now is keeping ourselves motivated and learning English so that we can fill out the applications for the medical exams and become licensed physicians here,” Alfonso Sandoval said.


The couple said they took university English courses in Mexico to help prepare for the United States, “but the reality of it is, you don’t learn everything from books. Our English courses were quite different from how English is spoken here,” said Carolina.

“We had no idea it was going to be this tough to live here,” she added.

Rolando Castillo, an assistant clinical professor of medicine at the medical school at UC Irvine, said many of the medical newcomers come unprepared.

“They arrive in Southern California with absolutely no orientation about what to expect or what they should do,” he said.


Castillo charged that the medical establishment, by making the licensing procedure for foreign doctors so long and difficult and expensive (preparatory courses can cost as much as $5,000) is trying to keep newcomers out because they fear the competition.

“We have a very closed system for doctors in this country,” Castillo said.

However, officials from the Medical Board of California (formerly the state Board of Medical Quality Assurance) disagreed. They contended the board does not discriminate, and noted that about one-fourth of the licenses issued last year went to foreign-trained doctors. About 25% of the state’s 69,000 licensed physicians are foreign-trained, they said.

“We have licensed thousands of foreign medical graduates over the years,” said Linda McReady, a board spokeswoman. “We look not at languages or where they’re from, but the medical training they got, and we have doctors from all over the world working in California.”


In 1987, an unsuccessful lawsuit was filed on behalf of Vietnam-trained doctors who could not prove they had graduated from the University of Saigon medical school after the city fell to the communists in April, 1975. The suit was filed by Julianne D’Angelo, supervising attorney for University of San Diego’s Center for Public Interest Law.

“These people escaped and had no diplomas. They had to take certain courses to qualify to become a doctor in this state, but the board didn’t allow them (because they had no diploma),” said Marcia Gilchrist, a spokeswoman for state Sen. Edward R. Royce (R-Anaheim). Royce sponsored successful legislation that created a task force of former Vietnamese medical school faculty members that eventually helped the Vietnamese doctors gain U.S. licenses.

D’Angelo claimed the board’s behavior in the Vietnamese issue is indicative of its attitude toward all foreign medical graduates--a criticism that was denied by Terresa Ciau, chief of licensing for the Board’s Division of Licensing.

“Are we fair?” said Ciau, who accepted her Board position after the 1987 lawsuit. “I think so. Our image hasn’t been what it should be but we’re working on it.


“Since I’ve been here, we’ve been trying to be more service-oriented,” Ciau said. “You do hear discrimination complaints but we’re working towards a consistent procedure. Basically everyone has to meet the same licensing requirements. That’s the bottom line.”

The board follows stringent guidelines, Ciau said, because its purpose is to protect the consumer.

“Would you allow these people to operate on your relatives or your loved ones without first seeing proof they were adequately trained?” she said.

There is no worldwide accreditation organization that monitors foreign medical schools, although the state medical board’s staff members have conducted some on-site inspections at schools in Great Britain, the Philippines and in Mexico, Ciau said.


However, the medical schools inspected in Mexico, at Mexico City and in Guadalajara are private institutions filled with mostly students from the United States. Few of Mexico’s public medical schools have undergone any similar inspections, she said.

The board did once rely on a World Health Organization listing of medical schools until a scandal erupted in 1983 when hundreds of would-be physicians were caught cheating on basic qualifying exams by purchasing questions or whole tests in a thriving illegal marketplace. Hundreds more were graduates of certain for-profit schools, located mostly in the Caribbean, that at best were providing second-rate educations, and at worst, were little more than diploma mills.

The legacy, said many Spanish-speaking foreign-born doctors, is that they are forced to meet the letter of the law that they claim is in contrast to more relaxed standards for graduates of U.S. medical schools.

Said Robert J. Moser, assistant director for Refugee and Immigrant Services of Catholic Charities in San Diego: “If you’re practicing medicine and saving lives in one country it doesn’t mean your education was inferior.”


For Rigoberto Flores, who was already licensed in Mexico, the long trek is just beginning.

As a general practitioner for Seguro Social, one of Mexico’s largest private health providers, Flores said that three years ago he was earning $254,000 pesos a month, or roughly $90.

“I was working at a health clinic in Queretaro where I was seeing 45 patients a day. I remember that on one night alone, I delivered 12 babies. I would come home exhausted,” Flores said.

It was then that he heard from friends who had visited the United States who told him, “that if you work hard here, you can get a good job, a nice car and buy a home within one year.”


His years of schooling worked against him while he was in Los Angeles. “I was not street-wise. In Puebla, I always had my nose in a book and really didn’t know the ways of the street.”

He would lend money to roommates who wouldn’t pay him back. Then, with little mechanical knowledge, he bought his first car, a 1976 Buick, from another Latino. It cost $1,000. It ran for two months, then broke down.

He has since moved to Fullerton and found another job as a cook, but recently was terminated. He is living off his partial savings, which help pay for a nursing course he is taking in Santa Ana. During the days, he attends adult English classes.

After three years in California, the dream is beginning to dim.


“I like it here. When I work as a cook, I still make more money than I made as a doctor (in Mexico). But it’s very difficult to communicate. If I don’t make it into nursing, I have to leave and go back home,” he said.

“It’s funny, because in my letters to my mother, I never mention how hard living here is.”