There is a tangible need to increase the representation of Latina/o physicians in health care to address disparities, improve access to care, and enhance health outcomes for the Latina/o community and other underrepresented populations.
Written by Norma Poll-Hunter, PhD
Finding a Latina/o physician is not a common occurrence. Carmen, an octogenarian living in New York City, was happy to share with her daughter that she finally had a Latino physician despite being in the United States since 1973. As a Puerto Rican woman, this was important. She noted experiencing greater comfort sharing her medical concerns and perceived that her Latino physician was more responsive to her needs. This is consistent with research showing that patients across all racial and ethnic groups experience greater satisfaction with their health care when treated by a physician of a similar racial and ethnic group.1
Her experience tells the story of Latina/o representation and its impact on medicine. Association of American Medical Colleges data show that 6% of US physicians identify as Latina/o.2 Trend data over the last 20 years shows small and slow increases in Latina/o representation in the physician workforce.3 This matters because research shows that physician workforce diversity expands access to care4, and improves health outcomes5, patient satisfaction and treatment adherence.6 These are life-saving outcomes for the health of the Latina/o community that continues to be disproportionately impacted by health and health care disparities. The COVID-19 pandemic further exacerbated these disparities by contributing to the shorter life expectancy of Hispanic and Black US communities.7
Latina/o Physicians Improve Access to Health Care
Latina/o, Black/African American, American Indian, and Alaska Native physicians are more likely to practice in medically underserved areas and treat patients with Medicaid and Medicare.4 Health outcomes are also correlated with greater physician diversity. A recent study revealed that greater representation of Black primary care physicians within a county was correlated with increased life expectancy for the Black community.8 For these reasons, diversity in the physician workforce is an essential part of the equation for advancing health equity for all. However, recent Latina/o medical school enrollment, both for MD and DO granting institutions at 6.8%, suggests that the representation of Latina/o physicians will remain relatively stagnant in the next few years.9,10
Systems-based strategies need to start as early as pre-kindergarten to increase workforce diversity. Challenges to becoming a physician may include lack of role models, limited access to quality K-12 public education, absence of advanced placement courses, and lack of financial resources. Disparities in education start as early as preschool for Latina/o children and are sustained through college. The Pew Research Center 2021 data show that although college enrollment is improving for Latina/o students, the overwhelming majority of 18 to 24 Latino/as are not enrolled in college. Financial responsibilities and affordability are reported as the most common dissuading factors influencing college going behaviors.11
To address these systemic barriers, pathway programs hosted by medical schools, community based and federally funded programs provide academic enrichment, socialization about the medical school process, exposure to role models, clinical and research shadowing experiences, and standardized test preparation. The Robert Wood Johnson Foundation Summer Health Professions Education Program, a free program for college students interested in the health professions, including medicine, has significant outcomes increasing medical and dental school diversity.12 Federal programs like the Department of Health and Human Services Health Career Opportunities Program and the Centers of Excellence also reach into communities that are often disadvantaged to provide opportunities for career exploration and development.13
Other major contributors to diverse college graduates are Minority Serving Institutions, Hispanic Serving Institutions (HSI), Historically Black Colleges and Universities (HBCU), and Tribal Colleges and Universities (TCU). For the Latina/o physician workforce, the four accredited medical schools in Puerto Rico - the University of Puerto Rico, Medical Sciences Campus, San Juan Bautista School of Medicine, Ponce Health Sciences University, and the Universidad Central del Caribe School of Medicine play a vital role. In 2022-2023, the schools in Puerto Rico accounted for 13.6% of Latina/o US medical school enrollment.9 Despite this contribution, bias and discrimination exist during the residency process against medical students from Puerto Rico.14
Workforce interventions only partially address this complex issue. The onus of health and health care disparities in the Latina/o community cannot rest on the shoulders of Latina/o physicians. Medical schools are integrating education on culturally responsive and appropriate care, and there is a movement to add medical Spanish to the medical school curricula. Recent waves of laws and proposed legislation, like the Florida legislature bill prohibiting diversity, equity and inclusion (DEI) initiatives in public colleges, however, threaten efforts to ensure that all doctors are trained to treat patients from all communities.
Latina/o Health is more than Health Care
Public policies have a significant influence on health and health care. Laws ending DEI programs, and changes to affirmative action via the Supreme Court, negatively impact curriculum, training and an increasing representation of the Latina/o physician workforce. The recent Supreme Court decision in Dobbs v. Jackson also shows how policy can limit access to care.
Research shows that nearly 50% of health outcomes are influenced by social, economic, environmental, and community conditions, also known as social determinants of health.15 These social determinants are directly shaped by public policy that US citizens can influence. Initiatives like VoteER promote civic engagement in emergency room departments and other health care settings by hosting voter registration and other activities to inform citizens about the connection between health, health care, and public policy.16 Organizations like the National Hispanic Medical Association, the Latino Medical Student Association, the Association of Hispanic Serving Health Professions Schools, and the Pre-Health Dreamers also advocate to improve access to health care and workforce diversity.
