Plan to Bring In Mexican Doctors May Be Revised

A program aimed at bringing 30 Mexican doctors to care for migrant farm workers in the state’s most underserved rural pockets has stalled because proponents have not found a medical school in California willing to oversee it.

The Licensed Physicians and Dentists from Mexico Pilot Program was hammered out last year in legislation carried by Assemblyman Marco Firebaugh (D-Los Angeles). By allowing Mexican professionals who are not licensed in the U.S. to practice here, it appeared to set nationwide precedent.

But although the dental portion is proceeding with only slight delay, the physician program, slated to begin July 1, now appears to be in jeopardy. Frustrated backers blame medical schools, whose oversight is required by the legislation and without which funding for the program is unlikely.

“Their concern is that if anything goes wrong, it’s their reputation that’s on the line,” said Arnoldo Torres, executive director of the California Hispanic Health Care Assn., which crafted the bill. “If we can’t get a medical school on board in the next few months, we will have to try to amend the bill” to remove the oversight provision.

Proponents of the bill argued that Mexican professionals would be well-suited to treat farm workers in California, who receive little or no medical care and suffer disproportionately from a range of chronic ailments.

“The bottom line is these patients aren’t being seen by anyone,” Torres said. “Negligence is destroying them -- negligence by the community at large. We offered an alternative.”

But the California Medical Assn. opposed the bill, saying it created a two-tiered system of care because all other physicians practicing here must pass the U.S. Medical Licensure Exam. The organization said it would oppose any future effort to remove the oversight provision.

“We do not think that setting up multiple-tiered licensing criteria is a good idea,” said Dr. Anmol Mahal, a Fremont gastroenterologist who is vice chairman of the California Medical Assn.’s board of trustees.

The medical group devised its own solution to the health care shortage -- the California Physicians Corps Loan Repayment Program. That program, which pays off up to $105,000 in U.S. medical school loans for “culturally or linguistically competent” physicians who agree to work in underserved areas, is now moving forward.

The Medical Board of California funded the effort with $3 million in licensure fees, and 32 doctors are dispersing across the state this summer, said Kevin Schunke, the board’s loan repayment program manager. The Central Valley towns of Shafter and Livingston are among those receiving help, although many doctors will be working in larger urban areas, he said.

The Mexican physician program, meanwhile, has been plagued by difficulties. According to Torres, some medical schools have declined to discuss participating. Torres said USC’s medical school agreed to participate but only if the physicians worked in its Los Angeles clinics and after the school conducted a feasibility study.

Torres bristled at the suggestion, saying urban areas were never the target of the bill, which stemmed from a round of discussions by the board of directors of Clinica de Salud del Valle del Salinas. That web of clinics serves many non-English-speaking farm workers but lacks Spanish-speaking doctors.

USC officials could not be reached for comment. The office of Firebaugh, who wrote the bills on both the Mexican program and the CMA-backed effort, did not return calls for comment.

Meanwhile, the dental program is proceeding more smoothly because California law already allowed for certification of foreign dental schools. Torres said a school in Leon, Guanajuato, has received provisional approval by the Dental Board of California. If final approval is granted in the fall as expected, 30 dentists could then begin arriving to work three-year stints in rural communities.

Medical and dental care is sorely lacking for California’s more than 1 million agricultural workers. According to research funded by the nonprofit California Endowment’s Agricultural Worker Health Program, workers suffer from a higher incidence of high serum cholesterol, high blood pressure and obesity than the general population.

The report, titled “Suffering in Silence,” found that though more than one-third of women reported a medical visit in the five months before the survey, nearly a third of men said they had never been to a doctor or clinic in their lives. Nearly one-fifth of those who said they had visited a doctor or clinic went to Mexico for that visit. Furthermore, half of all male subjects and two-fifths of female subjects surveyed had never been to a dentist.

Mario Gutierrez, who directs the nonprofit’s agricultural health initiative, called the Mexican doctor pilot program “a potentially solid approach to solving the problem on a short-term basis,” but added that persuading workers to see a doctor, and surmounting indigenous dialects, are other problems that must be overcome.

The California Endowment is eager to back the Mexican physician program, but believes oversight of the doctors is crucial.

“We have no question that the medical students sent here would be top-of-the-line physicians. The Mexican system is recognized as being of high standard,” Gutierrez said. “It’s more a question of comprehension of the medical system [here], and the use of pharmaceuticals.”