Gilberto Cota studied medicine in Mexicali, Mexico, but never
practiced medicine because he couldn't get into one of his home country's few
residency programs. After moving to Southern California several years ago, Mr.
Cota resigned himself to working as a diabetes counselor. His Mexican medical
license wasn't valid in the U.S.
Today, Mr. Cota is on the verge of practicing medicine, thanks
to a pilot program that taps into the surplus of medical-school graduates in
Latin America to address the chronic shortage of U.S. doctors who speak Spanish.
Amid a record influx of Latin American immigrants, clinics and hospitals across
the country are struggling with Spanish-speaking patients.
Mr. Cota, 33 years old, is on his way to becoming a licensed
U.S. physician. He receives a $21,000 stipend from University of California at
Los Angeles to take courses that are preparing him for U.S. medical board exams.
Mr. Cota recently interviewed at Riverside County Regional Medical Center in
Moreno Valley, Calif. Some two-thirds of its patients are Hispanic, and many
don't speak English. Yet only eight of the 27 resident family physicians there
speak Spanish.
The result is poor communication that can cost millions of
dollars annually in unnecessary tests, emergency-room visits and inaccurate or
delayed diagnoses. Lack of understanding leads to confusion about medication
dosage and side effects, noncompliance with doctors' instructions and a lower
likelihood of follow-up care.
"To provide safe and quality care, a physician has to
understand the patient," says Patrick Dowling, a professor of family medicine at
the David Geffen School of Medicine at UCLA.
Hispanics constitute 14% of the nation's 300 million people.
But only 5% of all physicians practicing in the United States are Hispanic.
The Pew Hispanic Center, a nonpartisan research group, reported
recently that fewer than one in four Latino immigrants reports being able to
speak English very well.
In California, where 33% of the population is Hispanic, only 4%
of physicians are Latino. Confronted with this reality, Dr. Dowling and fellow
physician Michelle Bholat designed a 14-month program that qualifies graduates
from Latin American countries to enter family-medicine residencies at teaching
hospitals in California.
Before starting the program, many of the participants had been
working in the U.S. as X-ray technicians, nursing assistants or as health-care
volunteers. A program that prepares them to work as physicians in the U.S. is
"an obvious solution," Dr. Bholat says.
The graduates receive prep courses for U.S. medical licensing
exams, observership training at a UCLA hospital and support in their application
for a residency program. On completing their residency, participants commit to
spending at least three years in a "medically underserved area," in a large city
or rural community.
Currently, 14 Latin American medical graduates are enrolled in
different stages of the UCLA program, at the cost of about $48,000 apiece. The
program, funded entirely by private foundations, is completing its first full
year in February. Drs. Dowling and Bholat are currently seeking funds to expand
enrollment.
Down the road, the two doctors plan to replicate the program at
other University of California campuses, as well as introduce it to other states
grappling to serve Spanish-speaking patients. Many states have burgeoning
Hispanic populations. In North Carolina, the Hispanic population has jumped to
more than 500,000 from 76,000 in 1990, according to the Census Bureau.
Midwestern states like Iowa and Wisconsin also have seen steep increases.
Texas, where 35% of the population is Hispanic, is already
eyeing the UCLA pilot. "This is a socially-responsible program that we need to
replicate in Texas," says Carlos Jaén, chairman of the Department of Family &
Community Medicine at the University of Texas Health Sciences Center at San
Antonio.
Dr. Jaén says that he has witnessed "multiple occasions" when
miscommunication has resulted in "dangerous situations." For example, the word
"once" is spelled the same as the Spanish word for eleven. When a prescription
states that a medication be taken "once a day," some Spanish-speaking patients
have interpreted it as 11 pills daily. For heart medication, this dose could be
toxic and cause death.
There is little research about the link between language
barriers and medical errors. In a survey conducted in 2003 by the California
Academy of Family Physicians, nearly half of all doctors said they were familiar
with incidents in which quality of care had been compromised by language
barriers. One doctor reported that a patient with shortness of breath was
believed to be having an anxiety attack. In fact, he was suffering from a
diabetes complication called diabetic ketoacidosis that can cause a coma.
In another reported case, a patient told a physician he had a
"mass" in his chest, suggesting a tumor. In fact, the patient had a leak from a
previously diagnosed abdominal aortic aneurysm, a vascular condition. The
patient's poor English and misunderstanding of the previous doctor delayed care
for a condition that can be fatal.
In 2000, 11.9 million U.S. residents were members of a
"linguistically isolated" household, in which no person age 14 or over speaks
English at least very well, compared with 7.7 million in 1990, according to the
Census Bureau. In that decade, there was a 53% surge in the number of U.S.
residents whose English proficiency is limited. "Unfortunately, cases in which
language barriers cause compromised quality of care and preventable medical
errors may become increasingly common," says Glenn Flores, professor and
director of general pediatrics at the University of Texas Southwestern Medical
Center in Dallas.
Meanwhile, Latin American countries produce more medical school
graduates than their hospitals can accommodate for residency training. In
Mexico, about 12,000 students complete medical school each year but hospitals
only offer 4,300 residency slots. The UCLA program is designed to tap into that
oversupply.
Blanca Campos, who couldn't secure a spot in a residency
program in Costa Rica, recently passed her medical boards and is applying for a
position as a family-practice resident at Los Angeles hospitals that cater to
many immigrants. "If they see doctors who understand their language and culture,
these patients are more open about their health issues," she says.
Asma Jafri, the physician who supervises the family medicine
residency program in Riverside, says that the majority of patient complaints at
the county hospital concern miscommunication. Aside from language fluency, Latin
American doctors are able to grasp cultural nuances and native medical
practices, such as use of herbal remedies, that may be relevant to a patient's
case.
"The schedules of physicians fluent in Spanish are always full
as opposed to the doctors who only speak English," Dr. Jafri says.