Program Tackles California’s Crippling Shortage of Spanish-Speaking Doctors

Dr. Jose Javier Hernandez examines Roselle Martinez at the Hanford Family Medicine residency clinic at the Adventist Medical Center, in Hanford, CA. Photo: Courtesy UCLA Medicine.

Her whole life, Isabel Gonzalez dreamed of becoming a doctor. In her native Spain, she was the first person in her family to attend medical school. For nine years, she trained intensively, finally reaching her goal of becoming a primary care physician.

Then she moved to California with her American husband, and everything changed.

Suddenly, Gonzalez’s years of study and experience as a doctor were worthless. She didn’t have a U.S. license to practice medicine, she didn’t speak English well enough to pass the licensing exams, and she couldn’t get a medical residency because she didn’t have American-based contacts or training.

“It was very frustrating because you know you can do more,” she said. “It’s ironic because some jobs I tried to apply for like senior living, they were telling me I was over-qualified so they would not take me. But at the same time I couldn’t do my job (as a doctor).”

There was another irony: California is desperately short of primary-care physicians, particularly Spanish-speaking ones like Gonzalez. Almost 7 million people in the state lack adequate access to a family doctor, according to the U.S. Department of Health and Human Services. A large proportion of these patients are Spanish speakers.

At the UCLA David Geffin School of Medicine, a unique program is trying to bridge that disconnect. Called the UCLA International Medical Graduate Program (IMG), it recruits students who trained as doctors in Spanish-speaking countries and are now legal residents in the U.S.  For up to two years, the students are guided through medical licensing requirements, learn English, receive hands-on training, and get help securing a medical residency.

Students attend the program for free, and even receive a stipend so they don’t have to work while they study. In return, they promise that once they graduate they’ll work two to three years in underserved communities.

“That’s the trade off,” said Patrick Dowling, a UCLA professor of family medicine and Executive Associate Director of IMH. He founded the program with Michelle Bholat, who is also a UCLA professor and doctor of family medicine. “We are going to give you this upfront, we’ll get you through,” Dowling said. “When you get done training your payback is to the people in this state.”

Large swaths of almost every county in California are designated as primary care physician shortage areas by the federal government, meaning they have less than 1 primary care doctor per 3,000 to 3,500 residents. Rural and low-income communities in northern California, the Central Valley, Inland Empire and some parts of Los Angeles County are particularly hard hit.

At the same time, more than a third of the state’s population is Latino, and about 1 in 5 residents have limited English proficiency. Yet, the number of Latino doctors in California is only about 6 percent, according to data provided by the university.

When doctors understand a patient’s language and culture, it helps prevent medical errors, said Bholat. Spanish speaking physicians can get a fuller understanding of their Hispanic patients’ medical backgrounds just by talking to them. English-speaking doctors often have to order a bunch of diagnostic tests to figure out what’s going on, the program founders said.

Bholat and Dowling launched the UCLA program in 2007, with funding from foundations, private donations and some university funds. The program received a further boost in 2012, when Gov. Jerry Brown signed a new law allowing IMG students in the final stage of the program to get hands-on clinical experience under supervision, instead of being restricted to observation only. That’s allowed more students to get the training they need to secure a residency, administrators said.

Training costs between $55,000 and $72,000 per student, far less than the average $200,000 to $400,000 cost of putting a student through U.S. medical school, said Dowling.

“We’re turning out physicians much quicker that have different needed traits, mainly language and understanding,” he said.  “They’re going into areas that we need them, so this is a real bargain.”

So far, 118 doctors have graduated from the program and all but five found jobs in California. The majority of graduates are from Latin America and the Caribbean, and almost half are from Mexico.

Often, these highly trained immigrants had been forced into low-skilled jobs such as fast-food and construction work when they arrived in the United States because they lacked English skills and knowledge of the U.S. licensing system, Dowling said. He was dumbfounded when he learned this, and it spurred the creation of the program. He said there could be hundreds more Latin American-trained doctors in California unable to work in their chosen field.

At the Rio Bravo Family Medicine Residency Program in Bakersfield, director Carol Stewart said she’s grateful to be able to draw on doctors from the UCLA program. Four IMG graduates completed their residency there this summer, and two have stayed on to work at a local community health center, she said.

“It’s hard to find a doctor at all in Bakersfield,” she said. “To find somebody who also speaks Spanish and is willing to work in this area is very challenging.”

With a Spanish-speaking physician “the patients really enjoy the fact that they don’t have to have a translator to communicate with their doctors, they feel like the doctors understand their culture better because they come from similar areas, and it just makes for a more pleasant interaction,” Stewart added.

After enrolling in the IMG program and completing her family medicine residency at a Riverside County clinic, Gonzalez is now working at a community health center in Ventura that serves many poor, Hispanic patients. She’s been there almost five years and is one of just two Spanish-speaking providers at the clinic. Although she’s interviewed for jobs at private practices in the past, none have appealed to her as much as working at a community clinic, she said.

“To me one of the most important things is to be able to help the community most in need. They are the sicker ones,” she said. “I really feel more fulfilled here as a professional than in a private setting, so that’s where I want to be until I retire.”

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