Healing Careers

Clinica Medica Latino Americana looks like any other small-scale clinic in downtown Santa Ana, but the staff at the recently opened medical office is delivering more than pills and checkups.

Inside the shopworn building, clinic executive officer Rolando Castillo is pursuing a formidable goal: returning Latino doctors to careers they had to abandon when they came to the United States. Castillo sees it as a mission of mercy that benefits the physicians as well as future patients by “bringing bicultural, bilingual health care to an underserved community.”

He is not alone in embracing the program, begun eight years ago in Anaheim as the Consortium of Physicians from Latin America--COPHYLA--and today expanded to include the new clinic.

“COPHYLA has opened up many doors for foreign medical graduates through this man’s vision of using an untapped resource to fill a critical need,” said Priscilla Gonzalez-Leiva, deputy director of the office of Statewide Health Planning and Development. “Why should these people be washing cars or working at a McDonald’s? That would waste years of medical training.”

The nonprofit clinic, at 121 E. Washington Ave., opened last month offering a range of services on a sliding-fee scale in a neighborhood that state officials say meets government standards as a “medically underserved area.”

By next month, hours will increase and a physician’s assistant will be on duty six days a week. The clinic will be open several evenings and Sundays to cater to its working-class patients. A pediatrician--and program alum--will work at the clinic some weekends, Castillo said. If the clinic can support itself, the consortium plans to open a second one in South-Central Los Angeles.

The group also hopes the clinic will be a catalyst in attracting young Latinos to the profession.

“We are trying to be role models for the community,” said Ruben Dorame, 38, a consortium member who works as a nurse at Anaheim General Hospital. “You have to tell these young kids to get their education, to motivate them to become doctors and nurses, not gang members.”

Dorame, who studies for the 1999 medical boards in the clinic’s community room, met on a recent morning with half a dozen other former doctors. Several, like Dorame, relocated to the area because of the group’s program and now do volunteer tasks for COPHYLA.

They gathered in a conference room a few feet from the clinic’s small waiting room to talk about the long, grinding road back. They vented about the loss of once-prominent careers. It is a bitter pill.

All work at less glamorous medical jobs so they can remain close to the profession they love. For some, simply achieving that is daunting: Being licensed as a nurse or physician’s assistant requires several years of schooling, English proficiency and state certification.

Maria Martinez, 38, of Mission Viejo practiced medicine in Mexico for four years. She now works weekdays as a certified nursing assistant for a stroke patient in Laguna Niguel. On weekends, she takes English and humanities classes at Fullerton College so she can apply to one of the three physician’s assistant programs at Southern California universities.

Eventually, she hopes to be licensed again as a doctor, but she recognizes the inevitability of interim steps. “It is frustrating [to work as a nurse],” she said. “But at the same time, I have to do something to support myself until I reach my goal--which for now is to be a physician’s assistant.”

Some never make the transition, wooed away by jobs in real estate or computer technology. Some simply disappear. Maybe it’s the shame of failure.

The step-by-step approach Castillo advocates is grueling. It tests the resolve, intellect and financial mettle of the would-be physicians and their families, said several of the former doctors.

There are 350 consortium members, each paying annual dues of $100. It is an exclusive club of medical acolytes.

“We help ease each other’s frustrations because we know we are not alone,” said Ignacio Cervantes, 46, who for 10 years was a hematology specialist at a Mexico City hospital. He worked as a farm laborer in Texas before moving to Placentia to take advantage of the program, he said. He is the clinic’s office manager and a medical assistant. Like Martinez, his immediate goal is to get into a physician’s assistant program.

There are significant hurdles to the final goal: licensing as a physician.

The most prominent is a three-part series of two-day tests--the national medical boards. They are basically the same tests taken by students at the nation’s 126 accredited medical schools, said Dr. Rebecca Patchin, a pain-management specialist in Southern California who is on the American Medical Assn.’s council on medical education.

International medical graduates also must take the clinical skills assessment exam in Philadelphia, an oral test and demonstrate English proficiency. The total cost, not including preparatory courses, is between $1,500 and $2,000, Castillo said.

The point, Patchin said, is to ensure competence regardless of whether doctors are trained in the United States or elsewhere. “There are a lot of hurdles for the international community, but I don’t think we can go to two standards of medical care,” she said.

Consortium members essentially agree, though they consider the English proficiency assessment to be potentially discriminatory for doctors who have an accent or are interviewed by conservative medical board members.

Regardless of the challenges, the program is filling an important need in “a very cost-effective manner for society,” Castillo said.

He points out that 15 COPHYLA members completed the testing process and in 1997 were placed in residency programs--the final step before licensing. That compares “very favorably” with the record of the University of California, he said. That same fall, six Latinos entered UC Irvine College of Medicine and a total of 53 enrolled in the five UC medical schools.

Central Santa Ana is particularly underserved by the medical community, state and local officials say. Though it has numerous medical shops and storefront clinics, some are unlicensed or dispense drugs not approved in the United States, according to a recent police investigation. Earlier this year, an infant with flu-like systems died after allegedly receiving a series of injections at a storefront office from a man with no medical license who posed as a doctor, police said.

Cindy Winner, associate director of ambulatory care for UCI Medical Center in Orange, recognizes the problem of providing quality health care, especially in communities such as Santa Ana. UCI operates a nonprofit community-based clinic there.

“There is definitely a need,” she said, pointing out that in addition to appointments, about 100 patients a day walk into the clinic--about 20 more than can be seen.

That’s precisely the niche that COPHYLA and the clinic want to fill. “Local institutions are not providing sufficient medical professionals for the Latino community,” Castillo said. “We need to provide alternatives so we can address low medical access by the bilingual community.”