AAMC Reporter: February 2005

Dual Degree Addresses Latino Health Needs

This is the second installment in a 2005 series of columns profiling individuals who work to increase diversity in academic medicine.

Last year, California's population reached a new milestone. For the first time, more than 50 percent of infants born in the state were of Latino heritage. Within 20 years, Latinos will comprise a near majority of the state's population, but the number of Latino physicians serving the community lags behind. For every 3,000 Latino patients there is one physician of the same heritage.

The University of California at Irvine College of Medicine hopes to improve the ratio through its Program in Medical Education for the Latino Community (PRIME-LC). This five-year initiative, in its first year, trains medical students and residents of all ethnicities who want to serve the Latino population.

Students receive both a medical degree and either a master's in environmental health science and policy or business administration. The dual degree program prepares participants to make a significant impact on Latino public health, said Alberto Manetta, M.D., Irvine's senior associate educational dean who is the program's founder and director.

"We're looking for a commitment to the underserved Latino community," he said. "That's far more important to us than MCAT scores, but students still must meet all medical school requirements."

In addition to satisfying all necessities to enter medical school, Dr. Manetta said the program requires that students speak Spanish, be culturally competent, understand alternative medicine, cultural or family values differences and possess knowledge of Latino history and geography.

The combination of skills helps the physician communicate effectively with patients who speak little or no English and have limited experience with the healthcare system.

Intensive Training

Carl Smith, a first-year medical student, attends to a patient in Cuernavaca, Mexico

In the beginning of the program, students move to Mexico for a six-week immersion trip where they live with Mexican families and work in local clinics. They speak only Spanish and even though they are not yet practicing medicine, they discuss health problems with various patients throughout the day. The goal is familiarizing the students with the culture and with health issues that are specific to the community.

The majority of coursework is identical to medical school curricula at other institutions, but according to Jose Rea, PRIME-LC's academic coordinator, some classes are modified to address Latino concerns. Administrators also created some courses not offered at other schools.

For example, the program offers "Physical and Human Interactions: The Politics and Science of Health Care for the Latino Community," and "Border Medicine: Medical, Legal, Social and Cultural Issues of Latino Immigrants."

Dr. Manetta said medical schools do not provide students and residents with the necessary Latino cultural background. Consequently, despite several healthcare initiatives both in California and nationwide, the Latino community's medical needs were falling by the wayside. Creating the dual degree program was his contribution to addressing the disparity and preparing competent physicians, he said.

Successful PRIME-LC candidates also have volunteer experience in a Latino community that is more extensive than spending one month in another country. Dr. Manetta said the program looks for past service that demonstrate a desire to help the unfortunate rather than the desire to earn a high salary. This year, 76 students applied to the program, 34 were interviewed and eight enrolled. According to Rea, the goal is to expand the program to 12 students.

Compassionate Care

Dr. Manetta said future success will be measured based on five outcomes including student retention at all levels, practice location, choice of specialty, percentage of Latino patients and what if any, leadership positions they achieve. In Dr. Manetta's view, the program has been highly effective because the students have "enormous enthusiasm and a huge social conviction for treating Latino patients."

Because program administrators want students to maintain their zeal for treating the underserved, they offer students a strong support network to search for residency programs, as well as future positions through the placement office, Rea said. Throughout medical training and after graduation, PRIME-LC plans to offer participants sessions on timely medical information and procedures. Administrators plan to offer continuing medical education courses in the future.

Any PRIME-LC graduate receives priority when applying for residency positions in internal medicine, family medicine, emergency medicine, pediatrics, psychiatry and obstetrics/gynecology at the UC-Irvine Medical Center and its affiliated clinics. The Latino community has a physician shortage in these concentrations.

"We are trying to piggyback and connect with residency programs to address dire needs in the Latino community," Dr. Manetta said. "We already have some programs that have agreed to a partnership with us."

To address concerns about student debt, the program provides students with financial incentive to work in the Latino community. Students accepted into the program can apply each year for an annual $7,000 need-based scholarship. In addition, graduates who establish a practice or work in an underserved area are eligible for the Office of State Health Planning and Development (OSHPD) loan repayment program that offers up to $120,000 in loan repayments.

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