A few years ago, Marlisa Olea-Gallardo was grasping the hand of a young woman from Tijuana about to give birth. They had just met and were the only Spanish speakers in the hospital room. Both were in their early 20s.
“She talked to me about her life and how she was so excited to have a daughter,” Olea-Gallardo said. “And she was so sad that her partner couldn’t be there with her.”
Olea-Gallardo was a volunteer medical interpreter at the time at Palomar Medical Center in Escondido and on that day her Spanish skills were needed in the operating room.
At one point, the woman said she couldn’t breathe. Olea-Gallardo held her hand throughout the entire cesarean procedure.
The experience “gave me a lot of exposure to even more inequities that existed within medicine,” Olea-Gallardo said. “Being able to translate for folks was very powerful for me because I noticed what an immediate difference it made in their comprehension, their health literacy, their level of care.”
The 26-year-old from Oceanside has been on a yearslong journey to become one of the few Latinx doctors in California, a childhood dream. She has been aware of how useful her language and cultural skills can be for patient care in a state that continues to see an expanding Latinx population.
500 YEARS UNTIL PARITY
In California, Latinos make up 6% of physicians and 8% of the state’s medical school graduates, despite making up 39% of the state populace, according to a California Health Care Foundation report examining 2019 and 2020 data.
Southern California medical experts say the cavernous disparity threatens the quality of care provided to Latinx patients. The shortage poses critical language and trust barriers between doctors and patients, making it more difficult to address health issues hitting Latinos hardest these days, from an ongoing diabetes epidemic to the current Covid-19 pandemic.
“It’s going to take us five centuries in California to close the gap for the Latino community,” said Jeff Kim, Program Director with The California Wellness Foundation, which has funded efforts to send more people of color to medical schools. “That is an obscene, absurd gap.”
Kim’s assertions are backed up by a 2018 UCLA Latino Policy & Politics Initiative analysis.
“If you don’t close this gap,” Kim said, “lots of people are going to suffer from not getting access to adequate quality care.”
Medical experts worry that the supply of Latino physicians isn’t keeping up with the growing Latino population in California. Latinos became the state’s largest ethnic group in 2014, according to the U.S. Census Bureau. There are 15.6 million Latinos in California and 13.7 million whites.
Nationwide, Covid-19 has increased the overall numbers of students interested in going into medicine, including among Latinxs whose applicant numbers increased from 5,820 to 7,281 between 2020 and 2021. But interest is outpacing enrollment.
The number of all medical school applicants spiked by 18% in 2021 from the year before as the number of accepted applicants grew 3% during the same period, reports the Association of American Medical Colleges.
Latinos have made some modest gains: In 2014, Latinos and those “of Spanish origin” made up 9.1% of all medical school matriculants, while in 2021 they made up 12.7%, per the AAMC.
During that time, the makeup of white matriculants in medical school shifted from 58% to 52%, Asians went from 21% to 27% and Blacks went from 7% to 11%.
The Latino doctor shortage hit California rural areas hardest, says Arturo Vargas Bustamante, faculty research director at LPPI. He said that in Los Angeles County – home to 4.8 million Latinos – tracking parity is difficult due to localities
’ changing demographics and population sizes.
“Being able to choose a Latino physician is the top preference of patients,” Bustamante said. “Obviously, many times they are not able to have that [choice], especially when they go to specialty care.”
The Covid-19 pandemic has been especially fatal for Latinos who make up 51% of all Covid-19 deaths in Los Angeles County, totaling about 15,500 losses, according to county Department of Public Health data. The second largest group, whites, saw about 7,500 deaths. Latinos also make up 46% of all county infection cases, totaling more than 1.2 million.
“While other factors also play a role in these statistics, like lacking health insurance, overcrowded housing, being an essential worker that made remote work not possible for many of these individuals,” Bustamante said, “definitely the lack of appropriate relationships, particularly having a usual source of care could have been key in making the consequences of the pandemic even worse among Latinos.”
With a disparate Latino physician gap, at loss is what Bustmante and other experts call physician concordance —which occurs when a physician and patient share a similar identity or race, often leading to better health outcomes.
