S7E22: Bridging the Gap—Latine Representation in Medicine

Hạ: Oh, yeah, I see the waveforms. Technology is so hard. Hello, dear listeners. We are here again on the virtual studio. This is Hạ. And so I am really excited for this episode today because I have two very awesome guests on, and I will let them introduce themselves.

Vida: Hi, I'm Vida Sandoval. I use she/her pronouns. My hometown is Sacramento. Both of my parents are born in Mexico. I am at UCSF in the pediatrics program with Hạ, and I'm specifically in the Plus program, which is our health equity track. I'm a second-year, and in terms of plans after residency, I think my goal is to continue working with newcomers and Spanish-speaking immigrant children and their families.

Marisol: Hello, my name is Marisol Solis, she/her pronouns, third-year medicine resident, last year of residency. I'm part of the primary care track, and then I will be a primary care doctor.

Hạ: Cool. And so the reason why I have Vida and Marisol here today is because they are co-founders of a really, really awesome organization at UCSF, and I really wanted to have their insights about it. I would love for them to introduce it. Marisol, would you be open to talking a little bit about it?

Marisol: So we are La Comunidad en Medicina. We are a group of 84 residents across 17 departments at UCSF, 53 medical students, 79 staff members. And really, this just started about six months ago as Vida and I met through a health equity and racial justice league, and it just kind of snowballed.

We created this group chat and started including other Latine residents who we know and then started reaching out. And it still continues growing, and I'm just amazed by how fast it has grown and how beautiful people have responded to this. It's been an incredible last six months that feels like forever, but it's been just truly, truly rewarding.

Vida: I was so happy that Marisol and I sat next to each other that day because we really just started talking about how we wanted to build this community, and we felt like it didn't exist yet. And so we chatted.

Like she said, we added all of our friends, and then we started social media and started reaching out to folks at UCSF to help us. And we're really hoping to grow it past our institution and continue to build this community. So we're really excited about it.

Hạ: This story fills my heart with so much warmth. It feels very clandestine. How do you pronounce it? Clandestine? I pronounce things really wrong, but it felt really perfect that you two met each other and were able to do this.

But all of this is just to give a preview about what I was really hoping to talk about today for the episode. For this season, one of the things that we've been focusing on is an overarching theme of exploration and discovery. And we really like to go for broad themes because we feel it can encapsulate a lot of the different topics. And also, navigating medicine is this constant ebb and flow of exploration and discovery.

I think a lot about how when you come from systemically-oppressed backgrounds or perspectives, this concept of exploration and discovery becomes really even more nuanced.

And that's why I wanted Vida and Marisol here today, because the topic for this episode is to chat about building community for and advocating for representation of Latinx in medicine.

As always, I need to give a disclaimer that this episode doesn't reflect the views of our associated programs or institutions.

And so, to start off, I can start off with some statistics I quickly saw from the AAMC, which, for people who don't know, stands for the Association of American Medical Colleges.

What they published in about 2023 in one report is that they found that while 1 in 5 people in the U.S. identify as Latinx, only 6% of all U.S. physicians identify as such.

And there have also been a lot of estimates. For instance, the U.S. Census Bureau has projected that the Latinx community will represent 111.2 million people by 2060, so 28% of the total U.S. population. And yet still, there hasn't been a lot of great movement and change in having matriculants to medical school who identify as Latinx. For context, in 2016, it was 10.5% of matriculants, or people entering medical school. And then in 2023, it was 12.7%.

When I start talking about those statistics, what are the immediate thoughts that come up for you, Vida?

Vida: Yeah, thank you for sharing those stats. I think those are really important numbers to be aware of for all of us. And specifically, the one that got my attention that you shared was that only 6% of U.S. physicians identify as Latino or Latina. And that statistic reminds me of something exciting that happened this year, was that we passed in California a National Latino Physician Day, which is October 1st. One of our slogans for that is "Necesitamos más," or "We need more."

