By Alejandra Rincón, Alana Pfeffinger and Alicia Fernández
The Latinx community in the Bay Area has been hit hard by COVID-19. In San Francisco, for example, Latinx residents make up 15% of the city’s population, yet they represent 49% of all confirmed COVID-19 cases. A recent UCSF population-based study in the ethnically diverse San Francisco Mission district found that 95% of those testing positive for Covid-19 were Latinx even though Latinx people made up only 44% of those tested.
Drivers of this disparity are easy to understand. Nearly everyone who tested positive in the UCSF Mission study reported being unable to work from home. The economic imperative to leave home to work, or working in an essential occupation, places these low wage workers at increased risk. Combine excess exposure risk with multi-generational households or the crowded living conditions created by this expensive area, and it is easy to see why the Latinx community has disproportionate numbers of Covid-19 cases and hospitalizations.
Addressing the complex interplay between social factors –such as low wages, no sick leave or health insurance and, in some cases, fear of immigration authorities– and Covid-19 public health measures will require an effective healthcare and public health workforce.
Spanish language skills and cultural competence are necessary to help many Latinx patients navigate Covid-19 testing and contact tracing. Research has shown that patient trust, comprehension and even some health outcomes such as blood sugar control in diabetes are better when patient and doctor speak the same language. In addition, Latinx physicians, like others underrepresented in medicine, are more likely to work with underserved populations. Unfortunately, Latinx healthcare workers, particularly primary care physicians, are in short supply.
California has a shortage of primary care physicians. The 2019 report of the California Future Health Workforce Commission predicts a shortage of over 4,100 primary care clinicians by 2030. This need is more acute in areas of the state with the highest concentration of Latinx residents such as the Central Valley. Currently, California produces Latinx physicians in astonishingly low numbers. Out of 1,172 medical school graduates in California in 2019, only 98 individuals or 8.4% were Latinx. The impressive growth of the Latinx population – now 39% of the state—makes these low numbers even more dramatic, both because there are so many young people who could become physicians, and, because the need so outstrips the supply. A 2016 analysis from UCLA Fielding School of Public Health found an overall shortage of 54,000 Latinx physicians across all specialties. It is impossible to make up this deficit without a massive and sustained effort.
Governor Newsom’s January budget planned for significant investments in California’s physician workforce including a $25M investment in UC Riverside School of Medicine and a $15M investment in the UCSF Fresno medical campus in partnership with UC Merced. While the May budget proposal made large cuts to these investments, most of the original investments have been reinstated (including Song-Brown funding) and these are now back at the Governor’s desk with the joint endorsement of the State Assembly and the Senate.
We recognize that California will be facing hard fiscal choices this year. Some stakeholders may be tempted to meet other important obligations by cutting these investments. However, Covid-19 has underscored an important truth: a healthy society requires a strong clinical and public health infrastructure. In California, that includes a racially, ethnically and linguistically diverse clinical and public health workforce.
The health inequalities exacerbated by Covid-19 are not new nor will they disappear with an effective vaccine. The mismatch between the state’s population and its health workforce needs correction. Plainly said, California needs both more primary care physicians and more physicians from underrepresented backgrounds. California must invest to create the diverse physician workforce it needs.
Alejandra Rincón PhD, Alana Pfeffinger MPH and Alicia Fernández MD are affiliated with the Latinx Center of Excellence at the University of California San Francisco.