YOU ARE HERE: LAT HomeCollections


A Shortage That's Killing Latinos

October 01, 2000|David E. Hayes-Bautista and Robert M. Stein | David E. Hayes-Bautista is director and Robert M. Stein associate director of the Center for the Study for Latino Health & Culture at UCLA

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.

Los Angeles Times Articles