Growing up in a home with limited access to healthcare services compelled Dr. Guillermo Padilla to pursue a career in which he could “be one of those doctors who are both comforting and able to save lives.”
As the Latino population has increased dramatically in the United States, the relative number of Latino physicians has declined. UCLA is at the forefront of efforts to achieve a greater balance.
When he was 7 years old, Guillermo Padilla, MD ’15, MPH, landed in the hospital with appendicitis. While a frightening experience for any child, Dr. Padilla did not yet have a command of English, so his parents — Mexican immigrants who were determined that their son learn Spanish first — translated for him. That experience made an indelible impression on the youngster.
“Being scared and not knowing much of the language made me realize after the fact that I wanted to be one of those doctors who were both comforting and able to save lives,” he says. Later, during his teen years, Padilla witnessed extended family members being too afraid to seek healthcare for fear of deportation or high healthcare costs. Those experiences, he says, further influenced him to want to become a primary-care physician and serve underrepresented minorities, particularly members of predominantly Spanish-speaking Latino communities.
“Growing up, I saw a lot of healthcare disparities,” Dr. Padilla recalls. “Seeing my family’s lack of access to care focused my attention on being an advocate for underserved populations.”
Yet, even with his clear ambition, the road to medical school wasn’t easy or direct for Dr. Padilla. After graduating from UC Davis in 2006, he took the MCAT twice but didn’t score well. In addition, his attention while in college was divided between his academic work and volunteer activities like working in a student-run health clinic. As a result, he didn’t achieve stellar grades.
So he gave up on his dream and began working in the bakery that his father managed. After a year, he took a job as an interpreter at a refugee clinic affiliated with San Francisco General Hospital. As it turned out, the clinic director had been one of the doctors at the clinic in Sacramento where Dr. Padilla volunteered during college. She encouraged him to return to UC Davis and improve his grades by completing a post-baccalaureate program and then retaking the MCAT. “I always had the idea of going back to school and improving my grades, but she mentored me to come up with a plan,” Dr. Padilla says.
While applying to medical schools, Dr. Padilla was drawn to UCLA’s Program in Medical Education (PRIME), a five-year course of study leading to joint MD and master’s degrees that aims to train students to work in medically disadvantaged communities, and to the UCLA/Charles R. Drew University Medical Education Program. In 2015, Dr. Padilla graduated with his MD and a master’s in public health, specializing in health policy and management. Today, he is a resident in family medicine at Sutter Santa Rosa Regional Hospital in Santa Rosa, California. After completing his residency, Dr. Padilla plans to work for a federally qualified community health center, improve the quality of care for patients and develop a mentorship program for students in his hometown near Sacramento.
“There are a lot of kids who grow up and don’t see people like themselves as doctors, and so they don’t think they can have that as a profession,” Dr. Padilla says. “It is so important for these children to have role models and mentors who look like them.”
AS THE COUNTRY FACES A NATIONAL SHORTAGE of primary-care doctors in general and Latino physicians in particular, Dr. Padilla’s experience demonstrates how successful “emphasis” programs such as PRIME and UCLA/Drew can encourage medical students from underrepresented communities to enter fields like family medicine and help reduce healthcare disparities, says Daphne Calmes, MD’84, associate dean of the UCLA/Drew program. Each year, UCLA/Drew accepts 24 students, plus an additional four applicants who are enrolled through the PRIME program.
“When we select a student for the program, we are looking for a demonstrable commitment to working with Latino or underserved populations,” Dr. Calmes says. “Some of our students have parents who are farmworkers and come from the very areas we want them to go back to and provide service. We provide faculty mentors who show students it really is honorable to choose to work for underserved populations.”
In fact, research has shown that students who graduate from the UCLA/Drew program are more likely to practice medicine in underserved areas than those who completed the traditional UCLA curriculum, even after controlling for race and ethnicity.
The need for Latino physicians is particularly acute. A study published last year by Gloria Sanchez, MD, associate clinical professor of medicine at the David Geffen School of Medicine at UCLA and a member of UCLA’s Center for the Study of Latino Health and Culture, and several colleagues indicates that while the Latino population has increased dramatically in the United States, the number of Latino physicians in relation to that population has declined.
It is estimated that by 2060, one-in-three U.S. residents will be Latino. Under the Affordable Care Act, more Latinos than ever have access to coverage, but the number of Latino doctors, who are more likely to speak Spanish and practice in underserved areas, is not keeping pace. After analyzing 30 years of U.S. Census data, Dr. Sanchez found that in 1980, there were 135 Latino physicians for every 100,000 Latinos in the U.S.; by 2010, that figure had dropped to just 105 per 100,000. Meanwhile, the national rate of non-Hispanic white physicians increased from 211 for every 100,000 non-Hispanic whites to 315 per 100,000. Among the five states with the largest Latino populations — California, Texas, Florida, New York and Illinois — California’s Latino-doctor-to-patient ratio was the lowest, with 50 physicians per 100,000 people. “In California, in particular, I really believe we’re at a crisis point,” Dr. Sanchez says.
Improving that ratio is a key step to improving care, she emphasizes. As the daughter of a Mexican migrant laborer, Dr. Sanchez says she knows first-hand the challenges that many of her patients face, chief among them language and culture. Non-Hispanic white physicians in the U.S. will speak Spanish just 6 percent of the time, Dr. Sanchez found; among Hispanic physicians, that number is 96 percent. That gap is disconcerting, as previous research has shown that Latino patients who have limited English-language skills visit doctors less frequently than those with stronger English proficiency.
