By Jade Pearce

In this Q&A, University of Washington School of Public health faculty Antoinette Angulo, Maggie Ramirez discuss their work on improving Washington state’s Latino physician workforce in their recently published paper.

Can you share the background behind your team’s decision to conduct research in the Latina/o physician workforce and health care?  

AA/MR: The study originated from one of our partners, Sea Mar Community Health Centers, a federally qualified health center in western Washington. The keynote speaker at Sea Mar’s annual Latino health forum in October 2019 was Executive Director Sonja Diaz from the Latino Policy and Politics Initiative at the University of California, Los Angeles. She presented on the findings from the California Physician Shortage Study where they looked at who comprised the physician workforce in California, and they zeroed in on Latino physicians. The numbers were abysmal; while Latinos comprise 40.3% of the state’s population, only 11.6% of medical school graduates were Latino. They realized that if current recruitment and admissions practices continued, it would take 500 years to reach parity in the state.  How are the health care needs of California’s diverse Latinx/e population being met in a linguistic and culturally responsive way when there is a shortage of trained bilingual and bicultural health care workers to appropriately provide that care?  Gino Aisenberg, co-director of the UW Latino Center for Health (LCH), was also at the presentation and our jaws dropped. Rogelio Riojas, the CEO of Sea Mar Community Health Centers, approached us and asked, “How bad is it in Washington state? We need LCH to investigate this.” This is how the work kicked off.   
 

This paper read like a community engagement plan (stakeholder engagement, data interpretation, policy guidance, public relations, and promotion to legislation). Where is this process currently?    

AA/MR: We attended Sonja Diaz’s presentation in October 2019, then we presented this study to the Washington State legislature, and it gets approved with the proviso to fund it in 2020. We convened stakeholders in the medical education ecosystem across Washington state in the spring of 2020, and then COVID-19 happens. We met once in person, which helped to begin building trust in our working relationship together, but pivoted like everyone else to virtual meetings, which happened to be a benefit to many eastern Washington stakeholders.

We then had to consider how the policy recommendations identified by this committee were going to be rolled out to a larger audience for further discussion and vetting. In fall 2020 we hosted a statewide virtual symposium. We wanted to engage more community partners and bring in more people who would be impacted and interested in the issue. This additional input helped finalize the policy recommendations we presented to the state legislature. We reached out to the media with press releases to mainstream and local ethnic media outlets in English and Spanish to cover the issue and raise awareness among the general population. Representative (now Senator) Javier Valdez in north Seattle and Senator Emily Randall in Kitsap County championed the issue among their colleagues in the state legislature. We assumed with the pandemic that legislative asks needed to be budget-neutral for the 2021 legislative session, so we focused on these policy recommendations. However, COVID-19 further emphasized the inequitable health outcomes (number of COVID-19 cases, hospitalizations and deaths) and disparities along ethnic and racial lines. The murder of George Floyd ignited a renewed commitment to address these racial inequities, and racism was declared a public health crisis. As a result, Senator Randall rolled up recommendations about medical and residency admissions into SB 5228.hen, Representative Valdez was also able to roll up the policy recommendation addressing a residency pathway for international medical graduates into HB 1129.  

With the passing of SB 5228, publicly funded medical schools and residencies are establishing representation goals. By 2025, the state will mandate these schools to publicly post these goals and report on them thereafter.   
 

What were the most surprising and interesting findings from your analysis and interpretive work?  

AA/MR: While Latinx/es make up 13% of Washington state’s population, Latinx/e physicians comprise 3% of the state’s physician workforce. Further, “among the practicing physicians, only 11% received their degree in the WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) region. Within Washington state, there are several predominantly Latino counties in central and eastern Washington who do not meet the federal standard for ratio of primary care providers to the population (1:3,500). Also, the GIS map that our data team generated summarizing the ratio of Latino physicians to 100,000 Latinos per Washington county allowed us to see for the first time that the vast majority of licensed and practicing Latinx/e physicians in the state were clustered around the urban I-5 corridor, mainly across King, Pierce and Snohomish counties. It was the high concentration of this workforce here that was most surprising. We had known of the health workforce shortage in rural areas, but we didn’t imagine it to this extent. This dynamic presented an opportunity to strategically recruit and train more Latinx/e physicians in central and Eastern Washington, which includes the top five counties where most Latinx/es live (Adams, Franklin, Yakima, Grant, and Douglas counties).   
 

Unlike traditional academic papers, this article states a call for action. What do you hope this paper can achieve?   

AA/MR: The goal is to achieve health equity for all Washingtonians. By sharing our case study with a wider audience, we can inspire other researchers to partner in a meaningful way that bridges their research with policy making to achieve large-scale impacts. This is especially important when dealing with issues caused by systemic and institutionalized racism that have prevented so many BIPOC people from thriving and contributing to society at their full potential. The unique policy solutions that come from meaningful multisectoral and community partnerships are needed to disrupt these systems in which racism is deeply rooted in. As researchers, we have a responsibility to inform policy through research and evidence in order to advance health equity statewide.