Doctor Shortage Severe in Poor Areas

Bell Gardens is twice as bad as Haiti when it comes to primary health care, with one doctor for every 27,000 or so residents.

Compare that to the county’s other extreme: Beverly Hills, with one doctor for every 275 residents. By this measure, even Nicaragua, with one doctor per roughly 1,170 residents, fares better than Bell Gardens and similar communities.

Such shortages in predominantly Latino and African American neighborhoods throughout California have prompted Dr. Juan Villagomez to lead a coalition of Latino doctors on a campaign to lift the state’s minority communities from Third World status.

The more than 350 physicians and surgeons who belong to the Chicano Latino Medical Assn. are the latest soldiers in a years-long struggle to put more doctors in poor neighborhoods.

So far, the effort is losing ground, largely because “there are just not enough physicians out there to provide adequate care,” said Villagomez. Compounding the problem, black and Latino enrollment in state medical schools has fallen by a third in the last four years.

His group has vowed to pressure legislators and health care officials to treat the shortage with the urgency seen in an emergency room.

“This is a health crisis,” said Dr. Joseph Martel, a group member who last year headed a study of medically underserved communities. “The shortage of doctors in predominantly Latino and African American areas makes no sense” in such an affluent society.

Latino and African American doctors are more likely than others to practice in minority communities, according to California medical school surveys and demographic studies on practicing physicians. But their numbers are minuscule. Members of each group make up only about 3% of the state’s 74,000 primary care physicians.

That explains how more than 8 million Californians, mostly minorities, live in areas with less than one primary care physician for every 3,500 residents, state health officials say.

Such ratios also explain the crowds at family clinics in working-class neighborhoods throughout Los Angeles County, where Latino and African American patients seek out physicians who speak their language and, culturally, can better understand their health concerns.

“We’re all exhausted by the end of the day,” said Dr. Margarita Keusayan, whose clinic in Cudahy is run by a handful of nurses, herself and her daughter, Leticia Gonzalez, a licensed physicians assistant.

“Here, 50 patients and above is the average, six days per week,” Keusayan said. “Sometimes we have 10 people in the waiting room.”

Since most physicians in California have been largely unwilling to practice in such neighborhoods, Villagomez said, the solution is to enroll more minorities in state medical schools--an idea endorsed by University of California officials and the medical establishment.

But a study released last month shows a steady decline in the number of Latinos, African Americans and Native Americans studying to become doctors in California, contributing to the decline nationwide of underrepresented minorities enrolling in medical schools.

As a result, Villagomez said, the prospect for improvement in medically underserved communities--including rural areas--is bleak. He said 28,000 new doctors would be needed statewide to provide roughly equal health care access for poor neighborhoods and affluent ones.

With Latinos and African Americans making up about 40% of the state’s population, the physician shortage shows how “the system is failing our communities,” Martel said. “These numbers are just not reasonable.”

Since the mid-1990s, the pool of underrepresented minorities applying to and entering California’s nine medical schools has shrunk by 25% and 32%, respectively, according to a new report by the Center for California Workforce Studies at UC San Francisco.

In 1993, 193 Latinos, African Americans and Native Americans entered California medical schools, the study showed, compared to 132 in 1998. During the same period, underrepresented minorities dropped from 19.2% of the incoming medical school classes to 14%.

Since 1994, out-of-state enrollment for the same group of Californians has increased 11%, leading the study’s authors to argue that California has become “less hospitable” to minority medical students since Proposition 209 outlawed affirmative action in government in 1996. Economic factors, such as higher tuitions and cuts in financial aid, also contributed to the declines, the authors conceded.

UC efforts to reverse this include high school science fairs and other outreach programs aimed at motivating more young minority students to consider becoming physicians, said UC Vice President Dr. Cornelius Hopper. But one problem, according to public and private medical school officials, is that many minority teenagers are not interested in careers as doctors.

Hopper said UC schools also have incentive programs that assist new medical school graduates with paying off their hefty school loans in exchange for agreeing to work in underserved communities.

Additionally, he said, for the past six years, UC admissions committees have been giving extra consideration to “students who have a commitment to primary care and to practicing in underserved communities.”

Villagomez’s group argues that the medical school admissions committees are not looking hard enough.

Breaking Through the Barriers

Many in the Chicano Latino Medical Assn. grew up in underserved communities. They have since become medical directors and division heads of hospitals and clinics throughout the state, pioneering their way during the 1970s through a health care system dominated by white male physicians.

