Mexican doctors to staff California clinics

A new state law permits doctors without U.S. licenses to work at nonprofit clinics, setting a precedent other states may follow.

By Myrle Croasdale, AMNews staff. Jan. 20, 2003.

In what looks to be a first in the United States, California is allowing 30 physicians and 30 dentists from Mexico to bypass its medical licensure system and practice in the state.

The Mexican doctors will work under a three-year, nonrenewable license at designated nonprofit clinics as soon as July 1, if money can be secured for the program.

The pilot is being touted as a short-term measure to address the need of the state's 950,000 Mexican agricultural workers, few of whom have access to any physician, let alone one who speaks Spanish.

The California Medical Assn., while acknowledging this need, said bringing in Mexican doctors to treat Mexican citizens in the United States undermines California's licensing system.

"We should have a level playing field, with one criterion for licensing professionals, so that California residents know that their doctor is qualified," said Anmol S. Mahal, MD, vice chair of the CMA board of trustees and a leader of the organization's opposition to the bill.

Bob McElderry, associate director of the CMA's Center for Government, said the bill creates a two-tiered licensing structure. "We're changing the nature of the licensure process. By not requiring the same exams and residency programs, we're raising questions about the minimum qualifications necessary to treat patients. ... We're lowering the bar."

CMA officials also expressed concern that other states with large immigrant populations, such as Texas, soon may follow California's lead.

"We're sure another state will follow, maybe two or three," McElderry said.

The program also would create 70 unaccredited one-year residencies for international medical graduates. Residents would need to pass the U.S. Medical Licensing Examination to move into accredited programs and get credit for the year already spent in residency.

To date, talks are ongoing with California medical and dental schools to determine which ones will oversee the one-year residency program or the physician pilot, including collecting data on the doctors' performances.

Meeting a need

The California Hispanic Health Care Assn., which supported the bill that brings in the Mexican physicians, said it's a practical approach to a long-standing need.

"The problem is so staggeringly documented," said Arnoldo Torres, director of CHHCA. "The lack of access to care, the number of uninsured, the physician shortages, the poor distribution of physicians -- and not just for one decade but for three decades -- it's an embarrassment for the medical profession."

Latinos make up 95% of the 1 million agricultural workers in California, Torres said, and 30 more doctors would mean at least 100,000 migrant workers getting medical care they might otherwise not have.

The 2000 U.S. census showed 11 million Latinos in California, while AMA data show 3,000 Hispanic practicing physicians in the state.

The pilot's doctors, who will come from the National Autonomous University of Mexico, will undergo a six-month orientation by the Medical Board of California, and will be allowed to work for their assigned nonprofit clinics only under the supervision of licensed California physicians.

They will have to take English as a Second Language courses and 25 hours of continuing medical education a year.

Otherwise, the pediatricians, family physicians, internists and ob-gyns who participate in the program will have no limits on their practice of medicine. They're expected to get hospital privileges so they can admit patients and perform surgery.

The program is unfunded, and the CHHCA is seeking private money to pay $500,000 a year to administer the physician portion of the program and $1 million to fund the residencies. Another $3 million is needed to cover collecting data and evaluating the Mexican physicians' performance.

Salaries for the doctors will be taken care of by the clinics, which have plenty of vacancies to fill.

"The clinics have never been able to operate at full capacity," Torres said. "It's not just that there aren't enough doctors who speak Spanish, we just can't get doctors who want to work in this setting, period."

Nine corporations are members of CHHCA. They represent more than 60 clinic sites and approximately 75 doctors. These clinics will have first priority in hiring the Mexican doctors.

Torres said the pilot would give Mexican doctors the chance to prove they are as capable as U.S. physicians.

CMA alternative

The CMA, instead, favors creating a California Physician Corps.

The corps, approved by the California Legislature, is a state version of the National Health Service Corps and would allow physicians to exchange a three-year commitment to work in underserved areas for an annual salary and forgiveness of $105,000 in medical school loans.

An initial 30 physicians are expected to be hired this summer, and the CMA is seeking $3 million to finance the program.

The CMA is also seeking approval from the state for more accredited residencies in California as an alternative to the pilot's one-year, unaccredited positions.

McElderry said California already tried to bypass licensing procedures several years ago when it allowed IMGs to practice under the supervision of licensed California physicians, in an effort to bring medical care to immigrants. But he said that project was short-lived because of a high volume of patient complaints.

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