“But in California, it’s not just getting past the language barrier that makes a difference,” she says. There is a multitude of “different beautiful cultures” that can influence the quality of care that a patient receives. Nuances like diet and community support networks can affect a doctor-patient visit, Dr. Sanchez says. Sometimes, it is difficult to find a translator, costing valuable time during a visit. Other times, important information can be lost in translation.
That language barrier can be a high hurdle that contributes to patient discomfort and confusion
An article in the Los Angeles Times published after Dr. Sanchez’s study came out highlighted the difficulty. A Latino woman attending a family-medicine clinic at Harbor-UCLA Medical Center, in Torrance, California, where Dr. Sanchez practices, recalled asking her 70-year-old husband, who was hospitalized for a heart condition, what the doctor had said to him. “He said, ‘I don’t know,’” the woman told the paper.
But when the physician also speaks Spanish, “It’s a powerful moment when you see your patient’s face express that relief, that ‘¡O, usted habla español, que bueno! You’re going to understand me,’” Dr. Sanchez says. “Even if a patient speaks English, when you’re vulnerable and scared, you may really prefer your native tongue.”
A patient also is more likely to reveal vital details about his or her life when they feel a connection to the physician. Such a connection may affect everything from medication decisions to a reduction in unnecessary trips to the ER. “It is important to know if they sleep on a couch and don’t have a home with access to refrigeration. A person’s living condition has significant implications when making choices about providing the most appropriate healthcare,” Dr. Sanchez says.
One route to increasing the number of Hispanic physicians in the U.S. is to reach beyond the country’s borders. Currently, some 25 percent of the nation’s 900,000 licensed physicians have come from abroad. The representation of Latino physicians a mong that group, however, is relatively small. The UCLA International Medical Graduate (IMG) program aims to increase those numbers. An innovative and highly successful program, IMG enrolls foreign-trained physicians from Latin America in a program leading to licensure to practice in California. The IMG program helps participants to compete for positions in family-medicine residency training in the state, after which they are eligible for a medical license. In return, the participants are required to practice in designated underserved communities in California.
Created a decade ago by Patrick T. Dowling, MD, chair of the Department of Family Medicine, and Michelle Bholat, MD (RES ’95, FEL ’96), executive vice chair, the program has graduated 104 bilingual and bicultural physicians now practicing family medicine.
Dr. Gloria Sanchez of Harbor-UCLA Medical Center confers with patient Miguel Torres in the Harbor City hospital’s family-medicine clinic.
ENROLLMENT OF LATINO STUDENTS IN THE DAVID GEFFEN SCHOOL OF MEDICINE AT UCLA is significantly higher than the national average. “Between 2011 and 2015, we had between 12-to-15 percent Hispanic students in our medical school versus the national average of 7-to-8 percent,” says Clarence Braddock, MD, vice dean for education. “By using so-called holistic admissions” — a process that looks at the totality of a student’s qualifications and experiences, in addition to metrics such as grades and MCAT scores — “we are able to achieve high rates of diversity.”
In fact, UCLA’s 2016 entering class of 175 students is among its most diverse, says Theodore Hall, MD, associate dean for admissions. Twenty-eight percent are Asian, 25.7 percent are white, 22.3 percent are Hispanic, 16 percent are black and 2.9 percent identified as being from multiple underrepresented minorities, he noted.
UCLA pipeline programs also have contributed significantly to attracting students who want to practice medicine in underserved communities. The Summer Medical and Dental Education Program, sponsored by the Robert Wood Johnson Foundation, addresses the decline of medical-school applicants by providing college students interested in health careers the opportunity for a transformative summer experience. Chicanos/Latinos for Community Medicine, a program of the UCLA Community Programs Office, also offers mentoring, peer-to-peer counseling, community service and outreach efforts.
“That helped me figure out what I needed to do to get into medical school,” says UCLA obstetrician and gynecologist Mya Zapata, MD (RES ’10). “Doctors came to speak to us, and it helped us understand what it really meant to be a doctor. They inspired me to think that they were really making a difference as one of their own.”
Today, Dr. Zapata is doing outreach whenever possible and trying to reach potential future physicians as young as possible.
Source: David Geffen School of Medicine at UCLA
“Reaching out to children, even in elementary school, when they are very young, is key,” she says. In addition, she and three Latino colleagues in her department work together to find opportunities to expand care for Latino women. “We are starting to change the conversation to figure out how do we give back,” says Erica Oberman, MD (RES ’12). “How do we get more Hispanic undergrads, medical students and residents involved in medicine and our specialty?”
Most agree that exposure and mentorship are the key. “In the end, the literature and research tell us that individual experiences with healthcare disparity are the motivation for many of our future doctors to go into primary-care medicine,” Dr. Hall says. “They’ve seen what it is like in their own communities and what it would be like for them to be part of the solution. We provide the exposure to all those pluses and the environment that will help enrich them, and they will pick and choose the person they want to become.”
For Dr. Padilla, the long journey has been worth it. “Along the way, the family-medicine community helped me significantly,” he says.
“Now I’m planting a seed because someone told me I can.”
Marina Dundjerski is managing editor of UCI Magazine and has been a regular contributor to U Magazine.
“Latino Physicians in the United States, 1980-2010: A Thirty-Year Overview from the Censuses,” Academic Medicine, July 2015