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Fernandez-Ruiz R, Duarte-García A, Rolle NA, Sattui SE, Saygin D, Dowell S, Alexander SA, Kumar B, Danila MI, Singh N. Supporting International Medical Graduates in Rheumatology: A Call to Action. Arthritis Rheumatol 2023; 75:145-148. [PMID: 36177492 PMCID: PMC9892202 DOI: 10.1002/art.42373] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Ruth Fernandez-Ruiz
- Division of Rheumatology, Hospital for Special Surgery,
New York, NY
- Department of Medicine, Weill Cornell Medicine, New York,
NY
| | | | - Noelle A. Rolle
- Division of Rheumatology, Medical College of Georgia at
Augusta University, Augusta, GA
| | - Sebastian E. Sattui
- Division of Rheumatology and Clinical Immunology,
University of Pittsburgh, Pittsburgh, PA
| | - Didem Saygin
- Division of Rheumatology and Clinical Immunology,
University of Pittsburgh, Pittsburgh, PA
| | - Sharon Dowell
- Division of Rheumatology, Howard University College of
Medicine, Washington DC
| | | | - Bharat Kumar
- Division of Immunology, University of Iowa Carver College
of Medicine, Iowa City, IA, and Kelting Family Scholar in Rheumatology, Division of
Immunology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Maria I. Danila
- Division of Clinical Immunology and Rheumatology,
University of Alabama at Birmingham, Birmingham, AL
- Geriatric Research, Education, and Clinical Centers
(GRECC) Birmingham VA Medical Center, Birmingham, AL
| | - Namrata Singh
- Division of Rheumatology, University of Washington,
Seattle, WA
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Müller F, Holman H, Hummers E, Schröder D, Noack EM. Multilingual competencies among ambulatory care providers in three German Federal States. BMC PRIMARY CARE 2022; 23:315. [PMID: 36474173 PMCID: PMC9724318 DOI: 10.1186/s12875-022-01926-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Providing medical care to newly arrived migrants presents multiple challenges. A major challenge is a lack of a common language in the absence of language interpretation services. We examine the multilingualism of German physicians and clinical psychotherapists providing ambulatory care. METHODS We retrieved publicly available data from the Associations of Statutory Health Insurance Physicians provider registry of three German federal states (Lower Saxony, Saarland, Bavaria). We selected and grouped relevant practice-based disciplines. We used descriptive statistics to analyze the provider's multilingualism among different disciplines. RESULTS 69.6% of ambulatory providers offer consultations only in German. 15.5% of providers reported offering consultations in one additional non-German language, and 14.9% in two or more additional languages. Most common additional languages were English (28.6%) and French (9.9%). 1.4% of providers reported offering consultation in at least one language of the Middle Eastern region (Arabic, Dari, Hebrew, Kurdish, Pashtu, Farsi, and Turkish). There were differences in the offered languages between the medical disciplines with the highest mean rates found for gynecologists and obstetricians, urologists, and general surgeons. Psychotherapeutic disciplines offered consultation in other languages significantly less often. CONCLUSION Our study suggests a significant numeric mismatch in the number of providers offering consultations in the languages of people seeking protection in Germany. The resulting language barriers are compromising equitable access and quality of care.
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Affiliation(s)
- Frank Müller
- grid.411984.10000 0001 0482 5331Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073 Göttingen, Germany ,grid.17088.360000 0001 2150 1785Department of Family Medicine, College of Human Medicine, Michigan State University, 15 Michigan St NE, Grand Rapids, MI 49503 USA
| | - Harland Holman
- grid.17088.360000 0001 2150 1785Department of Family Medicine, College of Human Medicine, Michigan State University, 15 Michigan St NE, Grand Rapids, MI 49503 USA
| | - Eva Hummers
- grid.411984.10000 0001 0482 5331Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073 Göttingen, Germany
| | - Dominik Schröder
- grid.411984.10000 0001 0482 5331Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073 Göttingen, Germany
| | - Eva Maria Noack
- grid.411984.10000 0001 0482 5331Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073 Göttingen, Germany
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Latimer B, Robertiello G, Squires A. Integrating Health Care Interpreters Into Simulation Education. Clin Simul Nurs 2019. [DOI: 10.1016/j.ecns.2019.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Garcia ME, Bindman AB, Coffman J. Language-Concordant Primary Care Physicians for a Diverse Population: The View from California. Health Equity 2019; 3:343-349. [PMID: 31312781 PMCID: PMC6626968 DOI: 10.1089/heq.2019.0035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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.
