Dr. Jose Chavez arrived in Southern California with a medical degree from his native El Salvador.
He wanted to work as a doctor but faced a daunting series of costly hurdles to obtain a U.S. medical license. Instead of treating patients in a region with a severe shortage of Spanish-speaking doctors, Chavez cleaned houses, worked in a meatpacking plant and installed flooring.
"After working construction eight to ten hours, it's impossible to study," Chavez said. "You're burned out."
Today, he's a resident physician at Riverside County Regional Medical Center in Moreno Valley, thanks to a UCLA program that pays costs -- for coursework, test-preparation classes and living expenses -- while residents study.
The goal is to increase the number of Latin American physicians in medically underserved areas -- like much of the Inland Empire -- and improve care for patients. Ten graduates of the program completed or are doing their residency at Riverside County Regional.
Dr. Patrick Dowling, chairman of UCLA's Department of Family Medicine, and Dr. Michelle Bholat, the vice chair, founded the International Medical Graduate program in 2007 to address the huge gap between Spanish-speaking immigrants and Latino doctors.
One in three residents of Riverside and San Bernardino counties speaks Spanish at home, according to U.S. census data. But fewer than 5 percent of doctors are Latino, according to the Medical Board of California.
There are likely more than 2,000 foreign-trained doctors in Southern California not practicing medicine, Dowling said. The program receives far more applicants than it can accept.
Most who enter the program don't graduate because they can't pass the rigorous first exam, due in part to less laboratory-science coursework in Latin American medical schools, he said. Two more exams and clinical observation are among the other requirements to obtain a U.S. license, Dowling said.
The program pays for students' living expenses because of the difficulty preparing for a license while working, he added.
Maria Luisa Ahumada, 60, has been seeing doctors at Riverside County Regional -- the county's public hospital -- since she immigrated from Mexico four decades ago. She speaks some English -- but not enough, she said, for doctors to always comprehend her descriptions of medical problems or for her to understand their advice.
Ahumada recently visited the hospital's emergency room with what turned out to be a urinary tract infection. She spent the night there with helpful but non-Spanish-speaking nurses.
"I said, 'I pain too much here,'" Ahumada said as Chavez sat on a stool next to her.
The nurses later found an interpreter, and the doctor in the morning spoke Spanish. But Ahumada prefers Chavez.
"I feel very comfortable with him, above all because we speak the same language and understand each other," she said.
Chavez prescribed medication to kill the bacteria that tests showed was causing the pain, and he discussed her other medical conditions in simple, often-colloquial language.
Over the years, Ahumada has communicated with some doctors through telephone or in-person interpreters, but she doesn't feel as comfortable, and she's not always sure if what she's saying is transmitted accurately to the doctor.
Teaching non-Latino doctors Spanish improves communication but they may miss cultural nuances, Dowling said.
"Learning to speak Spanish is not the same as learning a culture," he said.
Dr. Marco Uribe, 32, who graduated from the UCLA program in May and recently started his residency at Riverside County Regional, said that having spent most of his life in Mexico, he's learned that Latino patients are more stoic.
"The Hispanic patients -- they could be dying of pain and they'd say, 'No it doesn't hurt very much,'" Uribe said. "They're very quiet. That's where we have an opening as doctors."
If patients don't say something when they're starting to experience pain, they could suffer serious complications later on, he said. Uribe said he often can tell when people are not revealing problems, so he tries to gently coax information out of them. He also knows to look for signs that patients are using traditional herbal remedies, some of which can damage the kidneys or other organs.
"You know your culture," he said. "You know your customs, the things you're used to. You know how a patient will respond to your advice."
Chavez had long hoped to become a doctor in the United States, but he couldn't afford U.S. medical school.
Once he moved permanently to the United States in 2006, he struggled to study for the first of three exams for a U.S. license. He needed to work to fund his studies, so he had decided to work for awhile, study full time, then work again. That would have taken years.
Then he found out about the UCLA program. Once he was accepted, he was studying 12 to 15 hours a day.
"I didn't have to worry about food, transportation or rent," said Chavez, who spent 15 months in the program.
The privately funded UCLA program -- which saves students tens of thousands of dollars -- not only paid for him to get through the exams, it also provided him with clinical experience and letters of recommendation from a prestigious medical school.
All the program's graduates are required to spend their three-year residencies and their first two to three years of post-residency medical practice working in underserved regions for a non-profit organization that treats a large number of Medi-Cal and uninsured patients, Dowling said.
Large chunks of Riverside and San Bernardino counties are defined as medically underserved, a federal designation determined by factors such as high doctor-to-patient ratios, poverty and infant-mortality rates, and high populations of senior citizens.
The need for more doctors in general -- and Spanish-speaking doctors in particular -- will become more acute when the federal Affordable Care Act goes into effect Jan. 1, said Dr. G. Richard Olds, dean of UC Riverside's new medical school, which was created in part to ease the Inland region's physician shortage.
The health care reform law will give about 500,000 more Inland residents medical coverage, Olds said. He hopes that some of the doctors from the UCLA program stay long term in the Inland area. Nationally, about 40 percent of doctors stay in the areas where they begin their careers, Olds said.
Chavez said he wants to work wherever he's most needed.
"I come from a low-income family," he said. "I'm the first professional in my family. It was really, really hard to become a doctor. I will never forget where I come from. I want to work with an underserved population that is struggling with language barriers and cultural barriers."
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