doctor patient relationships, no English spoken - Your Doctor and You –Sick and Speaking No English, Fourteenth in a Series

“All of our people all over the country – except the pure-blooded Indians --- are immigrants or descendants of immigrants, including even those who came over on the Mayflower.”

President Franklin Delano Roosevelt, Boston Campaign Speech, 1944

You recently immigrated to the United States. You’re most likely from Mexico or another Central or South American country. You live among other immigrants, and your friends and family may speak no English. Many of you, being the lower rung of the socioeconomic ladder, or being illegal immigrants, have no health insurance.

Those who employ you offer no insurance, so you take your chances. You know from friends that American hospitals, by law, have to treat you, so hospital emergency rooms offer a place for care. You may speak no English have difficulty being understood by American doctors and nurses. That’s’changing as hospitals and large clinics hire interpreters.

Immigration and Politics

You know immigration is a hot political topic. You may have even joined street demonstrations demanding immigrants, legal and iillegal, become automatic citizens
Eleven million immigrants have infiltrated across the borders, mostly Mexicans or South Americans Undocumented immigrants stress America’s welfare, health, educational, and legal systems, and, as critics continually emphasize, pose a potential terrorist threat.

America draws people from around the world because of its wealth, opportunities, movies, and capacity to provide work paying more than can be made in immigrants’ native countries. Add these factors to the population growth of the non-white population, and you have an explosive political mixture.

Putting It in a Table

As you can see from this table, immigration growth is fast and diversified.
Table 4. Growth in Immigrant Populations in the United States by Regions of the World

Country 2000 1990 Increase Growth Rate
1. Latin America 14,200, 404 7,224,046 6,979,356 97%
(Spanish Speaking)

2. East Asia 5,764, 587 3,720, 367 2.044,220 55%

3. Europe 5.046,543 4,350 669 895,074 16%

4. Non-Spanish 1,746,108 1.029,525 716,503 70%
(Western Hemisphere)

5. South Asia 1,370,291 568,159 802,132 141%

6. Middle East 1,081,851 740,296 341,555 46%

7. Canada 843,880 741,688 102,182 14%

8.Sub-Sharan Africa 610,084 223,005 357,079 174%

9. Oceana 1,081,851 740,296 341,565 -67%
(Not indicated)

Totals 30,995,949 19,585,995 11,409,957 +58%

Source: Center for Immigration Studies analysis of 1990 and 2000 Micro data

This furious growth and the accompanying cultural diversity create problems for hospitals and doctors. Health professionals must hire translators to deal with patients from these different countries. According the Census Bureau, by the year 2000, almost 50 million people in the U.S. were from different ethnic backgrounds. In 1940, 70 percent of immigrants were from Europe. By 1992, the immigrant pool had changed. Fifteen percent came from Europe, 37 percent came from Asia, and 44 percent came from Latin America and the Caribbean.

The United States is the world’s greatest immigration magnet. The U.S. attracts two thirds of the world's immigration, and 85 percent of American immigrants come from Central and South America. Generalist physicians can now expect more than 40 percent of their patients to be from minority cultures (All information above from U.S. Census Bureau.

Contribution to Unexpected U.S. Population Growth

This rapid immigrant population growth caused the U.S. population to expand by 25 percent more than anticipated b the Census Bureau from 1980 to 2005. By 2000, instead of the anticipated 285 million we had nearly 300 million citizens. Dr. Richard Cooper, at the University of Wisconsin in Milwaukee, wrote a groundbreaking 2002 Health Affairs article saying this unexpected population explosion had created a physician shortage. (R. Cooper, et al, “Economic and Demographic Trends Signal Impending Physician Shortage, “ Health Affairs, Jan/Feb, 2002).

The Physician Shortage

Cooper noted medical authorities had underestimated effects of population and economic growth and lower physician productivity.

This combination produced a growing physician shortage. He predicted a doctor shortfall of 50,000 by 2010 and 200,000 by 2020. Cooper said we will need 15 new medical schools to provide care for the expanded population and a physician manpower deficit. Many of the new doctors will be caring new citizens who are foreign born or first generation. They will be non-English speaking with different cultural values.

Foreign Born U.S. Physicians

Ironically, foreign-born doctors practicing in the U.S will be invaluable in ameliorating the physician shortage. According to Joseph Hawkins of the Merritt and Hawkins physician recruiting firm, international physicians practicing in the U.S. will be critical in meeting health care needs of Americans ( “International Physicians: Making Use of an Indispensable Source,” Healthleaders News, March 6, 2006)

Hawkins observes:

“It is no longer realistic to think of international medical graduates as a supplement to the physician work force. IMGs, due to their sheer numbers and the contributions they are making to health care delivery, have become a resource so indispensable that our health care system would be hard pressed to function without them. Statistics tell part of the story. Fully one quarter of physicians active in patient care today are IMGs. In some specialties, the percentage is higher, as the numbers indicate.”

Specialty International Medical Graduates

Nephrology 41%
Internal Medicine 35%
Cardiology 30%
Neurology 30%
Anesthesiology 29%
Pulmonology 27%
Psychiatry 27%

Source: AMA Physician Master File

The Nonwhite U.S. Population Grows

Today, about one third of the U.S. population is nonwhite. By 2050, various ethnic groups and persons of color in the U.S. will total just over half (51.1 percent) of the population, according to the U.S. Census Bureau. Close to 90 percent of our total population growth will have come from high birth rates of persons of color due to historic levels of immigration.

Providing Health Care to Other Cultures

Providing health care services to persons, who act, talk, relate, dress, and eat differently from what we have often considered the "mainstream" will become far more commonplace.

Continued immigration into the U.S., along with increases in the population of various cultural groups, means more patients with different cultural customs, beliefs, and practices will enter into the health care delivery system. This immigration brings with it a unique and complex set of challenges for providers.
Cultures Vary in Health Care Perceptions.

While health care is a universal concept existing in every cultural group, cultures vary in the ways they perceive health and illness and how care is given. Culture shapes an individual's health and response to illness. For this reason, hospitals must not only provide excellent patient care, they must also be “cultural competent," i.e., they must understand different cultural customs and languages.
Becoming “Culturally Competent”

Some hospital leaders understand the importance of being culturally competent. They have responded by hiring more multilingual staff and interpreters. They have provided diversity training to help staff members understand their patients' different backgrounds. Some changes are required to meet the standards of the Department of Health and Human Services' Culturally and Linguistically Appropriate Services.

These are important steps; however, they’re only the beginning of preparing for the flood of multicultural and multilingual patient populations.

Next: Your Doctor and You – Sick and Speaking No English, continued, Fifteen in a Series.