SACRAMENTO, Calif. — The high number of coronavirus infections and deaths among California's Latino communities is underscoring the state's shortage of culturally competent, Spanish-speaking doctors.
Medical experts fear the scarcity of Latino or Spanish-speaking doctors could lead to worse health outcomes for the state's Hispanic communities, who, so far, represent more than 700,000 COVID-19 cases and 10,000 virus-related deaths in California.
"You can't plant strawberries in your front room. You can't stay at home and be a farmworker. Hence, because they're more exposed, they're more likely to become infected," said Dr. David E. Hayes-Bautista, director of the Center for the Study of Latino Health and Culture at UCLA. "Now, at that point, the Latino doctor shortage suddenly becomes critical."
California is home to a large immigrant community with limited English proficiency. About 44% of Californians speak a language besides English at home, according to a study by the Latino Politics and Policy Initiative at UCLA. An analysis by the Public Policy Institute of California shows about 53% of immigrants say they speak Spanish — the most popular language among immigrants in the state — at home.
Yet researchers say physicians who speak Spanish are "the most under-represented in the physician workforce in California," according to the LPPI study. There are about 62 Spanish-speaking physicians for every 100,000 Spanish speakers in the state, the study shows.
Researchers of the study say culturally competent doctors who speak the language of their patients can lead to better health outcomes for patients. The connection between a patient and doctor instills trust, leading patients to be more forthcoming about their symptoms and receptive to receiving preventative health care.
"I had a question for my doctor and my husband asked me why I hadn't asked it: because first of all, they don't speak Spanish, and second of all, they don't look at me," one study participant told researchers.
That trust is essential for a community twice as likely to not have medical insurance. But historic mistrust and systemic racism in medical institutions among immigrant communities, according to Hayes-Bautista, can dissuade them from getting treatment.
Hayes-Bautista said the reason Latinos are seeing higher infection and death rates than other groups is, in part, due to the fact that they are over-represented in jobs where socially distancing or limiting their exposure to the public is not possible.
In California, Latino workers are over-represented in meat-packing, construction, food service and agricultural industries, he said.
California's Latino physician shortage is partly a result of medical schools admitting and graduating few Latino medical students, according to Hayes-Bautista. Up until the 1960s, California medical associations barred Latino and Black physicians from joining their groups, he said.
"We have this very long history of very conscious exclusion of Latinos for medical education from the medical associations," he said.
At the current rate California's medical schools are graduating Latino students, Hayes-Bautista said, "it will take 500 years to make up the shortage."
Of the 1,224 medical school students who graduated from California medical schools between 2019-20, 132 students, or 10.8%, identified as Latino, according to data from the Association of American Medical Colleges.
During the initial weeks of the pandemic when COVID-19 tests were scarce, patients needed a doctor's approval to obtain a test. The lack of access to Hispanic or Spanish-speaking doctors during the initial weeks of the pandemic, according to Hayes-Bautista, contributed to Latinos not getting tested for COVID-19.
He said he witnessed Latino patients at a hospital in Boyle Heights receive their first COVID-19 test only after arriving at a hospital's emergency room to treat their worsening coronavirus symptoms.
"It's absolutely a public health issue to improve the diversity of people who go into healthcare professions," said Dr. Rob Oldham, Placer County director of health and human services, at a recent Latino Leadership Council forum.
In Placer County, where Latinos account for 15% of the population but represent 18% of cases, Oldman said the county used the help of promotores, also known as community health workers, to spread awareness to Latino communities about COVID-19 safeguards.
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