“One of the explanations why this is the case is because they share common ground, they have trust in each other,” Bustamante said. He also said that his past research indicates that in cases when doctors are not Latinos, their ability to speak Spanish is helpful.
“It’s appreciated and patients feel that they can communicate better,” he said.
APPLIED TO 45 MEDICAL SCHOOLS
Olea-Gallardo, the former volunteer interpreter, has spent recent weeks interviewing for medical schools and was eagerly waiting to hear back from any of the more than 45 campuses she applied to. It’s all part of her dream, she said, “to be able to provide culturally and linguistically competent care to the Latino population.”
Growing up, she saw countless relatives and co-parishioners in her Christian church community struggle with language and in accessing care.
“I saw a lot of undocumented folks that I know and care for being afraid to go to the hospital or seek medical attention for fear of deportation,” she said, “or folks who have no insurance, who never healed properly, because they were afraid of the bills that would come with that.”
“I would see that and think to myself, well, I’m in a very unique and privileged position where I speak English, and I also speak Spanish, and I have the opportunity to pursue higher education,” Olea-Gallardo said. “And I enjoy learning about the body. So I can fill this need and I can be of service to the people that I care for.”
Her journey has been long and expensive so far, Olea-Gallardo said, as she strives to become a doctor, already costing her more than $40,000 in loans and out-of-pocket expenses, ranging from tuition and housing to study materials and medical school applications.
Her father immigrated from Mexico when he was 3 years old. Her mother arrived from Honduras when she was 9. Olea-Gallardo’s parents grew up in South Central Los Angeles and married young. Olea-Gallardo became the first in her family to enroll in a university, with her siblings following suit after.
“I was the first in my family to navigate through these spaces. Learning how to advocate for myself, learning about office hours, learning about tutoring,” Olea-Gallardo said, “it’s something that I had never encountered.”
She left her tight-knit home and moved to San Diego State University to begin undergraduate studies, where she made rookie mistakes. As a freshman, she took six college courses at San Diego State University. “I thought that it was like high school. And I didn’t know that you can reach out to counselors as a resource,” she said.
Expectations were piling up for the first-generation student. One morning, she awoke in her apartment but couldn’t move.
“Every time I tried to get up off the bed my back hurt a lot,” she said. “So much so that I started crying. And the only movement that I could manage was reaching over to the nightstand for my phone and calling my mom.”
Doctors blamed it on a panic attack. She had been away from family and stressed over exams. There was also isolation in often being the only woman or Latino in a science class.
“It was the amount of the course load and being unable to navigate how to succeed well,” she said. “There were a lot of times when I had four exams in a day.”
After living away in San Diego for two years, she came back home to her Oceanside family and her mom’s comida.
“I was like, ‘Oh my God, these are the best frijoles,” she recalled.
She had missed her family and living expenses in San Diego were racking up; moving home saved her from high rent, other bills, and anxiety. However, the move back also meant a two-hour commute from Oceanside to SDSU each school day. So, she would record her own lectures to replay while driving.
“Living back home made a really big difference in my emotional and mental wellbeing,” she said.
Olea-Gallardo said her biggest obstacle was being a first-generation student not knowing how to navigate college life. There would also be the financial costs of more schooling, study materials and applying to numerous medical schools.
After graduating from SDSU, Olea-Gallardo’s total loan debt was $24,000, mostly for housing. As a freshman, her on-campus living cost was about $1,800 a month. She was required to live on campus her first year per campus policy and, in her sophomore year, her nearby apartment in a student housing complex cost $1,100 a month.
At different points, she also worked as an IT department secretary and a student athlete tutor.
“It was definitely difficult to juggle having to work and the responsibility of having to pay for certain things, along with my studies,” she said. “I definitely struggled.”
To begin paying off loans, Olea-Gallardo began working full time at a bank right before graduating. “I was looking at lab jobs, medical corporations or just tech companies. And they weren’t paying as much as the bank was paying,” she said. “But at that point, I just needed to make money to start paying back my loans and also be able to fund my medical school application process.”