And specifically, it reminds me that only 2% of physicians in the United States are Latina. And when I think about the patients that I serve on a daily basis, we see 10,000 patients at the county hospital where I see patients, and of those, almost 8,000 are primarily Spanish speakers. It reminds me that cultural and language concordance is so important when serving our patients. And multiple studies have shown that language and cultural and racial concordance do improve patient health outcomes.

Marisol: I think just hearing those statistics, we all can recognize that this is a problem on so many levels. And while we talked about the statistics across the U.S., it's also really important to recognize the statistics in places where there are a lot of Latine patients, places in California, like where we are practicing, or in Texas.

For example, in California, 48% of the population is projected to be Latino or Latina by the year 2050, which really is not that far from now. As you can probably tell, there's this huge, huge need.

Let's just back up a bit. We already know that there are significant healthcare barriers and poor outcome. Folks are less likely to have health insurance, higher levels of poverty, and especially among people who have recently immigrated. And then even if you do have health insurance, it's super-duper hard to navigate our healthcare system, let alone for us doctors.

I mean, I don't know about y'all, but for me, it's been crazy trying to find a primary care doctor and trying to get all of my stuff. And I'm just like, "How would one do this if you don't speak English?" Obviously, medicine is very English-centric. And then a lot of folks aren't able to read in English. I think just thinking about all of these things as we also recognize the need for increasing workforce.

Vida: Yeah, I totally agree, Marisol. I think about the reasons that I entered medicine, and I think about my family members and how I really wish they all had had someone who spoke their language or took the time to explain all those things in Spanish. And I can't help but wonder how better their care or their health would be today if they had that growing up.

Hạ: Before we really, really dive into the conversation, one of the things I just wanted to clarify with both of you, Vida and Marisol, is a bit about terminology. Typically I often hear a lot of people use Latinx, but I've been hearing you all use Latine. Did I say that wrong?

Marisol: You said it right.

Hạ: Okay. But I've been hearing you both use Latine in medicine a bit more. And so I wanted to understand a bit more about your choice of words.

Vida: Sure. So, for our organization, La Comunidad en Medicina, we're trying to use Latine more than Latinx. It's not that one term is better than the other. It's just that Latine is a word that we feel stays true to the Spanish language and its beauty. The letter X is not commonly used in Spanish, so it's thought to flow more naturally in Spanish and can be pronounced easily in both Spanish and English. That's what we've been using Latine.

I don't know if you have anything else to add about that, Marisol.

Marisol: So another thing that we're trying to do in La Comunidad is incorporate more Spanish. I think a lot of us speak Spanglish naturally and we know that medicine is so English-centric, so also just trying to use a little bit more in our name, like La Comunidad en Medicina, and using Latine and just reintroducing that a little bit more into our language.

Hạ: Thank you for explaining that. I think about this a lot because both in Utah and then now in California, whenever I'm working with patients who speak a language other than English, it is often Spanish, and I don't speak Spanish. And every time I've had to work with interpreters, if they're not an in-person interpreter, it's really, really difficult to get things across.

And then also there's the questions about . . . Marisol had mentioned about literacy, being able to read. And then a lot of times how we convey information is by MyChart messaging. That's how we're trained, is in primary care panels, MyChart messaging, or being able to send discharge paperwork. I often feel like for the patients that need the support the most, we just don't have that system to be able to really execute that care for their exact needs.

And I think it's because there's no one within leadership and within the people thinking about how to set up these systems. There are not really people who come from those backgrounds and understand the experiences of the patients to be able to execute that, and it really frustrates me.

Marisol: Yes, 1,000%. Yes, yes, yes. We obviously need to increase the number of Latine . . . I think just diversity in health, but we're speaking about the Latine physician workforce. But thinking about what leadership looks like too. We're like, "We're doing a great job. We have more medical students. Great. Now we have more residents." I don't know.

Also thinking about, "Who are the people making these decisions?" I think one day we hope it'll be someone who's more representative of the communities that we're serving. But I think we're not really there yet. I think there's progress, but there's so much work to be done.

