Immigrant Health

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Even With Obamacare, Many Latinos Still Seek Medical Care in Mexico

Dr. Cecilia Espinoza meets with her patient Irma Montalvo. Montalvo, a U.S. citizen, prefers to travel to Mexico for health care, even though she signed up for a health plan through Covered California (Heidi de Marco/KHN).

Dr. Cecilia Espinoza meets with her patient Irma Montalvo. Montalvo, a U.S. citizen, prefers to travel to Mexico for health care, even though she signed up for a health plan through Covered California (Heidi de Marco/KHN).

By Anna Gorman, Kaiser Health News

TIJUANA, Mexico – Irma Montalvo signed up for a health plan through Covered California, the state’s insurance marketplace, last month, getting coverage for the first time in eight years.

“To be honest, I like to come here better even if I have insurance.”
But when she needed treatment for a painful skin rash, Montalvo didn’t go to a doctor near her home in Chula Vista. Instead she drove to Mexico, about 16 miles south. Her doctor, Cecilia Espinoza, diagnosed her with shingles and prescribed medication to relieve pain and head off complications.

Montalvo, 64, said she comes to Tijuana in part because it costs just $15 to see the doctor. She can’t use her insurance for care outside California but it’s still cheaper because she doesn’t have to worry about a deductible. More important, she said, is that she feels comfortable with Espinoza.

“She listens to me,” said Montalvo, a U.S. citizen who was born in Mexico, said in Spanish. “I come here feeling really bad, and three days later I am better.” Continue reading

Immigrant Doctors Help Ease California’s Primary Care Doctor Shortage

By Jenny Gold, Kaiser Health News

Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News).

Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News).

It’s a familiar story in California.

When Jose Chavez Gonzalez moved to the United States from El Salvador, he took any job he could get — stocking warehouses, construction, cleaning houses and working in a meat processing plant.

But unlike most of the other immigrants he worked alongside, Chavez, 38, was a doctor with eight years of medical training. He came to the U.S. in the mid-1990’s to be with his family, but like all doctors from other countries, he still had to pass the U.S. medical boards and go through at least three years of residency in order to practice here. The process can be both expensive and time consuming, so during the day he worked various menial jobs. At night he studied for the boards.

Hundreds, maybe thousands, of immigrant doctors from Latin America could be practicing, but are instead working other –- often menial –- jobs. That’s a wasted resource.
“I had to do it. And I wouldn’t complain,” says Chavez. “It was OK to me. I mean, of course medicine is my passion, but since I didn’t have a license here, I couldn’t practice it.”

A quarter of U.S. doctors are foreign-born, mostly from countries like India that focus on training ­­medical students to work in the U.S.  Many other immigrant physicians never become American doctors, particularly those who come from Latin American countries like Chavez.

But a program at the University of California is seeking to change that, while at the same time helping to address the shortage of primary care doctors in the state. The UCLA International Medical Graduate Program offers Latino doctors a stipend along with board preparation classes, mentorship and references to help them find a good residency slot in primary care. In return, the doctors pledge to work in an underserved area of California for two or three years. Continue reading

As ‘Bodega Clinicas’ Fill Void, Officials Torn on Embracing Them

By Sarah Varney, Kaiser Health News

(Sarah Varney/Kaiser Health News)

The so-called bodega clinicas that line the streets of Los Angeles’ immigrant neighborhoods blend into a dense forest of commerce. Wedged between money order kiosks and pawn shops, these storefront doctors’ offices treat ailments for cash: a doctor’s visit is $20 to $40, a podiatry exam is $120 and at one bustling clinica, a colonoscopy is advertised on an erasable white board for $700.

County health officials describe the clinicas as a parallel health care system, servicing a vast number of uninsured Latino residents, yet the officials say they have little understanding of who owns and operates them, how they are regulated and the quality of the medical care they provide. Staffed with Spanish speaking medical providers, few of these low-rent clinics accept private insurance or participate in Medicaid managed care plans.

“Someone has to figure out if there’s a basic level of competence,” said Dr. Patrick Dowling, professor and chair of the department of family medicine at the David Geffen School of Medicine at the University of California, Los Angeles.

Not that researchers haven’t tried. Dr. Dowling, for one, has canvassed the local clinicas for years as part of his research for the state to document physician shortages. What he and others have found, however, is that clinca owners were reluctant to answer their questions. Continue reading