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Affiliation(s)
- Maria E Garcia
- Division of General Internal Medicine, Department of Medicine, University of California at San Francisco (UCSF), San Francisco, California
| | - Andrew B Bindman
- Division of General Internal Medicine, Department of Medicine, University of California at San Francisco (UCSF), San Francisco, California.,Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco (UCSF), San Francisco, California
| | - Janet Coffman
- Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco (UCSF), San Francisco, California.,Department of Family and Community Medicine, University of California, San Francisco (UCSF), San Francisco, California
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Talamantes E, Bribiesca Y, Rangel-Alvarez B, Viramontes O, Zhou M, Kanzaria H, Kuczewski MG, Moreno G. The Termination of Deferred Action for Childhood Arrival (DACA) Protections and Medical Education in the U.S. J Immigr Minor Health 2019; 22:353-358. [PMID: 31016563 DOI: 10.1007/s10903-019-00891-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The termination of the Deferred Action for Childhood Arrivals (DACA) immigration policy poses unique challenges for medical education and healthcare. A survey on DACA was administered online using Qualtrics Software System to 121 unique U.S.-MD granting medical school admissions leadership using e-mails between January 2018 and April 2018. A total of 39 individuals out of 121 (32%) responded to the survey; 23 (59%) of respondents identified as medical school admissions deans, 11 (28%) identified as directors and 5 (13%) as staff/officers. During the past 4 years, 19 (49%) reported having accepted DACA students. The majority either incorrectly answered or were otherwise unsure about the effect of DACA on medical education. The correlation between perception of understanding DACA and mean knowledge composite score was 0.38, P < 0.05. This study found that U.S.-MD granting medical school admissions leaders self-reported knowledge was moderately correlated with actual knowledge about DACA.
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Affiliation(s)
- Efrain Talamantes
- AltaMed Institute for Health Equity, AltaMed Health Services, Los Angeles, CA, USA. .,Department of Medicine, Center for Diversity in the Healthcare Workforce, Center for Reducing Health Disparities, UC Davis School of Medicine, Sacramento, CA, 95817, USA.
| | - Yadira Bribiesca
- Program in Medical Education, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Omar Viramontes
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Marcela Zhou
- Program in Medical Education, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Hemal Kanzaria
- Department of Emergency Medicine, University of California, San Francisco, CA, USA
| | - Mark G Kuczewski
- Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA
| | - Gerardo Moreno
- Program in Medical Education, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Family Medicine, UCLA, Los Angeles, CA, USA
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Parker MM, Fernández A, Moffet HH, Grant RW, Torreblanca A, Karter AJ. Association of Patient-Physician Language Concordance and Glycemic Control for Limited-English Proficiency Latinos With Type 2 Diabetes. JAMA Intern Med 2017; 177:380-387. [PMID: 28114680 PMCID: PMC5339062 DOI: 10.1001/jamainternmed.2016.8648] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Providing culturally competent care to the growing number of limited-English proficiency (LEP) Latinos with diabetes in the United States is challenging. Objective To evaluate changes in risk factor control among LEP Latinos with diabetes who switched from language-discordant (English-only) primary care physicians (PCPs) to language-concordant (Spanish-speaking) PCPs or vice versa. Design, Setting, and Participants This pre-post, difference-in-differences study selected 1605 adult patients with diabetes who self-identified as Latino, whose preferred language was Spanish, and who switched PCPs between January 1, 2007, and December 31, 2013. Study participants were members of the Kaiser Permanente Northern California health care system (an integrated health care delivery system with access to bilingual PCPs and/or professional interpreter services). Spanish-speaking and English-only PCPs were identified by self-report or utilization data. Exposures Change in patient-PCP language concordance after switching PCPs. Main Outcomes and Measures Glycemic control (glycated hemoglobin [HbA1c] < 8%), poor glycemic control (HbA1c > 9%), low-density-lipoprotein (LDL) control (LDL < 100 mg/dL), and systolic blood pressure (SBP) control (SBP < 140 mm Hg). Results Overall, 1605 LEP Latino adults with diabetes (mean [SD] age, 60.5 [13.1] years) were included in this study, and there was a significant net improvement in glycemic and LDL control among patients who switched from language-discordant PCPs to concordant PCPs relative to those who switched from one discordant PCP to another discordant PCP. After adjustment and accounting for secular trends, the prevalence of glycemic control increased by 10% (95% CI, 2% to 17%; P = .01), poor glycemic control decreased by 4% (95% CI, -10% to 2%; P = .16) and LDL control increased by 9% (95% CI, 1% to 17%; P = .03). No significant changes were observed in SBP control. Prevalence of LDL control increased 15% (95% CI, 7% to 24%; P < .001) among LEP Latinos who switched from concordant to discordant PCPs. Risk factor control did not worsen following a PCP switch in any group. Conclusions and Relevance We observed significant improvements in glycemic control among LEP Latino patients with diabetes who switched from language-discordant to concordant PCPs. Facilitating language-concordant care may be a strategy for diabetes management among LEP Latinos.
