Doctors not nearly as diverse as the valley

Southeast Asians and Latinos underserved

By Barbara Anderson

A huge gap exists between the minority populations in California and the number of doctors of diverse backgrounds, particularly Latino and Southeast Asian doctors in the San Joaquin Valley, according to a report made public Wednesday.

Results of a California Medical Board Survey found just 3,282 Latino doctors are practicing medicine in the state and only 90 in the state are of Lao, Cambodian, Hmong or Samoan background. There are about 61,800 doctors with practices in California.

Researchers were shocked by those results, said Dr. Kevin Grumbach, director of the Center for California Health Workforce Studies at the University of California at San Francisco and principal author of the study.

"The problem is even worse than we thought," Grumbach said during a teleconference at the University of California at Davis School of Medicine.

When physicians share a language and culture with patients, they can communicate better and provide better medical care.

The survey, which used ethnic information collected from doctors when they renew medical licenses every two years in California, also shows a stark disparity between the Latino doctor work force in the valley and the patients they treat.

Only 5.2 percent of doctors statewide are Latino; in the survey region that includes the valley, only 8.1 percent of doctors are Latino.

But Latinos represent 38 percent of the population in Stanislaus County, 36 percent in San Joaquin County and more than 50 percent in Merced County, according to the U.S. Census Bureau 2006 American Community Survey.

Large numbers of Cambodians, Hmong and Vietnamese live in the valley.

Making a healthier community

There's no question the valley needs to increase the number of minority doctors, said Bertha Dominguez, education director for the UCSF-Latino Center for Medical Education and Research.

To do so would benefit the entire population, not just minorities, she said. "Overall, it will make us a healthier community."

The Scenic Faculty Medical Group has 26 doctors serving patients in the Stanislaus County Health Services Agency clinics, which provide health care to low-income and uninsured patients. The clinics have three Latino doctors, and eight other doctors have learned Spanish to try to bridge the language gap, the group said.

But there is only one Cambodian physician to focus on the county's Southeast Asian community.

"Most Southeast Asian people in the county don't have a doctor who speaks their language or understands their culture," said Marge Leopold, site coordinator for The Bridge, a Southeast Asian community organization in Modesto.

Because of the language barrier, Hmong and Cambodian patients with English-speaking physicians have limited understanding of their prescription medication. Some of the Cambodians are survivors of the Khmer Rouge genocide in the late 1970s, Leopold said.

"A lot of Southeast Asians are put on antidepressants because of the trauma they have experienced," she said. "After they have been on antidepressants, they have had side effects they don't understand because they didn't comprehend what the doctors told them."

Residency program recruiting

Peter Broderick, director of the Stanislaus Family Medicine Residency Program, said it's tougher for Latinos and Southeast Asians to get into medical school. Many grew up in poor or rural communities without access to good schools.

The county's residency program prides itself in giving culturally competent training to the 27 residents in the three-year program. Right now, it has four Latino residents and two who are Hmong, and it's always looking for Southeast Asian residents to recruit, Broderick said.

Graduates of the program are encouraged to work in the community, although there is no guarantee they will. Dr. Sa Vang, who is Hmong, will complete her residency in June and plans to work at the county's Ceres Medical Office starting in September. The other Hmong resident is in the second year.

The physician survey found 20 percent of doctors statewide spoke Spanish and more than half were non-Latino white doctors, which was encouraging, Grumbach said. But the pattern wasn't the same for Asian languages. For example, 2 percent of doctors spoke Vietnamese.

Children continue to serve as interpreters at medical appointments when doctors are not fluent in Hmong or other Southeast Asian languages, said Silas Cha, associate director at the Fresno Center for New Americans.

"When things are communicated through the young child, the young child does not understand the level of seriousness of the condition or may not even understand the condition at all," he said.
Area medical school needed

The doctor survey found minority doctors are more likely to work in underserved communities and areas with large minority populations, such as those in the valley. And they were more likely to work in primary care, such as family and internal medicine and pediatrics, than are white physicians.

But doctors, regardless of ethnic background, are in short supply in the valley.

There are 173 doctors per 100,000 residents, the lowest of any region in the state, according to a recent study by the Central Valley Health Policy Institute.

A medical school proposed for UC Merced could boost the numbers of doctors, said Maria Pallavicini, dean of natural sciences. "Certainly a mission of the proposed medical school is to train students to become physicians who will stay in the valley and reflect the face of the valley, which is certainly diverse," she said.

The UCSF health work force researchers recommended increasing minority representation in medical schools and increasing incentives for doctors to work in underserved areas. They said the state needs to invest more in the educational pipeline to prepare minority students for careers in medicine and other health professions.

Bee staff writer Ken Carlson can be reached at kcarlson@modbee.com or 578-2321.