A Shortage That’s Killing Latinos

On a wintry night last year, the temperature of 18-month-old Selene Segura Rios, suffering from vomiting and diarrhea, suddenly spiked. Her parents realized she needed immediate medical attention, but they couldn’t afford to take her to a hospital. Instead, they sought an unlicensed inyectionista (shot-giver) who practiced in a room behind a Tustin greeting-card store. Two hours later, Selene died, not as a result of the shot, but of severe dehydration due to her illness. Sadly, her parents hadn’t found proper medical care in time.

Many factors drove Selene’s and similar parents to seek out clandestine pharmacies. For example, hundreds of thousands of Latino parents in Los Angeles County are ineligible for Medi-Cal because they work, often two or three jobs. Their employers do not offer them private health insurance, and they are unable to afford out-of-pocket fees. But one factor stands out. Selene’s parents were unable to find a physician nearby, much less one with whom they could communicate. Selene was a victim of a Latino physician shortage.

Addressing the shortage of Latino doctors is not an affirmative-action issue. Rather, it is one of access to medical care for 10.4 million Latinos in California. The fewer the number of Latino doctors, the greater the risk that infectious diseases, for example, may endanger public health.

There are more than 70,000 non-Latino licensed physicians in the state, about one for every 335 non-Latinos. By contrast, there are only 3,500 Latino physicians, and they account for less than 5% of the total physician pool. Since one-third of the state’s population is Latino, this means there is one Latino physician for every 2,893 Latinos.

Access to Latino physicians could well have meant a difference in Selene’s case, for at least three reasons. First, Latino physicians are far more likely to be established in heavily Latino areas, where the physician shortage is most acute. Assemblyman Marco A. Firebaugh (D-Los Angeles) estimates that in Bell Gardens, there is only one physician for the city’s 28,000 residents.

Second, since more than nine of 10 Latino physicians are fluent in Spanish, they could have communicated effectively with Selene’s parents about her illness and possibly saved her life.

Third, Latino physicians tend to be more than just culturally sensitive to Latino patients. They generally know that the poorer among them seek out curanderos (folk healers) or clandestine clinics, hence they can anticipate problems connected with these nonmedical care-givers. Moreover, they know how to motivate Latino patients to work with them so that together they can protect the health of their families.

Although heir to a medical tradition dating back to 1582, when the first medical school in the Western Hemisphere opened its doors in Mexico City, California produced few Latino doctors during its first 100 years after statehood in 1850. One reason was that there was no equivalent of historically black colleges and university medical schools such as Howard and Meharry.

When the state’s population tripled between 1945 and 1970, state health and medical authorities feared a “doctor shortage.” They decided to build three new medical schools. To alleviate the shortage until the schools began turning out doctors, the authorities invited international medical graduates, known as IMGs, to practice in California. Among them were doctors from Mexico, Argentina and other Latin American countries. Because California’s medical schools were graduating only one or two Latino physicians annually at the time, the Latino IMGs con stituted close to 90% of all Latino doctors licensed in the state up to 1980.

The first class of California-trained physicians that included a sizable contingent of Latino physicians graduated in 1973. There were 12. The numbers quickly ramped up from there. By 1980, between 50 and 60 Latino physicians, out of a total of about 900, were graduating yearly, close in size to the 70 to 80 completing medical school in Latin America.

Then, suddenly fearful of a “doctor surplus,” California--and only California--virtually closed the doors on IMGs in the early 1980s. While this action negligibly affected the non-Latino physician pool, it effectively removed nearly half the Latino doctors in the pipeline. Currently, less than a half-dozen Latino IMGs enter the state. Curiously, nearly all other states continued to allow them to enter. In Northeastern states, for example, IMGs often constitute more than half of all first-year medical interns and residents.

If California’s medical schools had increased Latino enrollments to compensate for the loss of Latino IMGs, the current shortage would not be as grave. But not only did Latino enrollment in California not increase significantly during the 1980s, it dropped by nearly one-third during the ‘90s, and by about 20% in out-of-state medical schools. While schools in Texas have also experienced a drop in Latino enrollments, on a comparative basis, Texas educates twice as many Latino physicians as California.

If Selene’s parents had difficulty in finding a Latino doctor in 1999, her brothers and sisters will find it even more difficult when they are adults. By the time they are grown, most Latino IMGs will have retired, effectively cutting the current Latino doctor pool in half again. Decreasing Latino enrollment in U.S. medical schools means fewer and fewer Latino doctors in the future. Taken together, in just 20 years, the ratio of Latino physician to Latino patient will likely be 5,157 to 1, nearly twice as large as today’s.

There are three ways to alleviate the Latino physician shortage. The most obvious is to increase the number of Latinos attending California’s medical schools. Currently, Latinos are not encouraged to pursue medical careers. Latino students seem to have interpreted Proposition 187, the anti-immigrant measure, and the end of affirmative action as signs they are unwelcome in higher education. The number of Latinos applying to medical schools has dropped correspondingly. “We have to enhance efforts to improve the applicant pipeline,” says Gerald S. Levey, dean of the school of medicine at UCLA. “We need to influence and encourage students to follow careers in science no later than the seventh or eighth grade.”

It’s reasonable to expect that if more Latinos apply to medical schools, more are bound to be admitted. Admissions committees can judiciously increase the applicant pool by giving greater weight to skills and knowledge that better serve the state’s changing demographic profile than the highest possible MCAT scores--for example, the ability to speak Spanish and knowledge of the cultural aspects of Latino health. These skills and knowledge need not be ethnic-bound. Anyone who takes the time to master them could earn preference points in admissions policy. Such an approach would not violate the ban on affirmative action.

A second way would be to provide training and education for non-Latino physicians who wish to become fluent in cultural motivation for a Latino patient base. There is much knowledge available. A group of Latino providers recently compiled a book, “Healing Latinos: Realidad y Fantasia,” to share with their non-Latino colleagues.

The third way is controversial, but it at least needs to be discussed seriously as a temporary measure: Raise the limit on the number of Latino IMGs who can practice in California, under regulations that target their skills in areas where they are most desperately needed, while safeguarding the public against poorly trained doctors.

While non-Latino Californians do not have to think twice about finding a physician to communicate with, for Latino Californians, this is becoming an insurmountable barrier. As long as the state’s health and medical authorities do not address the problem effectively, there will sadly be more cases like Selene. *