A huge gap exists between the minority populations in California and the number of doctors of diverse backgrounds -- particularly Hispanic and southeast Asian doctors in the central San Joaquin Valley -- according to a new report.
Results of a California Medical Board Survey made public Wednesday found only 3,282 Hispanic doctors are actively practicing medicine in the state and only 90 are of Hmong, Lao, Cambodian or Samoan background. There are about 61,800 doctors with active 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 UC Davis School of Medicine.
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When physicians share a language and culture with patients, they can communicate better and provide better medical care.
Silas Cha, associate director at the Fresno Center for New Americans, said he can name only a handful of Hmong doctors in Fresno, which is home to about 30,000 Hmong.
"We have a lack of doctors, and then there's a vulnerable population limited in English and access to health care," Cha said.
The survey, which used ethnic information collected from doctors when they renew medical licenses every two years in California, also showed a stark disparity between the Hispanic doctor work force in the Valley and the patients they treat.
Only 5.2% of doctors statewide are Hispanic; in the survey region that includes the Valley, only 8.1% of doctors are Hispanic.
But Hispanics represent 47% of the population in Fresno County and more than 50% in Merced and Tulare counties, according to the UCSF-Latino Center for Medical Education and Research.
There's no question the Valley needs to increase the number of minority doctors, said Bertha Dominguez, the center's education director.
To do so would benefit the entire population, not just minorities, she said. "Overall, it will make us a healthier community."
Patients are more likely to take medicine that's prescribed to them, and more likely to return to a doctor with whom they can communicate and who understands their culture, said Dr. Mouatou Mouanoutoua, a Hmong cardiologist practicing in Fresno.
And medical errors are less likely to occur, he said.
"If you don't understand what's going on with the patients and their symptoms, you may make the wrong diagnosis," he said.
The doctor survey found 20% of doctors statewide spoke Spanish -- and more than half were non-Hispanic white doctors -- which was encouraging, Grumbach said. But the pattern wasn't the same for Asian languages. For example, only 2% 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, Cha said.
"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.
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 being proposed for UC Merced could boost the numbers of doctors, particularly those from diverse ethnic backgrounds, 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 also said the state needs to invest more in the educational pipeline to prepare minority students for careers in medicine and other health professions.
The Valley gets students interested in medical careers while in high school, Dominguez said.
The Doctors Academy, offered at Sunnyside High School in Fresno and Selma and Caruthers high schools, encourages minority students to pursue careers in medicine, she said.
This year, 198 students are enrolled.
"The big barrier is the unknown," Dominguez said. "It's just not having the experiences -- not having the opportunity to shadow a doctor."
Anthony Evaristo, 18, a Doctors Academy student at Sunnyside, had a role model -- his mother, Dolores Evaristo, a nurse.
Following her around the hospital inspired him to pursue a medical career, he said. He plans to attend UC Davis.
"I used to go with her everywhere -- to the hospital -- it really interested me in how she gets to save people's lives for a living," he said.