Reflections on the impact of the Latinx physician shortage in the US

A 52-year-old woman presents to the ED with epigastric abdominal pain and bright red hematemesis. She is hypotensive and tachycardic. The attending physician calls on you, their voice sharp with urgency: “… what do you want to do, doctor …?” Your heart rate goes up and the fluorescent lights above appear to brighten with anticipation.

These defining moments in our clinical training become etched in our subconscious, shaping who we are as physicians. Faced with such time-sensitive crises, we are forced to rely on our knowledge base, our intuition and our commitment to first, do no harm. It is in the thick of these high-pressure encounters that we discover our emotional intelligence, our capacity for resilience and commitment to empathy, advocating for patients’ ultimate right to choose the care they receive.

While my initial pursuit of medicine stemmed from a desire to understand the scientific underpinnings of health and disease, I quickly discovered a calling for navigating the complexities of medical decision- making and their ethical implications, extending to public health policy. My commitment to patient- centered care continues to fuel my clinical practice goals today, even as it often clashes with the health industry’s prevailing emphasis on cost containment, high patient load and hyperfocus on efficiency.

As health care faces a physician shortage and limited resources, especially for patients with growing disparities in social determinants of health, balancing competing priorities and being mindful of our medical education pipeline has become even more essential. We must consider ways to facilitate enrolling more medical students of diverse backgrounds who will be well-equipped to care for diverse patient populations.

The Latinx physician shortage

To that end, as the U.S. celebrates National Hispanic Heritage Month, I hope to draw your attention to the urgent Latinx physician shortage in the U.S. Roughly 19% of the U.S. population is Hispanic/Latinx, but just 6% of physicians are Latinx and roughly 2% are Latina.

For the past few years, I have collaborated with a few physicians in California to designate Oct. 1 as National Latino/a Physician Day (NLPD). Having a day set aside for Latinx physicians will help to highlight the essential roles played by Latinx physicians in delivering quality health care services and advancing medical knowledge. The COVID-19 pandemic further demonstrated the urgent need for Latinx physician representation in medicine and surgery.

As a Latina and Puerto Rican, my commitment to providing culturally and linguistically concordant care remains unwavering. When I started my first private practice, associate work, a Joint Commission quality officer explained the importance of understanding my community standards of care, as safety and quality measures. He stressed that it would be my obligation to inform patients of my clinical recommendations within the context of the shared care recommendations of the physicians in my community.

It is thus clear that community standards of care are guides to clinical practice goals within shared patient-physician values that foster trust and better communication between health care professionals and patients. However, our current reality remains far from this ideal.

During medical school and residency training, we learn about health, disease and therapeutics as gold standards of care. However, once we enter clinical practice, we notice that these standards of care are often not aligned with patients’ goals of care. This discord in turn often creates an impasse for clinicians who are not able to prioritize their critical role in helping patients align their goals of care with the options afforded by health care. And it is precisely in this discomfort that we are called to deliver factual information about available resources, within a principle-based methodology that fosters transparency and patient autonomy in assisted decision-making.  

In striving to engage and legitimize community standards, including public health policies, the health care industry can also safeguard accountability measures to ensure inclusive and diverse perspectives are considered.

The importance of culturally competent communication

Reflecting on the last 18 years in medicine, I recognize the profound influence of the emotionally intelligent physician leaders who taught me. They instilled in me virtues like self-awareness, honesty, courage, integrity and fairness. Practicing medicine has been both a privilege and an opportunity for enlightenment, which philosopher Immanuel Kant defines as the earned freedom to courageously use one’s own understanding without the guidance of others. This freedom to reason publicly now allows me to address a critical knowledge-gap in multidisciplinary translational medicine—welcoming the expertise, resources, and techniques from different disciplines to improve patient health.

Communication within and between communities has proven to be the essential element for building ethical and sustainable clinician-patient relationships. To foster culturally competent communication in health care, we need more Latina/o/x physicians included during conversations in leadership circles about the values, beliefs, social norms, language-specific and idiomatic subtleties of the culture.

Over the last four years alone, I have witnessed too many patients from marginalized communities forgoing care for themselves and their families. They are avoiding encounters with clinicians who do not share their language, who are not familiar with their cultural norms and who, in some instances, devalue their goals of care. Patients describe communication barriers to be like blindfolds because they allow clinicians to rely on “greater good” or “broad efficiency” care, not unlike the decisions made in the proverbial trolley problem of moral theory. 

A clinician’s ability to interpret their patients’ nuanced vocabulary or cultural norms significantly influences how they interpret their own ethical obligations in health care. This suggests that culture and idioms play a crucial role in shaping how we all perceive and navigate ethical dilemmas, particularly in cross-cultural contexts where language variations can lead to diverse ethical perspectives.

Multilingual individuals are well-suited to counter biases that arise from language barriers—while shared universal principles, values and moral duty communicated via open, team-based discourse is the ethical approach to allocation of limited health care resources. A more regimented, principle-based approach in patient care and population-based decisions in public health should phase out less nuanced, utilitarian “greater good” decision-making that maintains barriers to communication.

The osteopathic profession has been inclusive and welcoming to marginalized groups from its founding. A.T. Still, MD, DO, an avid abolitionist, included women in the first class of students at the American School of Osteopathy, which was unheard of at the time. Today, the osteopathic medical profession is well-positioned to take a leading role in helping address the importance of diverse thinking in medicine.

The Latinx physician shortage is part of a larger crisis in civic duty that requires us to address complex ethical dilemmas in today’s interconnected world, with a global skill set that accounts for diverse values and beliefs. A multidisciplinary, multicultural and language-proficient approach to decision-making in medicine will lead to less social fragmentation and political polarization, while fostering trust from community stakeholders. The quality of public conversations about important issues affecting us is a reflection of healthy civic discourse when it’s accomplished through respectful dialogue, open-mindedness and a willingness to consider different perspectives.

My hope for us, as stewards of the medical profession, is that we create an awareness of our current Latinx physician shortage with the goal of strengthening society’s civic health by building more self-aware and resilient communities. Please join me in celebrating National Latinx Physician Day on Oct. 1 in years to come during National Hispanic Heritage Month. I urge us all to support policies and programs that will strengthen the pipeline of bilingual, bicultural Latinx physicians in the U.S., because this will enable ethically sustainable health outcomes.