En nuestras manos
The Latina/o US population is diverse and a growing force. The available data and research evidence present a compelling case for increasing the Latina/o physician workforce and advocating for policies in education, economic opportunity, and other social determinants of health that offer a window for systemic change. Through these efforts, everyone has the opportunity – está en nuestras manos to change the health of the Latina/o community and all communities, especially those often left behind.
This perspective does not represent the opinions of the AAMC or other organizations referenced in this article.
References:
1. LaVeist, T. A., & Nuru-Jeter, A. (2002). Is doctor-patient race concordance associated with greater satisfaction with care? Journal of health and social behavior, 296-306.
2. Felida, N, Zhuang, J.C., Nouri, Z, Dill, M & Poll-Hunter, N. (September 2021) Diversity among Hispanic/Latinx US Physicians. AAMC Workforce Studies Data Snapshot https://www.aamc.org/media/56736/download
3. Salsberg E, Richwine C, Westergaard S, et al. Estimation and Comparison of Current and Future Racial/Ethnic Representation in the US Health Care Workforce. JAMA Network Open. 2021;4(3):e213789. doi:10.1001/jamanetworkopen.2021.3789
4. Marrast LM, Zallman L, Woolhandler S, Bor DH, McCormick D. Minority Physicians’ Role in the Care of Underserved Patients: Diversifying the Physician Workforce May Be Key in Addressing Health Disparities. JAMA Intern Med. 2014;174(2):289-291.
5. Alsan M, Garrick O, Graziani G. Does Diversity Matter for Health? Experimental Evidence from Oakland. American Economic Review 2019, 109(12):4071-4111.
6. Jetty A, Jabbarpour Y, Pollack J, Huerto R, Woo S, Petterson S. Patient-Physician Racial Concordance Associated with Improved Healthcare Use and Lower Healthcare Expenditures in Minority Populations. J Racial Ethn Health Disparities. 2022 Feb;9(1):68-81. doi: 10.1007/s40615-020-00930-4.
7. 2022 National Healthcare Quality and Disparities Report. Content last reviewed May 2023. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/research/findings/nhqrdr/nhqdr22/index.html
8. Snyder JE, Upton RD, Hassett TC, Lee H, Nouri Z, Dill M. Black Representation in the Primary Care Physician Workforce and Its Association With Population Life Expectancy and Mortality Rates in the US. JAMA Netw Open. 2023;6(4): e236687. doi:10.1001/jamanetworkopen.2023.6687
9. Association of American Medical Colleges (November 4, 2022) Total Enrollment by U.S. Medical School and Race/Ethnicity (Alone), 2022-2023 Available at https://www.aamc.org/data-reports/students-residents/data/2022-facts-enrollment-graduates-and-md-phd-data
10. Association of the Colleges of Osteopathic Medicine (March18, 2022) Total Enrollment by Race/Ethnicity 1976-2022 Available at https://archive.aacom.org/reports-programs-initiatives/aacom-reports/student-enrollment
11. Mora, L. (October 7, 2022) Hispanic enrollment reaches new high at four-year colleges in the U.S., but affordability remains an obstacle. Pew Research Center. Available at https://www.pewresearch.org/short-reads/2022/10/07/hispanic-enrollment-reaches-new-high-at-four-year-colleges-in-the-u-s-but-affordability-remains-an-obstacle/
12. About the Summer Health Professions Education Program. Available at https://www.shpep.org
13. HRSA Health Workforce. Health Careers Opportunity Program https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/hcop-outcome-report-2015-2020.pdf
14. Latino Student Medical Association. (August 30, 2022) Equity for Medical Students in Puerto Rico https://fpac.lmsa.net/equity-for-medical-students-in-puerto-rico/
15. Whitman, A., De Lew, N., Chappel, A., Aysola, V., Zuckerman, R., & Sommers, B. D. (April 1, 2021). Addressing Social Determinants of Health: Examples of Successful Evidence-Based Strategies and Current Federal Efforts. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation. Office of Health Policy.
Available at https://aspe.hhs.gov/sites/default/files/documents/e2b650cd64cf84aae8ff0fae7474af82/SDOH-Evidence-Review.pdf
16.Vot-ER. Available at https://vot-er.org/about/
About the author
Norma Poll-Hunter, Ph.D. serves as Senior Director, Equity, Diversity, and Inclusion at the Association of American Medical Colleges. She earned her Ph.D. in Counseling Psychology at the University of Albany, SUNY, and her BA in Psychology at Lehman College, CUNY.
