Abstract
Purpose: The population with limited English proficiency (LEP) in California is growing. We sought to determine whether enough primary care physicians (PCPs) have the language skills to meet patient needs.Methods: The authors determined the number of PCPs who self-report proficiency in the five most common non-English languages spoken in California (Spanish, Cantonese, Mandarin, Tagalog, and Vietnamese) using Medical Board of California data from 2013 to 2015. The authors estimated LEP populations during 2011–2015 using Census data. They calculated PCP supply (the ratio of PCPs/100,000 LEP individuals) compared to a federal standard to judge adequacy. They performed a sensitivity analysis adjusting the percentage of LEP patients in a bilingual physicians' practice from 100% to the percentage of LEP individuals in California who spoke that language.Results: Of 19,310 PCPs in California, 15,933 (83%) provided information about languages they speak. There were 5,203 (33%) Spanish-, 486 (3%) Cantonese-, 986 (6%) Mandarin-, 956 (6%) Tagalog-, and 671 (4%) Vietnamese-speaking PCPs. PCP supply, compared to a federal standard, was adequate if we assumed that bilingual PCPs only care for LEP patients. However, if one assumes the number of LEP patients in a PCP's practice reflects the percentage in the general population, there is a large PCP undersupply for all languages.Conclusion: Estimates of access to language-concordant PCPs for LEP individuals are sensitive to assumptions about the percentage of LEP patients in a PCP's panel. Ensuring language-concordant access will require deliberate effort to match LEP patients with bilingual PCPs.
Highlights
Sixty-four million Americans speak a language other than English at home and nearly 26 million of those report limited English proficiency (LEP)—defined as speaking English less than ‘‘very well.’’1 These numbers are expected to grow over the few decades.[2]
We examined Medical Board of California data to determine the numbers of primary care physicians (PCPs) who self-report proficiency in Spanish, Cantonese, Mandarin, Tagalog, or Vietnamese
We restricted our analysis to PCPs (Family Medicine, Internal Medicine, General Practice, Geriatric Medicine, and General Pediatrics physicians) with a practice address in California, who renewed their licenses between September 2013 and August 2015, who were involved in direct patient care for 20 hours or more per week, who were no longer in training, and who responded to the question on non-English language proficiency.[18]
Summary
Sixty-four million Americans speak a language other than English at home and nearly 26 million of those report limited English proficiency (LEP)—defined as speaking English less than ‘‘very well.’’1 These numbers are expected to grow over the few decades.[2] Language barriers between patients and their providers have been linked to a number of disparities, including less patient-centered care, decreased receipt of recommended preventive health services, diminished joint decision-making, poor patient-physician communication, and difficulties developing trust.[3,4,5,6,7,8] language discordance can present additional barriers to health systems, as it is associated with increased interpreter costs, lower provider and patient satisfaction, and increased opportunities for medical errors.[5,7,9] In contrast, language concordance (i.e., when patients and physicians speak the same language) is associated with improved quality of care, including improved control of chronic medical conditions, greater health education received, and improved adherence to medications, compared to reliance on professional interpreters.[4,10,11,12].
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