Latino physician supply in California: sources, locations, and projections.

PURPOSE: To determine the number of Latino physicians in California, identify the schools and countries where they were educated, determine the percentage located in Latino areas, and project the supply of Latino physicians to 2020. METHOD: From a 1999 list of 74,345 licensed physicians, the authors identified Latino U.S. medical graduates (USMGs) by "heavily Hispanic" surnames and Latino international medical graduates (IMGs) by country and school of graduation. The 1999 license addresses of all physicians in Los Angeles County were analyzed against 1998 Latino-population data by zip code. A baseline projection of the supply of Latino physicians was based on the ten-year (1986 to 1995) average annual production of Latino physicians educated in California, out of state, and in Latin America. A worst-case projection assumed the continuation of recent trends: a 32% decrease in California-educated Latino USMGs, a 19% decrease in out-of-state Latino USMGs, and a reduction of Latino IMGs to five per year. RESULTS: In 1999, 3,578 Latino physicians comprised 4.8% of all Californian physicians. In contrast, Latinos made up 30.4% of the state's population. Latino physicians were more likely than non-Latinos to have addresses in a heavily Latino zip code. In the baseline projection, while the overall supply of Latino physicians will increase by nearly 30% by 2020, that growth will be dwarfed by the 74% growth in the Latino population over the same time. In the worst-case projection, the actual number of Latino physicians will decrease from the 1999 figure of 3,578 to 3,448 by 2020, while the Latino population continues to grow. CONCLUSIONS: (1) The Latino USMG supply must be markedly increased in the number of first-year matriculants in both California and out-of-state schools. (2) The issue of Latino IMGs requires special attention, and may provide a temporary solution to the Latino physician shortfall. (3) Non-Latino physicians need to be prepared to be culturally effective with a large and growing Latino patient population.

Latino health in California, 1985-1990: implications for family practice.

Family practice, especially when applied to the Community-oriented Primary Care model, needs to incorporate the epidemiological profile and health care needs of a particular community. The rapidly growing Latino population is creating a great number of largely Latino communities. While they tend to have high poverty rates and low education rates, their family and health profiles contradict many assumptions made about poor, underserved minority groups. Data for the 29.8 million California residents, including 7.7 million Latinos, show a strong Latino health profile. Compared to Anglos and blacks, Latinos have high complete nuclear family rates and low non-family rates. They have low rates of low birth weight babies and low infant mortality, about equal to the rate among Anglos and Asians. Latinos also have lower age-adjusted death rates due to heart disease, strokes, and cancers, again, about equal to Asians. Latinos do, however, have higher death rates due to motor vehicle accidents and cirrhosis than Anglos, blacks, or Asians and a diabetes death rate higher than Anglos or Asians. Surprisingly, Latinos have lower age-adjusted death rates due to drug-related causes and weapons-related causes than Anglos or blacks, but substantially higher than Asians. It is suggested that, much against the stereotype, Latinos should be considered a high-level wellness population for whom family practice, based on prevention and primary care, would be an ideal match.

Latino health in Los Angeles: family medicine in a changing minority context.

The inner city population of the Los Angeles county has rapidly become largely Latino. The 3.3 million Latinos living in the county in 1990 had much higher poverty rates and lower educational attainment rates than Anglo (non-Hispanic white) or blacks. The health indicators of the three groups are compared for 1990. In birth outcome, although Latinos were the least likely to receive care in the first trimester, Latinos and Anglos had identical rates of low birth weight babies, and lower rates than blacks. Latino infant mortality was the lowest of the three. The age-adjusted death rates showed that Latinos have a lower overall death rate than Anglos or blacks, and lower specific rates for heart disease, cancer, AIDS and stroke. Latinos did have higher death rates than Anglos for accidents, homicides, cirrhosis and diabetes. Latinos had incidence rates of gonorrhoea and syphilis similar to Anglos and lower than blacks. The communicable disease rates for Latinos was many times higher than Anglos or blacks, including those for measles, shigellosis, giardiasis and hepatitis A. Implications for family medicine are discussed.