How the lack of Latina physicians has decades-long effects
It creates severe challenges for true health equity, experts say.
While gender diversity in medicine continues to improve, stark gaps remain for Latina physicians.
Latinas are just 2.4% of all physicians in the U.S., whereas Latinos make up 18% of the total population.
In California, Latinos represent 40% of the population, yet only 11% of medical school graduates. Research from the UCLA Latino Policy and Politics Initiative and the Center for the Study of Latino Health and Culture show it could take up to 500 years to close the physician gap.
“How can we be sure that things are not being lost in translation when our limited English-proficiency patients show up in clinic and the available doctors don't speak Spanish?” asked Yohualli B. Anaya, MD, MPH, assistant clinical professor, Department of Family Medicine at the David Geffen School of Medicine.
“2.4% can't be split between all of our clinics, all of our medical schools, all of our operating rooms, and all of our board rooms.”
Dr. Anaya and Carrie L. Byington, MD, executive vice president, University of California Health, University of California Office, discussed how the Latina physician shortage came to be, the challenges that it creates for health equity, and possible solutions to address the root causes in a one-hour webinar sponsored by the Center for the Study of Latino Health and Culture.
Citing findings from her recent study, Dr. Anaya opened the discussion with the existing disparities:
- Spanish-speaking physicians are scarce, despite Spanish being the second-most used language in the U.S.
- Latina physicians tend to be younger – almost half are under 40.
- Compared with the general Hispanic U.S. population, a higher proportion of Latina physicians are immigrants.
“Although generally, women have been have made gains in representation from the time period before the passage of Title IX, we can see that inequity still hinders women's representation – and are worse for minority women,” said Dr. Anaya.
Dr. Byington, a trained pediatrician specializing in the treatment of infectious disease, now leads one of the largest public academic health care systems in the U.S.
Of the 19 women in her medical class, Dr. Byington was one of 10 who graduated and the only Latina in the class.
“It’s a lonely road when you find yourself always the only woman or the only Latina, the only one who can speak Spanish,” she said. “But it is so important for our patients that we persist.”
Dr. Byington grew up along the Texas-Mexico border in a multi-generational home, speaking both English and Spanish at home.
“Those were things that I felt marked me in a way that I didn't fit in, in medical school,” she said. “Now I realize that those are the strengths that made me who I am, make me able to understand the experiences of my patients, and have given me the drive to succeed in medicine.”
Dr. Byington was the only Spanish-speaking physician in Salt Lake City when she arrived in the early 1990s and started a clinic for Latino immigrants. She said having a physician that shares the patient’s life experience, and understands the dynamics of having a family with mixed immigration status and how that impacts medical care, is just one example of the importance of representation.
Drs. Anaya and Byington discussed many historical root causes to the Latina physician shortage, including Latino culture, systemic and structural barriers, and costs for education and training.
Dr. Byington said her outreach involves having conversations with families of newborns about what their daughter’s futures might look like.
“I answer their questions in a way that would give them confidence that their daughters will have a life that still allows them to be the daughters that they want in a Latino household,” she said.
In most Latino cultures, family and tradition are core values that affect decision-making and career choices.
“Then we have the systems that we have to get through, and cost is so very important and so much of a barrier,” Dr. Byington said.
Some possible solutions she posed were ensuring the availability of scholarships, compressing training to shorter time frames or allowing prior class credits to count in medical school and providing friendly family-leave policies.
To get there, Dr. Byington says evaluation is key.
“You will never get to change if no one is evaluated on that change, so we need to hold people accountable,” she said. “You need to have leadership that will say: diversity, equity and inclusion is important.”
She said diversity, equity and inclusion should be incorporated into goals at every level.
“Representation matters and it matters in leadership. When we are in leadership positions, we can change the narrative, we can push the institution in ways that they may not have considered,” said Dr. Byington.
Solutions and accountability
Dr. Anaya’s research poses several policy recommendations to increase representation among Latinas and other historically excluded groups in medicine.
- Increase financial resources available to support prospective underrepresented minority physicians by expanding loan repayment programs and scholarships.
- Address academic and structural disadvantages by coordinating and expanding pipeline programs, increasing funding to support such programs, and pursuing institutional partnerships to provide academic support, advising and health care development support.
- Increase recruitment and training of linguistically capable students and residents, and protect the physicians, trainees and students who depend on Deferred Action for Childhood Arrivals (DACA) to study and practice medicine in the U.S.
- Incentivize medical schools to prioritize the matriculation of linguistically capable students, especially those interested in pursuing primary care in underserved areas. One area includes protecting the Song-Brown Physician Training Program, a program that provides funding to underrepresented minority students pursuing medical education.
“You can drive change at any level,” said Dr. Byington. “For me, I didn't start here, as the executive vice president of a of the largest academic health system. I started as a very junior student trainee with no background.”
She continued, “But what I have learned is, in medicine, people want to do the right thing. They really do. And the people we work with are always advocating for their patients, so they understand advocacy, but they sometimes just don't see what's around them.”
Through implicit bias and cultural competency training, medical schools and health systems can begin to mitigate these disparities, she said.
“We cannot be excellent, if we are not inclusive, and we all want to be excellent,” Dr. Byington says. “So let's open the doors, let's break down the silos, break down the barriers, and let's become more excellent.”