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Affiliation(s)
| | - Alicia Fernández
- Division of General Internal Medicine, San Francisco General Hospital, Department of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Howard H. Moffet
- Kaiser Permanente, Division of Research, Oakland, California, USA
| | - Richard W. Grant
- Kaiser Permanente, Division of Research, Oakland, California, USA
| | - Antonia Torreblanca
- Kaiser Permanente, Department of Adult and Family Medicine, Oakland Medical Center, Oakland, California, USA
| | - Andrew J. Karter
- Kaiser Permanente, Division of Research, Oakland, California, USA
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Goodfellow A, Ulloa JG, Dowling PT, Talamantes E, Chheda S, Bone C, Moreno G. Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:1313-21. [PMID: 27119328 PMCID: PMC5007145 DOI: 10.1097/acm.0000000000001203] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE The authors conducted a systematic review of the medical literature to determine the factors most strongly associated with localizing primary care physicians (PCPs) in underserved urban or rural areas of the United States. METHOD In November 2015, the authors searched databases (MEDLINE, ERIC, SCOPUS) and Google Scholar to identify published peer-reviewed studies that focused on PCPs and reported practice location outcomes that included U.S. underserved urban or rural areas. Studies focusing on practice intentions, nonphysicians, patient panel composition, or retention/turnover were excluded. They screened 4,130 titles and reviewed 284 full-text articles. RESULTS Seventy-two observational or case-control studies met inclusion criteria. These were categorized into four broad themes aligned with prior literature: 19 studies focused on physician characteristics, 13 on financial factors, 20 on medical school curricula/programs, and 20 on graduate medical education (GME) programs. Studies found significant relationships between physician race/ethnicity and language and practice in underserved areas. Multiple studies demonstrated significant associations between financial factors (e.g., debt or incentives) and underserved or rural practice, independent of preexisting trainee characteristics. There was also evidence that medical school and GME programs were effective in training PCPs who locate in underserved areas. CONCLUSIONS Both financial incentives and special training programs could be used to support trainees with the personal characteristics associated with practicing in underserved or rural areas. Expanding and replicating medical school curricula and programs proven to produce clinicians who practice in underserved urban or rural areas should be a strategic investment for medical education and future research.
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Affiliation(s)
- Amelia Goodfellow
- A. Goodfellow is a medical student, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California. J.G. Ulloa is a VA/Robert Wood Johnson Foundation Clinical Scholar, UCLA, Los Angeles, California and Surgery Resident, Department of Surgery, University of California, San Francisco, San Francisco, California. P.T. Dowling is professor and chair, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. E. Talamantes at the time of this research was primary care research fellow, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, and is now assistant professor, Division of General Internal Medicine, Department of Internal Medicine, University of California, Davis, School of Medicine, Sacramento, California. S. Chheda is research assistant, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. C. Bone at the time of this research was a third-year resident physician, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. G. Moreno is assistant professor, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
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Rubin D, Coles VB, Barnett JT. Linguistic Stereotyping in Older Adults' Perceptions of Health Care Aides. HEALTH COMMUNICATION 2016; 31:911-916. [PMID: 26606170 DOI: 10.1080/10410236.2015.1007549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The cultural and linguistic diversity of the U.S. health care provider workforce is expanding. Diversity among health care personnel such as paraprofessional health care assistants (HCAs)-many of whom are immigrants-means that intimate, high-stakes cross-cultural and cross-linguistic contact characterizes many health interactions. In particular, nonmainstream HCAs may face negative patient expectations because of patients' language stereotypes. In other contexts, reverse linguistic stereotyping has been shown to result in negative speaker evaluations and even reduced listening comprehension quite independently of the actual language performance of the speaker. The present study extends the language and attitude paradigm to older adults' perceptions of HCAs. Listeners heard the identical speaker of Standard American English as they watched interactions between an HCA and an older patient. Ethnolinguistic identities-either an Anglo native speaker of English or a Mexican nonnative speaker-were ascribed to HCAs by means of fabricated personnel files. Dependent variables included measures of perceived HCA language proficiency, personal characteristics, and professional competence, as well as listeners' comprehension of a health message delivered by the putative HCA. For most of these outcomes, moderate effect sizes were found such that the HCA with an ascribed Anglo identity-relative to the Mexican guise-was judged more proficient in English, socially superior, interpersonally more attractive, more dynamic, and a more satisfactory home health aide. No difference in listening comprehension emerged, but the Anglo guise tended to engender a more compliant listening mind set. Results of this study can inform both provider-directed and patient-directed efforts to improve health care services for members of all linguistic and cultural groups.
