The Hispanic Doctors Who Refuse to See Spanish-Speaking Patients Without an Interpreter

When a patient and a doctor are unable to communicate, a certain kind of silence descends upon the hospital room. Something heavier than the quiet of serenity or trust. Laura Martinez, PhD, is familiar with that quiet. Growing up in the mostly Mexican-American neighborhood of Boyle Heights, California, east of downtown Los Angeles, she went to doctor’s appointments with her parents and translated their symptoms, anxieties, and medical histories into English for doctors who never once asked if anyone in the room spoke Spanish. She never forgot that she worked as a professional interpreter when she was younger.

Eventually, that encounter led Martinez to pursue research, particularly in the area of language concordance, which is the clinical term for what occurs when a patient and a doctor speak the same language. It seems like a minimal requirement. It is still an ideal in a large portion of American medicine.

The figures present an annoying picture. 19% of Americans are Hispanic. Approximately 70% of them, or 42 million people, speak Spanish at home. However, only 2% of non-Hispanic doctors speak Spanish, and only roughly 6% of doctors in the nation identify as Hispanic. There is more to that gap than just a staffing problem. It has direct, quantifiable effects, according to researchers: patients who do not have a language-concordant provider are much less likely to return for follow-up care, are more likely to misunderstand their diagnoses, and are less likely to take their medications as directed. These are not abstract concepts. They are results.

For years, Yohualli Anaya, MD, an associate professor at the University of Wisconsin School of Medicine and Public Health, has studied this disparity in the workforce. “When we have examined the representation of languages within the physician workforce,” she states, “Spanish was the most underrepresented of all the languages in comparison to population.” That framing is important. This is about a language spoken by tens of millions of people being systematically underrepresented in the rooms where health decisions are made, not just about comfort or culture.

The medical establishment has largely ignored this issue, but the doctors fighting against it—the Hispanic doctors who won’t see Spanish-speaking patients without the assistance of a qualified interpreter and who maintain that ad hoc workarounds don’t constitute care—are calling attention to it. Advocates in this field believe that patients have been subtly burdened by the system. Learn English or take care of things. In the words of Pilar Ortega, MD, who created the University of Illinois at Chicago’s medical Spanish program: “People have this idea — they subtly blame patients for not speaking English.” She notes that people who speak English never have to worry about whether their doctor will understand them. This presumption is a privilege, and most American medical institutions haven’t really addressed it because it’s ingrained in the system.

Language is inextricably linked to race, culture, and trust, which makes this more difficult to sort out. Black patients who see doctors who share their race have better health outcomes, such as reduced infant mortality and increased medication adherence, according to research. Language barriers exacerbate preexisting mistrust and cultural misunderstanding in Latino communities. According to Anaya, it’s layered. And just because a hospital hires a phone interpreter at the last minute doesn’t mean those layers vanish.

The Latino medical communities themselves are home to some of the most intriguing conflicts. Many Hispanic and Latino medical students were raised speaking Spanish at home; they are heritage speakers with true linguistic fluency who bring valuable skills to medical school and frequently leave without developing them. Almost all medical students in the United States are trained in English. When Spanish-language programs are available, they are frequently intended for novices. A beginner’s course is inadequate for a student who grew up speaking Spanish with their grandmother but never learned clinical terminology, but it is often the only option available. These students carry the ingredients but aren’t given the kitchen, which Ortega characterizes as a paradox.

Perhaps something more structural than awareness campaigns or electives is needed to move forward. According to Anaya’s research, it would take 500 years for California, which is currently 40% Latino, to achieve proportionate Latino physician representation if current trends continue. Five hundred years. That number has a way of making small steps seem insufficient. Proponents are advocating for residency programs specifically created to support Spanish-speaking communities, specialized training pipelines, and standardized tests of medical Spanish proficiency. Not as extras. as prerequisites.

As all of this takes place, it’s difficult to ignore the fact that the doctors who are taking a firm stance—those who demand appropriate language assistance before entering an examination room—are, in a sense, doing what the system ought to have done for them all along. They won’t allow patients to pay for institutional failure. That’s not being stubborn. From this vantage point, it appears to be a standard of care.