By Rosa Ramirez
California Health Report
Dr. Ana Solis, who was born in rural Mexico, felt helpless when her mother was bedridden during a high-risk pregnancy. Seeing her mother’s agony prompted her to pursue a career in medicine.
“With all my soul, I wanted to alleviate that pain,” she recalls. In 2004, she earned her medical degree from the Universidad Autónoma de Baja California. Dr. Solis, who has since relocated to California and become a legal permanent resident, now seeks to improve healthcare of U.S. military men and women.
Shortly after obtaining her green card, she says, she visited military recruiting offices and signed for 20 years of service in the U.S. Navy. Dr. Solis has been assigned with a medical team to work with U.S. Marines. If they are deployed to Iraq or Afghanistan, says the Navy officer, “We will be there. And I look forward to it.”
The University of California (Los Angeles) International Medical Graduate program, which aims to recruit doctors from Latin America like Dr. Solis, hopes to increase the number of Spanish-speaking physicians who have the cultural background to treat the growing Latino population at a time when the state is poised to face a doctor shortage.
Started in 2006, the program has at least 66 graduates, according to Dr. Michelle Bholat, who co-directs the program. Without any state funds, Dr. Bholat and others must raise funds to keep the program running.
The doctors hail from Mexico, Cuba, El Salvador, Brazil, Colombia and Ecuador. And their stories are as diverse as their backgrounds. One woman was born in Seoul and moved to Brazil with her family as a teenager. Fluent in English, Spanish, Portuguese and Korean, she was accepted into the program with advance standing. Another participant worked as a janitor and made tamales to earn money while learning English and studying for the U.S. Medical Licensing Examinations. And yet another is an officer with the U.S. Navy.
“Let’s challenge the traditional view of Latinas—count on me to show that Hispanic females can be doctors, and also wear uniforms and boots,” Dr. Solis likes to say.
Looming physician shortage
It’s estimated that only 30 percent of U.S. doctors practice primary care. The Association of American Medical Colleges projects the country will face a shortage of more than 90,000 physicians by 2020, a figure that’s expected to grow to 130,000 by 2015.
California’s dwindling supply of primary care physicians is poised to become even greater in rural areas, said Dr. Patrick Dowling, co-director of the program.
(RELATED: In rural California, physician shortages expected to increase.)
In Kern County, for instance, there are 1,200 patients for every primary care physician, nearly double the nation’s average, according to the California Medical Association. The uneven geographic distribution is part of the reason for the program, Dr. Dowling says.
The program helps the foreign doctors qualify for medical residencies by preparing them for the U.S. Medical Licensing Exam. It also offers them clinical observerships. The doctors then compete for competitive residency spots. Upon completing California’s three-year residency training, foreign doctors must commit to work in medically underserved areas for a minimum of two years.
“There’s where we can make the biggest difference,” says Juan M. Cabrales, who also obtained his medical degree in Tijuana. He will join the UCLA Family Medicine residency training this summer.
“I’m planning to stay in California,” the 33-year-old Mexican doctor says. “I feel that I can make a bigger difference here than in my country.”
For years, health professionals have found direct links between cultural competencies and the elimination of racial and ethnic health disparities.
With the Affordable Care Act adding an estimated three million insured Californians into the system, including many who are limited English speakers, the need of doctors who understand how to communicate with them is expected to grow, says Dr. Bholat.
Representing 39 percent of the state’s population, Hispanics will become the dominant ethnic group in California by the end of the year, data released earlier this year by California Department of Finance has indicated.
One in every 10 persons is of Mexican origin yet Latinos account for only 4.5 percent of physicians in the state, Dr. Bholat says.
It’s only natural the program reached to California’s southern neighbor, says Dr. Dowling. Mexico has an oversupply of physicians. A 2005 study published in Human Resources for Health discovered that out of 1000 graduates, more than 30 percent could not find “remunerated positions in the labor market.”
“Why shouldn’t we have some of those physicians?” Dowling says.
Attracting foreign-born doctors is nothing new. Currently, more than one in four doctors, and one in eight nurses, were born outside the country. A June study by the Migration Policy Institute indicated that more than 25 percent of physicians and 27 percent of surgeons in 2010 were foreign born.
Most, however, are from places like Pakistan, China and India. Only about five percent of physicians and surgeons are from Latin America, according to the Institute.
What about creating an internal pipeline of U.S. doctors?
Dr. Dowling and Dr. Bholat have worked for the past three decades to increase diversity in the medical field, he says. “I’ve always been involved. But it’s a hard thing to resolve.”
For starters, the state’s Hispanics and African America continue to have lower-than-average high school graduation rates, although recent data show those figures are improving.
About 65.7 percent of African American students graduated with their class in 2012, up 2.9 percentage points from the year before, while 73.2 percent of Hispanics graduate, up 1.8 percentage points from the previous year, according to the state’s Education Department.
In addition, Hispanics nationally reached a milestone by surpassing whites in college enrollment, a recent Pew Hispanic Report shows. Some 69 percent Hispanic high school graduates in the graduating class of 2012 matriculated in college that fall, compared 67 percent of their white counterparts.
Despite those improvements, though, blacks and Hispanics continue to lag in bachelor-degree attainment.
And even as communities of color continue to make small gains in medical school enrollments, according to a recent Association of American Medical Colleges report, they remain severely underrepresented.
In the meantime, Mexican doctor April Arias, 35, will continue to fill the needs of patients with limited language skills. A resident at the Family Medicine Residency Program at University of California San Diego, Dr. Arias understands that Hispanics often gather around food, celebrations and family.
She tells them to prepare traditional foods with alternative ingredients to make them more healthily. Incidences of diabetes, she tells them, are high among Latinos. They are surprised when she’s familiar with foods like cactus.
What she finds equally rewarding is being able to speak with them in their native tongue. It takes them a shorter time to convey their message, she says.
“I see the enthusiasm in their eyes,” Dr. Arias says. “You make a deeper connection with them. And when the [visit] is over, they’ll ask me for a hug.”