Juan is a 2-year-old boy from San Ysidro, Calif., who was born with a dislocated hip, undescended testicles, and a muscle ligament disorder.
To avoid suffering potentially lifelong consequences, early intervention was crucial.
But the specialist physicians who met with his family did not speak Spanish, and as a result, Juan missed key appointments.
At one point, the miscommunication triggered the involvement of child protective services, giving the parents a scare. Worse, the confusion meant that precious time for his recovery had elapsed.
Juan's story is demonstrative of a chronic issue in California: a shortage of Hispanic doctors.
Although Hispanics make up a third of California's population, they constitute just 5 percent of the state's pool of physicians, according to a 2008 study by the Center for California Health Workforce Studies.
Health officials say the shortage is problematic because Hispanic doctors are many times more likely than non-Hispanic doctors to work in areas where healthcare services are lacking. They're also more likely to practice primary care, a branch of medicine that is lagging as medical students flock to the more lucrative specialty fields.
But while health officials have long declared California's paucity of Hispanic doctors a major concern, relief seems a long ways off.
That's because California medical colleges, instead of progressing or even stagnating, have lost ground when it comes to enrolling Hispanic medical students, said Dr. David Hayes-Bautista, a professor of medicine at UCLA.
Even though the population of Hispanics has exploded in California over the past couple decades, the number of first-year Hispanic medical students during that time has -- somehow -- decreased.
In 1992, the number of first-year Hispanic medical students in the UC system amounted to a modest 90. As of 2006 -- the last year for which the data are available -- there were only 82, he said.
"I thought the rising tide was supposed to lift all boats, but evidently it didn't," Hayes-Bautista told HispanicBusiness.com.
As a result of the shortage, many low-income minorities in California are hit with a double whammy. Not only are they disproportionately uninsured, they also live miles away from the nearest doctor. And the doctors practicing in their vicinity usually don't speak their language.
"It's not so much that we need more Latino doctors," Hayes-Bautista told HispanicBusiness.com. "You don't have to be Latino to see Latino patients. I want to see, one, more doctors learn to speak Spanish, and two, more doctors practice in a shortage area. ... It just so happens Latino medical students are about 50 times more likely to make those choices."
At least one of the three healthcare reform bills being debated on Capitol Hill addresses this issue head-on. The legislation, introduced by House Democrats, contains a provision calling for healthcare professionals to receive linguistic and cultural training, and another that would boost scholarship opportunities for disadvantaged students in the health profession.
As it is now, few clinics in underserved, predominantly Spanish-speaking areas of California employ translators, said Kara D. Ryan, a health policy research analyst with the National Council of La Raza, a Latino civil rights advocacy group. The NCLR, which supports the House bill, told Juan's story during a recent media briefing on health care reform.
"A lot of times lay people are pulled in for either a private or complicated medical situation," she told HispanicBusienss.com. "It can lead to confusion and medical errors. It is not appropriate."
As for the shortage in the medical schools, it is surprising, given the trends in the Hispanic population.
Since 1990, the state's Hispanic population has surged by 70 percent, to 13.5 million, according to U.S. Census.
Also skyrocketing is the share of Hispanics who graduate college; since 1992, the number has risen 150 percent, Hayes-Bautista said. Had the number of Hispanic first-year medical students risen in tandem, there would be 204 first-year Hispanic medical students in the UC system instead of 82, he said.
Still, the current scenario is an improvement from a low point that was reached in the 1990s, said Janet Coffman, an assistant adjunct professor in the medical school at the University of California, San Francisco.
Coffman, who has researched the shortage of Hispanic doctors, attributed the med-school underrepresentation in part to how University of California regents voted to ban affirmative action from the admissions process in 1995, causing black and Hispanic enrollment at schools like UC Berkeley to plummet. The next year, the state's voters strengthened the ban with Prop 209, which barred all public state institutions from engaging in affirmative action.
"There certainly was a time when they went backwards in the 90s," Coffman told HispanicBusiness.com. "My sense is that things have improved somewhat."
Indeed, though the number of Hispanic UC medical students is currently around 82, it's up from a nadir of 50 in the year 2000.
The improvement might be partly the product of the UC's recent high school outreach efforts to bring more diversity to more rigorous fields of study, she said, as well as the UC regents' recent decision to counterbalance the effects of prop 209 by allowing admissions officials to consider factors such a poverty and hardship.
In any event, contrary to some circles of conventional wisdom, since the passage of Prop 209 in 1996, Hispanic enrollment in the UC system has actually bumped up, from 13 percent to 16 percent in 2005. However, Hispanic enrollment at the UC system's most prestigious schools has since fallen. At UC Berkeley, for instance, it stood at 11.6 percent in 2008, down from 14.6 percent in 1997.
Hayes-Bautista draws a connection between the decline of Hispanic students in the elite UC schools and the tapering off of first-year Hispanic med students, though he adds that thus far, this explanation is speculative.
As for the huge boost in Hispanic college grads, Hayes-Bautista said the vast majority of them are attending the less-prestigious state college system, which sends virtually no Hispanic students to any of the five UC medical schools.
"We wound up pushing Latinos into the Cal State system," he said. "That is where most Latinos who get a bachelor's degree receive it."
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