With their present influence, they feel compelled to prove “there are plenty of talented people already out there” in the Latino community, said Martel.

Take Adrian Gonzalez, a Los Angeles native who applied to and was rejected by several of the state’s medical schools for two years before enrolling at the predominantly African American Howard University Medical School in Washington, D.C.

While growing up in Venice, Gonzalez said, he intended to practice medicine in one of the city’s underserved communities. But after seeing conditions in the nation’s capital, he may work there instead.

Villagomez’s group says the first step UC should take to correct the shortage of minority medical students is an overhaul of the admissions department at the UC Irvine Medical School, which for the past four years has had the state’s worst record for minority enrollment.

In a letter mailed recently to state legislators and UC officials, the group demanded “immediate replacement of the present dean of admissions” at Irvine.

Since 1995, school records show, 11 minority medical students have begun training at UC Irvine: six African Americans and five Mexican Americans. The school during the same time received more than 1,800 applications from such underrepresented minorities.

“How can you justify that?” Martel asked.

Ralph Purdy, dean of admissions at the UC Irvine Medical School, did not try.

Except for the call to replace him, “I share their view,” he said. “We’re looking at anything and everything we can do to reverse the situation.”

The problem, Purdy said, is “we simply were hit very hard by Prop. 209” and the UC regents’ 1995 decision to eliminate race- and gender-based affirmative action in admissions.

Forced to compete for admission with a larger pool of applicants in the post-affirmative action era, Purdy said, underrepresented minorities are losing out at UC Irvine and other schools largely because they tend to have lower entrance exam scores and grade-point averages than their competitors.

Noting that the Irvine medical school has so far accepted 12 underrepresented minorities for the 1999-2000 academic year, Purdy added that there’s always the chance “they might not choose us. Many out-of-state schools offer full scholarships to underrepresented minorities [based on their ethnicity], which is something we’re not allowed to do anymore” under Proposition 209.

State Assembly Speaker and UC Regent Antonio Villaraigosa (D-Los Angeles) said the UC regents and the Legislature “need to put their money where their mouths are and make a financial commitment to address this medical priority.” He advocated better outreach programs and more scholarships.

Villaraigosa said the state needs new policies to boost overall college minority enrollment--such as the one recently approved by the UC regents that guarantees an undergraduate spot to students in the top 4% of all public high schools in the state.

Dr. Richard Corlin, a Santa Monica-based board member of the American Medical Assn., suggested that physicians in more affluent communities could help by donating time to areas lacking doctors.

Looking Elsewhere for Solutions

Another solution could come from the thousands of graduates of foreign medical schools who are not eligible to practice in California.

Roughly half of the Latino doctors licensed in California were trained in Latin America, said Dr. David Hayes-Bautista, director of the Center for the Study of Latino Health at UCLA, which is compiling a demographic report for Villagomez’s group.

Thousands more are studying for their Medical Board of California exams while working at unrelated, low-wage jobs, said Dr. Rolando Castillo, who heads a Santa Ana-based organization called the Coalition of Physicians From Latin America.

Passing the exams may be the easy part. Competitive hospital residency programs favor doctors trained in the United States, Castillo said, and openings are extremely limited.

Despite those obstacles, he believes that Latin American-trained physicians remain an untapped resource. “These doctors are fully able to relate to the concerns of the Latino immigrants here on a level much more detailed than a simple diagnosis,” much like, say, a Chinese doctor might be more effective with somebody from China, he said.

Hayes-Bautista, who co-edited a new book of essays on cultural nuances in Latino health called “Healing Latinos,” added that non-Latino doctors are likely to use rudimentary Spanish to go down a checklist of health questions with their Spanish-speaking patients, often missing subtle hints that something more is wrong.

Shelves full of Mexican trinkets and candy reflect the gratitude of Dr. Carlos Rodriguez’s patients at the Community Health Foundation clinic in Bell Gardens.

A physician in Mexico City before immigrating to the United States 10 years ago, Rodriguez has a close bond with his predominantly Spanish-speaking patients.

The reason is simple, said Marcela Guevara, a patient from Bell Gardens who complained of abrupt consultations in the past at crowded Los Angeles hospitals with no Spanish-speaking doctors.

Thankful for a long conversation she had with Rodriguez about a feminine problem that ailed her for months, she said: “It’s nice to know that somebody really cares about your health instead of treating you like another number.”