Vida: How do we get there, Marisol? I don't know. That's a hard question. I think maybe more mentorship. I see a few people at the top. And I think that goes back to the idea of reaching back while you climb, right? Once you're a resident, helping a med student. As a med student, helping the undergrad. And as you get higher in leadership, remembering that there are folks out there who want to be where you are and helping them get to that place. But I agree, there's so much work to be done to get there.

Marisol: This is something I feel like we often don't talk about, but there are a lot of places where people get lost in general, right? You're going from high school to college. I think, in high school, there were a lot of people who were like, "I want to do this, I want to do that," but then it's like, "If I'm a first gen, how do I even get there?"

And then when you're in college, then it's like, "You've got to do O chem and physics," and all the things I tried to put behind me.

And then a lot of people are working and it's really hard to get a good GPA while you're also working and have a lot of things going on.

Then here's the next hurdle, MCAT. I feel like that's a big step right there, where a lot of folks are just like, "This is almost impossible." It's like a full-time job studying for the MCAT. Now imagine having a family or having to care for others, whatever it may be.

And then getting to med school and then matching. There are so many steps along the way where I feel like we need to be more supportive to folks who are underrepresented in medicine if that is our goal, and I think we're not.

I mean, we try. We try, obviously. We all know this, everyone probably listening to this podcast, but we need to make sure that people in leadership and everywhere else are also thinking about this.

Hạ: It is really sad that throughout the whole system, it's not built to really nourish people. It's really built for specifically very privileged people with very specific identities to be able to navigate.

And thinking about that, if you are all comfortable, I would love to hear a little bit about your own reflections about getting to medicine personally too. I think it's a lot of times because whenever I feel really frustrated when I think about systems-level thing, I really like to center it on people's journeys and narratives to try to maybe brainstorm solutions too.

Vida: Yes, I'm happy to share a little bit about my experience. I am the first one in my family to be a doctor. Both of my parents were born in Mexico. I'm a daughter of a construction worker. I'm a granddaughter of farm workers. I'm very proud to be those things because it has shaped me and my experience getting to medicine.

But I think that that imposter syndrome is so real sometimes. You don't see a lot of us here. You don't see people who speak your language or look like you in medicine, and that really starts to affect you.

For my own experience, I had a lot of mentors who helped get me here. But I think intern year was rough for me. There were definitely some low moments where I felt like medicine was not for me, and I actually considered leaving medicine. I took a leave of absence. I took about three weeks off. And I talked to my program director and I was like, "I'm leaving. I can't do this. This is not for me. I don't belong here."

It really was a combination of mentorship and community that kept me in medicine. And specifically, there were a few Latine residents who were third-years at the time who rallied around me, took me out to dinner, and told me, "Hey, you belong here. We need you here." And that really gave me the confidence to keep going and come back eventually.

Eventually, a few months later, I met Marisol, and when we talked about this idea, we were just so excited. And I felt like for me, it was something that I was really excited about because I wanted to create this community that I didn't have intern year and that I feel like could have prevented some of my imposter syndrome and stress.

The other night we had a resident and fellow dinner on National Latino Physician Day, and just there was a moment where Marisol and I were just sitting there observing and looking at this community that we all built together. It was just the most beautiful thing, and I'm so glad that we were able to have that. And I'm excited to see how it continues to grow.

Marisol: I'll share a little bit about myself, too. So I am the eldest of three. My parents are also from Mexico. My dad, farm worker. My mom, she's had a lot of jobs throughout my life, but she's now a factory worker.

My sister spent so much time in the hospital growing up. She had epilepsy when she was little. My dad doesn't speak English. Mom does, but she worked full time. Like so many, I think, children in the Latine community, I grew up interpreting for my dad. I remember calling 911 when she was having a seizure and just being that person. And I was little. I think I was 7 or 8. But I was always wondering, "Why am I doing this?"

I vividly remember asking why people didn't look like us. And I still think about my dad's face and not knowing what's happening to his little girl. I think that just always stuck with me.