More expenses were to come after graduation. She wanted to become more competitive in her medical school applications, so she enrolled in 10 post baccalaureate science courses via UCLA Extension, each costing between $750 to $1,000 in the span of two years. She said that she practically aced all of them. Then there was the much-dreaded Medical College Admission Test, the exam needed to enter most medical schools.
She paid about $1,000 for class prep materials – with online question banks and practice exams – and another $350 for exam registration.
Olea-Gallardo applied to more than 45 medical schools, from California to New York to enhance her chances of being accepted. However, the process in some cases included follow-up essay responses, interviews, and more application fees. She estimated the cost to apply to those 45 schools to be around $6,000.
“That’s why I had to work. I had to save up money and pay for all those expenses out-of-pocket,” Olea-Gallardo said.
Today, when she is not banking, Olea-Gallardo serves as the volunteer Chief Executive Officer for MiMentor, a nonprofit and digital app network created in Los Angeles that connects practitioners with Latino students, each eager to become the next médico or dentista. The group has more than 13,000 members nationwide.
Joining the organization “provided me with a ridiculous amount of mentorship that I don’t think I would have been exposed to,” Olea-Gallardo said. “It’s really truly like a family and everyone is really willing to help each other out.”
Olea-Gallardo said that she would love to study anywhere in California. She recently accepted a seat at the University of California, Davis School of Medicine and will start this fall.
”My family is here,” she said. “And that population here is very near and dear to my heart. we have a really large Latino population, which is ultimately whom I want to be serving.”
Cynthia Gonzalez was just out of high school when she began working as a nurse assistant at the convalescent home across from her former middle school – Gage Middle School off Gage Avenue in Huntington Park, an immigrant working class hub.
“I noticed a lot of the health care disparities among our community,” she said. “And being able to address those head on, that was one of the reasons I pursued medicine.”
Later as a college student, Gonzalez would commute from her biology classes at the University of California, Irvine (UCI) to work at a raspaderia selling shaved flavored ice in East Los Angeles.
“That was also very difficult work,” she said laughing. “I was working like 12 to 14 hour long days.”
After about $350,000 in loans, 14 years of study and training post-high school, and many raspados later, Gonzalez is now a family physician, practicing back in the Huntington Park barrio where she grew up.
“The patients in Huntington Park are like my family. They’re my tias, my abuelitas, my cousin’s kids,” Gonzalez said. “They’re very grateful, as well, when they see a Spanish speaking, Latino physician come into the room.”
“I deal with patients who are undocumented or have no insurance. And so trying to navigate through that and provide the best patient care that I can is one of the difficulties that I’ve come across,” she said.
Growing up, Gonzalez was raised by a single mother, her brother, grandmother, and uncles. The family got by with government assistance and free church meals, while her mother, a seamstress with a 4th-grade education from Mexico, worked multiple jobs. With her background, she can relate to her patients, she said.
“A lot of patients, as soon as they see a familiar face, and then you speak the language, they feel so comfortable,” Gonzalez said, “and you just see and feel the sigh of relief because they’re like, ‘Okay, I can speak to someone in my language, I don’t need an interpreter,’ where a lot of things can be lost in communication.”
Gonzalez’s brother was the first in the family to go to college, but she was the first to leave home, her Huntington Park barrio, for school at UCI. There, she was one of the few Latinas in the dorms.
“It was very, very lonely sometimes as a Latina pursuing a bioscience degree,” Gonzalez said. She ended up befriending at least one other Latino, who is now a psychiatrist. “I got lucky and I knew one,” she said.
Gonzalez also had to deal with a lack of mentors – no one in her family had pursued medicine.
In the end, she racked up about $350,000 in school debt, including costs for housing.
“When you come from humble beginnings and not being wealthy, you have to think about that,” she said. “It often scares people.”
She shares her experience with her mentees, encouraging them to see the long journey as an investment. “Otherwise, it becomes very, very overwhelming to think about getting in debt to pursue something that is hopefully to give back to your community,” she said.
Being among the few Latina doctors out there, Gonzalez said that she feels a mixture of pride and fear.
“I’m worried about our patients not getting the care that they deserve. I feel great and proud for the work that I do,” she said. “But I also feel like there’s a lot of room to make sure that we are doing whatever we can as Latinx physicians to walk others through that path as well.”