The Latino Physician Shortage In
California 1999
By
David E. Hayes-Bautista,
Ph.D.
Paul Hsu
Robert Beltran, M.D.
Juan Villagomez, M.D.
Center for the Study of Latino Health
Division of General
Internal Medicine & Health Services Research
UCLA School of Medicine
Introduction
Access to medical care has been an ongoing problem for many
Californians. The increasing lack
of health insurance, coupled with its high cost when available at all, have
kept many in the state from enjoying full access to care.
For the 10.4 million Latino Californians, the
problem of access is compounded by issues of language and cultural competence:
often, even when they have insurance, they encounter difficulty finding
physicians who can understand their illness experience, and can communicate clearly
and effectively with them.
To help alleviate the situation, the California
Latino Medical Association (CLMA) asked the Center for the Study of Latino
Health (CESLA) at UCLA, to develop a directory of Latino physicians in
California. Such a directory has
never been compiled before, as there is no comprehensive data set that
identifies Latino physicians. The
Center developed a methodology for identifying Latino physicians, described
briefly below.
Once the directory was compiled, the two
organizations possessed a valuable piece of information that had never been
available before: the number of Latino physicians licensed to practice in the
state of California. This single
piece of information is so compelling, and has so many policy implications,
that the two organizations wish to share that information, to accompany the
release of the Directory of Latino/Hispanic Physicians, 1999.
Methods
Because no single source is able to identify Latino
physicians, a composite methodology was developed to identify an estimated 90%
of such physicians. A master list
of all physicians licensed to practice in California as of February, 1999, was
obtained from the California Department of Consumer Affairs. This list does not include any
indicators of ethnicity. An
algorithm was developed to identify Latino International Medical Graduates
(IMG) by using a list of medical schools in Latin America. Graduates of US Medical schools were
identified by using a list of over 12,000 Spanish surnames utilized by the US
Bureau of the Census. The
resultant list was compared to a list of two Latino physician organizations and
one Latino medical student alumni association. A detailed methodology is
described in the forthcoming paper.
Latino Representation
This method identified a total of 3,578 Latino physicians
licensed to practice in California in 1999, out of a total of 74,345 physicians
of all ethnicities licensed to practice.
Latino physicians were 4.8% of all physicians licensed in the state.
By way of comparison, the Latino population for
1999 is estimated to be 10.4 million, and comprised 30.4% of the state’s
population. Figure
1 shows Latino representation in all physicians and in the state’s
population.
It is immediately apparent that Latino
physicians are greatly under-represented in the state’s physician supply. While this representation should not be
construed to mean that only Latino physicians can, or should, treat Latino patients,
it is indicative of the relative lack of access to higher education and the
medical profession. Many academic
medical organizations such as the Association of American Medical Colleges
(AAMC) and the Council on Graduate Medical Education (COGME) have argued that
the nation should move in the direction of parity between population
representation and physician representation.
In light of this goal, the California physician
supply is critically lacking in Latino physicians.
Population to Physician Ratio
One way to appreciate this discrepancy in physician supply
is to examine the ration of population per physician. Overall, for every Non-Latino physicians in California,
there are 335 Non-Latino Californians, giving a ratio of 335:1.
For Latinos, the ratio is much worse. For every Latino physician in the
state, there are 2,893 Latino Californians, giving a ratio of 2,893:1.See Figure 2.
Comparison to Latin America
Another way to grasp the disparity in Latino physician supply
is to compare the California ratio to the ratio seen in other countries in
Latin America. The 10.4 million
Latino population in California would be equivalent to a medium-size Latin
America country, approximately that of Chile or Cuba.
While Latin American countries are often
considered to be developing countries, not yet fully economically developed,
some have ratios close to the Non-Latino California ratio of 335 Non-Latino
population per Non-Latino physician.
Cuba, with its ratio of 226 Cubans per physician; and Uruguay, with its
ratio of 268 Uruguayan per physician, actually have better ratios than
Non-Latino California. Argentina,
with its ratio of 364 Argentines per physician, is very close to the Non-Latino
California ratio. Mexico has a ratio
nearly double that of Non-Latino California, with 593 Mexicans per physician.
The Latino population to Latino physician ratio
is lower than that of every other Latin American country. It is worse than the ratios of Honduras
(1,351 Hondurans per physician), and Nicaragua (2,247 Nicaraguan per
physician). With 2,893 Latino Californians for every Latino physician, Latino
California has the dubious distinction of having a worse population to
physician ratio than all of Latin America. See Figure 3.
The Latino Physician Shortage
The magnitude of needed policy goals can be seen when this
physician disparity is presented in terms of the Latino physician shortage.The
shortage refers to the number of Latino physicians that would be needed if the
Latino population were to experience the same ratio as Non-Latino California.
If there were one Latino physician for every
335 Latino Californians, there would have to be a total of 30,887 Latino
physicians in the state.The difference between the number of Latino physicians
that should be available (30,887) and the number of Latino physicians that
actually exists (3,578) is the Latino physician shortage.
For 1999 there is a Latino physician shortage
of 27,309 Latino physicians. See Figure 4.
Implications for California
The Latino physician shortage is the product of years of
Latino health professional supply neglect. This shortage did not happen overnight, and the problems
created by this shortage likewise will not be answered overnight.
However, two very clear areas for policy work
emerge from these simple, but compelling, data. These areas are: 1) Expanding the number of Latino
physicians; and 2) Providing training in cultural effectiveness for Non-Latino
physicians.
Expanding the Latino Physician Supply
One obvious answer to the problem of the Latino physician
shortage is to create more Latino physicians by a more effective use of the
state’s medical schools. This can
be accomplished by increased outreach, recruitment, admissions and retention
efforts. The types of efforts that
can succeed are known, having been discovered and implemented in the early
1970’s.Prior to then, the state’s medical schools graduated an average total of
4 Latino medical students who wound up practicing in the state every year. Within ten years, that total average
number had increased over ten-fold, to an average annual total of 48 by the mid
1980’s.
However, since the mid-1980’s, the number of
Latino medical students graduating to practice in this state has stagnated, and
has not kept pace with the population growth. The types of efforts developed in the early 1970’s need to
be modified for the 21st century and applied with redoubled
vigor. Thus can Latino physician
supply quickly increase.
Cultural Effectiveness Training
It is very important to increase the number of
Latino physicians. However, it is
equally important to train Non-Latino physicians in culturally effective ways
of providing medical care services.
Latino patients can present a number of paradoxes and enigmas to
physicians who are not trained to manage them. Yet, those who are well prepared in managing these paradoxes
and enigmas report experiencing a high degree of mutual satisfaction and
compliance.
Cultural effectiveness training should begin
taking place in the pre-medical years.
It should be built into the medical school core curriculum. The residency years can provide
marvelous opportunities in bringing culturally effective skills to full bloom. And Continuing Medical Education can
provide opportunities for cultural effectiveness education for providers
already in practice.
Conclusion
The Latino population to Latino physician ration in
California is dismal, yet should provide a spur to resolving the issue of poor
access to medical care that many in the state suffer. The solutions to this problem can best be found by a
cooperative working arrangement between the California Latino Medical Association,
the California Medical Association and its local affiliates, the universities
and medical schools, the legislature and governor’s office, the state’s
hospitals and clinics, and the pharmaceutical and medical equipment
companies. All should have a stake
in increasing access to services by increasing both the supply of Latino
physicians and increasing the cultural effectiveness of Non-Latino physicians.