And then I think it wasn't until really college that I started learning about social determinants of health and health inequities. I was like, "Oh, hold up. I've seen this before. I know what this is. I've seen it in my family." It's just one example, but I've seen it time and time again. So I just got really excited and I was like, "I'm going to transform healthcare."

I still obviously want to do that, but I think coming into it, I was so naive. Like Vida said, residency is so hard. Intern year was so rough. And I think the more you progress in your career, the lonelier it gets. And so it was really hard.

So when I met Vida, I got really, really excited again because it reminded me of LMSA, the Latino Medical Student Association, which I was really involved in undergrad and med school. And that was very, I think, motivating in such a low moment. It's been amazing.

And shoutout to Vida because I think that, really, it took the both of us. I was very excited, but I was like, "Where do we go from here?" So I think we just kind of fed off of each other's excitement, and now we're here.

I think while it's been really rough, it's also been very beautiful to become people's primary care doctor. And I see my dad, I see my uncle, my grandma, my abuelita, abuelito, and I think those moments make it all worth it. But I have a lot of moments of reflection, and I'm really happy to be here.

Hạ: As I kept listening to you both speak and throughout this whole conversation, the thing that I keep thinking about is what actions can we really take to move forward and to make medicine more inclusive and really be able to have better representation of the Latine community, and really be able to nourish and produce mentorship and also really tackle a lot of the challenges that we've been talking about throughout this episode.

I don't know if there's anything for both of you that immediately comes to your mind. Marisol, do you have any thoughts?

Marisol: You said it. Mentorship, I think, is really the foundation of all of this. But just remembering what happens to folks once they get there. Once you recruit those people, once they're in medical school, once they're in residency, how do we support that community to make sure that they thrive?

Yeah, they're there. Yeah, they bump up the statistics. Beautiful. We're there. But just increasing mentorship along the way and asking people how they would like to be supported, because that can look very different for many people. And as you've mentioned, people who make these rules, it's important to just include everyone in a conversation.

Vida: I think you said it best. I think we need more Latine medical students, and we need more Latine residents. We need more Latine folks in leadership, especially women in leadership at the top and at the table.

And I think radical imagination. Maybe there are some National Latino Physician Day folks who are saying, "Maybe we need a Latine-focused medical school." Let's think bigger. How can we make a bigger change in our community?

Hạ: I guess now just thinking about final things as we wrap up the episode, I really appreciate both of you taking time out of your busy schedules to talk with me. And I guess, looking forward, do you have any final words of wisdom, any encouragement, or any final things that you want people to be aware of, particularly for Latine premeds or medical students at any stage of training or life?

Marisol: I just came back from a Latinas in Medicine conference, which was just so refreshing. And one of the quotes that somebody said was, "Just don't listen to those who don't believe in you," or something along that.

I think, along the way, you will find that a lot of people will tell you, "Don't do this. You can't do this." But if people aren't believing in you, just brush it off and turn to those who do believe in you because you can make it, and you will make it. It's just about surrounding yourself with people who believe in you and will help you get there.

Vida: Yeah, I completely agree, Marisol. I think lean on your community. Lean on your comunidad. Échale ganas. You've got this, because we need you here.

Marisol: Yes. "No te rajes" is what my dad would always say. That was my motto throughout my entire training. It still is.

Vida: Necesitamos mas. We need more. So for folks interested in connecting with us, you can follow us on Instagram @lacomunidad_enmedicina. Feel free to shoot us a DM. We're happy to connect you with folks at UCSF who are in a specialty that you're interested in or help you find some mentors in the community as well.

Hạ: Great. So, once again, thank you both for making time for us. Thank you to our listeners for listening. And as always, you can listen to the podcast wherever you podcast. You can follow @bundleofhers on Instagram, and also highly encourage following La Comunidad, as Vida had said, @lacomunidad_enmedicina. We will also make sure that that information is out in writing, too, wherever you can find us.

Vida: I'm just going to say gracias por tener [foreign language 00:22:48] comunidad. Adios.

Marisol: Igualmente. Muchas gracias.