Oncologist John ******, MD, 65, was first inspired to learn Spanish when he found that once diagnosed, his Hispanic cancer patients here often sought treatment in Mexico, where they were more comfortable. “I felt bad about it,” he says. He was also frustrated trying to convey information to patients while on rounds when translators were not available. So he immersed himself in Spanish-first in Cuernavaca, Mexico, in 1996, and then in Costa Rica in 1999. Now, as the only Spanish speaker in a seven-person group practice, his colleagues send their non-English-speaking patients to him. For doctors, it’s a mixed blessing, but one that’s here to stay.

Spanish is the most widely spoken language in the U.S. after English, and the number of Spanish speakers is rising. In 1990 17.3 million people over age 5 spoke Spanish at home. By 2000 the number jumped to 26.7 million, about half of whom speak English “less than very well.” At midcentury Hispanics are estimated to represent one quarter of the U.S. population.

Besides the need to better communicate with patients, physicians are being prodded by federal mandates to learn to roll their R’s. In the summer of 2000 former president Bill Clinton signed an executive order in essence requiring doctors who accept Medicaid and Medicare Part A payments to pay for interpreters for patients with limited English proficiency.

Arguing that the expense is overwhelming, the AMA and all 50 state medical societies are seeking to have the order repealed. Until that happens, physician groups are supporting legislation to have the federal government pay for translators. Meanwhile, physicians who fail to comply could be disenrolled from Medicare and Medicaid programs, though sanctions cannot be imposed until HHS notifies physicians and requests voluntary compliance.

“The impact is that doctors are going to try to go with things less costly. That means learning Spanish themselves instead of hiring translators,” says Elena Rios, MD, president of the National Hispanic Medical Association.

Many physicians find learning Spanish can be a rewarding experience. When Miami internist Stacey Murray, MD, joined a Hispanic physician, her partner paid for her immersion course in Costa Rica. Dr. Murray was so thrilled with her experience that she wrote about it for an article published in Diversion. Now she speaks Spanish with about 20% of her patients.

Even outside California, Texas, Florida, and New York-states with large Hispanic populations-doctors are seeing a need to habla Español. Minnesota EP David Dvorak, MD, sees at least one Hispanic patient with limited English on every shift. “It’s stressful enough for patients to be in an ER,” he says.

Dr. Dvorak took Spanish classes in high school and later attended an adult education program, yet didn’t feel he attained fluency. In November 2000 he spent a month in Costa Rica living with a multigenerational family while attending the Costa Rican Language Academy. Now he introduces himself in Spanish to Hispanics. “It puts patients considerably at ease,” he says.

Spanish-speaking doctors may also find they are more attractive job candidates if they are English-Spanish bilingual. “Requests for Spanish-speaking MDs have doubled in the last five years,” says Don DeCamp, of the physician placement firm CompHealth, in Salt Lake City. And, adds David Faries, of Staff Care Inc., Dallas, “Demand for bilingual doctors is creeping up in unexpected locations, like Arkansas, eastern Colorado, and rural Indiana.”

Bilingual doctors are reportedly good for the health of Hispanic patients. One fifth of Spanish-speaking Latinos in fast-growing Hispanic communities say they do not seek medical treatment because of language barriers, according to a report by Robert Wood Johnson Foundation.

Language barriers make it much harder to fully explain symptoms, ask questions, and follow through with filling prescriptions. When patients use family or friends as translators, there are failures to disclose information, inaccuracies, confidentiality violations, and rapport issues, according to a 1994 report published by the American Public Health Association, “Latino Health in the U.S.: A Growing Challenge.”

Robert Wood Johnson is offering grants of up to $1 million to doctor groups and other health professionals willing to provide translators to patients, through its program, Hablamos Juntos, or We Speak Together.

Medical Spanish may become a required course in some medical schools. At least one school that offers the class as an elective, U. Texas at San Antonio, is considering making it mandatory. Other schools offer it as an elective, such as Vanderbilt and Chicago Medical School.

For doctors eager to accelerate the learning curve, there are dozens of Spanish-language schools in Mexico and Central and South America.

Frequently, salsa lessons, Hispanic cooking sessions, and excursions to attractions are available. One-month stays with room, board, and instruction average between $800 and $2,000 without airfare. Husband-and-wife forensic pathologists George Thomas and Jill Gould of Jacksonville, Ore., paid only $650 each for private lessons, room, and board when they underwent an immersion program in Antigua, Guatemala, in 2000. Dr. Gould called it “a fantastic experience.”

She adds, “I love to be able to express myself in Spanish so that families understand what my investigation has found.” -- Maureen Glabman
http://www.physweekly.com/article.as...=7&articleid=8

when i went on my residency interviews, the fact that i am fluent in spanish was mentioned at EVERY interview. when you get to residency, you will find that most of your clinic patients are the indigent, or not-wanted patients of the area. my spanish skills mean i deal with less psych patients and less drug addicted patients. in our clinic, i get all the spanish speakers. they all, or close to it, are stuck with our clinic due to a lack of english, a lack of insurance, or a combination.

jim,
Hablo espanol tambien, is it a great "edge-up" on the others who do not speak spanish? If so, how much? would you not have gotten the placement you did if you didn't speak spanish?

when it comes to lack of insurance, how is the clinic compensated? medicaid?

the clinic we have is set up for the residency. it is paid for by medicaid and medicare, as well as some other govt grants. my hispanic patients are divided up about 40% mexican, many of whom are just farm workers, and have no insurance. the rest are the ones my boss likes. they are colombian and venezuelan, here on political asylum, working, educated, and .....INSURED!. because of this group, i believe that i actually have the highest reimbursement of the residents at my clinic. as for getting my job, its hard to say. I was heavily recruited by a few places, but this place was way better then all the others, so i ranked it number 1. i am sure my scores helped alot, but i think my spanish skills probably would have been the difference if i had a competitor who had equal scores. the area i am in doesnt have a large hispanic population. soem fo the places who seemed very interested in me did. when it comes down to your app, there are many "intangibles", thinsg that many people dont take into account. i dont recall that there was even a question on ERAS about foreign language skills, but i knew that if i mentioned them, it would be something different, that most of the competition(including USgrads) couldnt match me.

and the need is only getting greater for spanish speaking docs.