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Affiliation(s)
- Donald Rubin
- a Department of Communication Studies and the Center for Health & Risk Communication University of Georgia
| | | | - Joshua Trey Barnett
- c Department of Communication and the Center for Global Change and Sustainability University of Utah
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Talamantes E, Mangione CM, Gonzalez K, Jimenez A, Gonzalez F, Moreno G. Community college pathways: improving the U.S. physician workforce pipeline. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:1649-1656. [PMID: 25076199 PMCID: PMC4245373 DOI: 10.1097/acm.0000000000000438] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE To examine the association between participation in a community college (CC) pathway, medical school admission, and intentions to practice in underserved communities or work with minority populations. METHOD The authors performed cross-sectional analyses of the 2012 Association of American Medical Colleges matriculant and applicant files and the Matriculating Student Questionnaire to assess associations between student characteristics and participation in a CC pathway. They used logistic regression to estimate the association among CC pathway and acceptance to medical school, intention to practice in underserved areas, or intention to work with minority populations. RESULTS There were 40,491 applicants and 17,518 matriculants to U.S. MD-granting schools; about one-third used a CC. A higher proportion of underrepresented minority (URM) matriculants used CC pathways compared with whites. Applicants who attended a CC after high school and before a four-year university (First-CC) had lower odds of acceptance into medical school (adjusted odds ratio [AOR] = 0.68; 95% CI 0.61-0.75; P < .05). Compared with medical students who never attended a CC, First-CC matriculants were more likely to have parents without a college education (304/895 [34%] versus 1,683/12,598 [13%], P < .001) and higher odds of intentions to practice in underserved communities (AOR = 1.26; 95% CI 1.04-1.53; P < .05), after adjusting for covariates. CONCLUSIONS There is both high representation of URM students and higher prevalence of intention to work with underserved communities among CC pathway participants. These findings may be of interest to those seeking to enhance diversity in the physician workforce.
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Affiliation(s)
- Efrain Talamantes
- Dr. Talamantes is a Robert Wood Johnson Foundation Clinical Scholars Program Fellow, Department of Veterans Affairs, University of California, Los Angeles, Los Angeles, California. Dr. Mangione is professor, Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, and Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California. Ms. Gonzalez is a fourth-year medical student, David Geffen School of Medicine at UCLA, Los Angeles, California. Dr. Jimenez was a fourth-year medical student, David Geffen School of Medicine at UCLA, Los Angeles, California, at the time of the study. He is now a first-year resident, Department of Internal Medicine, University of California, San Francisco, San Francisco, California. Mr. Gonzalez is a community college counselor, San Jose City College, San Jose, California. Dr. Moreno is assistant professor, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
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Sears J, Khan K, Ardern CI, Tamim H. Potential for patient-physician language discordance in Ontario. BMC Health Serv Res 2013; 13:535. [PMID: 24373325 PMCID: PMC3909311 DOI: 10.1186/1472-6963-13-535] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 12/18/2013] [Indexed: 11/20/2022] Open
Abstract
Background Patient-Physician language discordance occurs when the patient and physician lack proficiency in the same language(s). Previous literature suggests language discordant clinical encounters compromise patient quality of care and health outcomes. The objective of this study was to quantify and visualize the linguistic and spatial mismatch between Ontario’s population not proficient in English or French but proficient in one of the top five non-official languages and the physicians who are proficient in the same non-official language. Methods Using data from the 2006 Canadian census and the 2006 Canadian Medical Directory, we determined the number of non-English/non-French (NENF) speaking individuals and the number of Ontario physicians proficient in the top five non-official languages in each census division (CD) of Ontario. For each non-official language, we produced bi-variate choropleth maps of Ontario, broken down into the 49 CDs, to determine which CDs had the highest risk of language discordant clinical encounters. Results According to the 2006 Canadian census, the top five non-official languages spoken by Ontario’s NENF population were: Chinese, Italian, Punjabi, Portuguese and Spanish. For each of the top five non-official languages, there were at least 5 census divisions with a NENF population speaking a non-official language without any primary care physicians proficient in that non-official language. The size of NENF populations within these CDs ranged from 10 individuals to 1,470 individuals. Conclusions Understanding the linguistic capabilities of Ontario’s immigrant population & the linguistic capabilities of Ontario’s primary care physicians is essential to ensure equal access and quality of healthcare. As immigration continues to increase, we may find that the linguistic needs of Ontario’s immigrant population diverge from the linguistic capabilities of Ontario’s primary care physicians. Further research on the language discordance in Ontario is needed in order to reduce the risk of language discordant clinical encounters and the negative health outcomes associated with these encounters.
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Affiliation(s)
- Jennifer Sears
- School of Kinesiology and Health Science, York University, Toronto, Canada.
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