Can We Better Serve Our Hispanic Patients Through Language Concordance?

The United States grows more diverse with each passing year, but is that diversity reflected in the care provided by the family medicine community? The United States Hispanic population grew to more than 62 million individuals in 2020, a 25% increase in 10 years. In that time span, the number of practicing Spanish-speaking family physicians has remained relatively stagnant, creating a disparity of care for those with limited English proficiency (LEP).

To recognize National Hispanic Heritage Month, The American Board of Family Medicine (ABFM) is sharing results from a recent study which analyzed language concordance among Spanish-speaking family physicians and their patients. Their findings may provide a foundation for more balanced patient care moving forward.

The “Practice and Characteristics of Board-Certified Family Physicians Who Provide Care in Spanish” study was crafted over an 18-month period by a team of Pisacano Scholars, Center for Professionalism and Value in Health Care (CPV) leadership, ABFM Board Chair Dr. Gerardo Moreno, and Robert Graham Center Director Dr. Yalda Jabbarpour.

Survey data from 24,808 physicians was used as the basis for these findings:

• 7.2% of the ABFM Diplomates surveyed identified as Hispanic.
• 82.1% of those physicians provide care in Spanish.
• 16.2% of non-Hispanic physicians who responded also provide care in Spanish.
• Those who provide care in Spanish practice in counties with a population that is 27% Hispanic on average.
• For those who provide care in Spanish, 87.6% work in Urban areas.
• 37.5% serve populations with a majority of “vulnerable” patients.

“The fact that the number of family physicians who provide care in Spanish is not increasing tells me that, as a specialty, we need to enhance our recruitment
and retention efforts for physicians who provide care in Spanish,” said Dr. Andrea Banuelos, a California-based family medicine resident and 2020 Pisacano Scholar who took part in the study.

Her colleague and fellow Pisacano Scholar, Dr. Alberto Ortega, helped prompt the study to take place. Dr. Ortega is a 2021 Pisacano Scholar whose interest in medicine began when he accompanied family members to health care visits and interpreted on their behalf.

“My parents immigrated from Latin America, and I’m the first in my family to be born in the United States,” said Dr. Ortega. “As my family can attest, language discordance between patients and their care teams can negatively impact health outcomes.”

During a visit to the 2021 Pisacano Leadership Foundation’s Annual Symposium, Dr. Ortega connected with Drs. Bob Phillips and Andrew Bazemore of CPV. They encouraged Dr. Ortega to pursue his passion and learn more about Hispanic patient care in the United States. Soon, analysis of ABFM’s data was underway. The results of the study were presented at the North American Primary Care Research Group conference in 2022.

There are multiple ways that the gap between Spanish-speaking patients and Spanish-speaking physicians may be addressed. Dr. Banuelos provided some examples of policy that could be put in place to improve language concordance.

“We could consider loan forgiveness for physicians caring for Spanish-speaking populations in under-resourced communities, scholarship or grant opportunities for medical students who pass a language proficiency exam, or even recruitment bonuses for Spanish speaking physicians to practice at FQHCs,” Dr. Banuelos suggested.

Many offices are already using interpreter services to bridge language divides. However, there are limitations to consider.

“Whether the interpreter is in-person, video remote or via telephone, each modality has its advantages and disadvantages,” said Dr. Ortega, noting that physicians should also be mindful of the difference between qualified and certified interpreters.

“Qualified interpreters may be self-taught or acquired their skills through informal or non-standardized means. Certified interpreters typically pass an examination that evaluates language skills, interpreting techniques, and knowledge of professional ethics and standards. Certified interpreters are often preferred due to their verified skills and adherence to established standards.”

This is a challenge that doesn’t have a simple identifiable solution. But, by bringing more attention to the issue, there is hope that “Practice and Characteristics of Board-Certified Family Physicians Who Provide Care in Spanish” will be the study that leads to significant change in the future.

The study is currently available as an abstract. It is being prepared for wider publication in late 2023.