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We have a math problem in the physician patient relationship

David Marulanda

MS2, Drexel University College of Medicine

LMSA National Conference Chair, '21-'22

Imagine you are working on a group project at school with four other students. The five of you are assigned to solve 20% of a puzzle. The next group has 56 members and they have to solve 61% of the puzzle. Members of your small group are tasked with nearly four times more of the work. Doesn’t seem fair, does it? And yet, using data from the AAMC and the 2020 Census, this burden is what Latino physicians in America are facing.

The Latino community represents slightly less than 20% of the U.S. population (18.5%) as per the most census, and it is growing. According to the AAMC, 12.7% of MD school students and 5.6% of DO school students identify fully or partly as Latino. By the time the AAMC polls active physicians, that number is down to 5.8% (as of 2018). Additionally, we are underrepresented in academic medicine. Please correct me if I am wrong, but you’ll be hard-pressed to find more than a few mainland allopathic medical school deans plus the four deans of the LCME-accredited medical schools in Puerto Rico that identify as part of the Latino community. As a whole, the medical community is doing the bare minimum to ensure that nearly one in five patients are getting the appropriate level of care.

The puzzle metaphor isn’t perfect because there are some non-Latino physicians who speak Spanish, and obviously there are so many more of us in the Latino community that speak English. However, for the subset of Hispanic folks that do not speak English, our 5.8% of physicians needs to take on the added load. This is the minority tax.

When I was a medical scribe in New York City prior to coming to medical school, there were always Spanish-only patients to see. There wasn’t always an attending, fellow, resident, nurse, or anyone else with Spanish language fluency to communicate with these patients. Worse, interpreters weren’t always used because some of the physicians felt that their broken, high school level (at best) language skills were sufficient. I can attest that they were not. These interactions were less of a conversation and more of scared, sick people acquiescing to the higher authority of an educated person in a white coat.

If we cannot establish a physician workforce in this country that mirrors the demographics of our population, then we are not providing equitable healthcare. We are very much doing harm tacitly, thus breaking the oath we all took.

We, the medical community, need to get the percentage of Latino physicians to mirror the American population. It will increase our rate of burnout if we are frequently the only ones who can provide high quality care to an entire subset of patients. To do this I propose that medical schools actively move from whatever admissions algorithms they use, to an approach centered on patient care. What good will it do for a patient to have a physician with decades of research experience and a 520 on the MCAT if the patient cannot understand a word?

As we all slowly come to realize that standardized tests often are more indicative of socioeconomic status than anything else, we can try to find those underrepresented students that never had the resources to compete. If we are to increase the number of Latino physicians to mirror our population, we need to prioritize matriculating Latino students. We need to reconsider what we look for in medical school candidates because a poor kid from the hood, no matter how intelligent and how dedicated, will almost never have the same scores and experiences as a rich white kid. One will likely have had to work through college (maybe high school) to make ends meet. And how can you do research, volunteer, pay your bills, excel in school, and deal with the social determinants of health that rarely affect the upper classes? We need to AT LEAST give more prospective Latino students the opportunity of an interview before we rule them out. We need to provide more in-house resources to accepted medical students that come from lower socioeconomic backgrounds for equitability. Some of my classmates can afford to live stress free, have every convenience, have every comfort, and purchase every third-party resource.

Some of us cannot. And we have the added bonus of having to do nearly four times as much work solving this puzzle.

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