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PRIME-LC: A New Medical School Program at UC Irvine Geared to Helping Latinos, Becomes Model for Improving Health Outcomes in California
In California, one-third of the population is Latino, and the Latino population is projected to increase to more than 40% by 2025. At the same time, the number of California physicians identified as Latino is a small fraction of California's physicians, about 5%. These demographic realities make it imperative to increase the number of physicians who are Latino or fluent in Spanish and sensitive to Latino cultural values.
One challenge facing those seeking to improve health care outcomes for Latinos in California is how to increase the number of physicians able to treat Latino patients in a linguistically and culturally sensitive manner. Some have advocated increasing the enrollment of Latinos in medical school. While this approach has some merit, it does not guarantee that these Latino students will retain their linguistic and cultural skills or choose to work with the targeted underprivileged populations after they graduate. An alternative strategy is to find and train physicians from all backgrounds who are already culturally competent, able to communicate effectively with Latino patients, and committed to reducing disparities in health care outcomes between Latinos and non-Latinos. This approach focuses on meeting the needs of the target populations, rather than focusing on educating students from a particular race or ethnicity.
PRIME-LC, University of California at Irvine School of Medicine's Program in Medical Education for the Latino Community, takes this second approach, training future physicians to address the distinct healthcare needs of the Latino community. PRIME-LC is a new medical training program designed to train medical students of all ethnicities who want to serve the health needs of the Latino population. Students who are admitted to the five year program receive both a medical degree and a master's degree in public health or public policy or an MBA. Not only must program participants meet all medical school entrance requirements, but they must be proficient in Spanish, demonstrate a commitment to public service, and express a strong desire to serve underserved Latinos after graduation.
The program was piloted in 2004 with an entering class of 8 students. In 2005, another 11 students enrolled in the program. The program is gaining in popularity—there were 137 applicants for the 2006 class for 12 slots.
At the beginning of the program, students live in Mexico for a five-week language, cultural, and clinical immersion. They live with local families and work in local public clinics. The medical school curriculum is fairly standard, although it is supplemented by newly-designed graduate courses that explore specific health issues relating to the Latino community. In addition, there is a focus on the epidemiology of diseases with high incidence and prevalence among Latinos. After their residencies, program participants will receive support from the program in identifying practice opportunities and taking on an advocacy role on behalf of the Latino community.
Dr. Alberto Manetta, UC Irvine's Senior Associate Dean of Educational Affairs and the founder and director of PRIME-LC, believes the success of the program will ultimately be measured by a number of outcomes—whether students remain in the program, where they choose to practice, what specialty they pursue, the percentage of Latino patients in their practices, and what leadership positions they achieve. Early supporters of the Irvine program are the California Endowment, Molina Health Inc., and the UniHealth Foundation. In 2005, permanent funding was approved for the PRIME-LC program at the state level.
One indicator of the program's timeliness and appeal is that the Irvine model is being replicated throughout the UC medical school system, with different emphases based on the population sectors facing health challenges in different locations. Dr. Manetta partnered early on with Dr. Michael Drake, previously UC's Vice President of Health Affairs, to support an expansion of PRIME programs within the UC system to address the needs of other underserved populations. Like PRIME-LC, the other PRIME programs seek to address unequal medical treatment and access among other underserved populations, including Asians, African Americans, the homeless, Central Valley residents, and remote rural Californians. UC San Francisco piloted a program in 2005 called PRIME-US. It is geared to the urban underserved in the Bay Area. UC Davis will pilot a program in 2006 called PRIME-RH designed to serve the rural poor in the San Joaquin Central Valley area. It will enroll students in fall 2007. Finally, UC San Diego is piloting a program in 2006 called PRIME-HP which will focus on the specific health disparities faced by people living on the US-Mexico border region and in Indian reservations. An education bond, the Kindergarten-University Public Education Facilities Bond Act of 2006, to fund (among other things) an increase in the number of medical students in the California system and all the PRIME programs, was passed in November 2006 by the California voters.
The proponents of PRIME-LC attribute their success to the following:
- Broad-based and Early Support from Key Stakeholders. The designers of PRIME-LC at the University of California at Irvine organized key stakeholders from the project's earliest stages. By bringing together a varied group comprised of Latino medical students, CEOs from area non-profits, physicians, foundations, political leaders, faculty from a variety of disciplines within and outside of the medical school, and university administrators, PRIME-LC's champions at UC Irvine were able to gather political support, identify issues from a variety of perspectives, develop a solid curriculum, and design the "profile" of the PRIME-LC participants that would best meet Latino community needs.
- Patience and Persistence. It takes a few years of persistent effort to realize a program that transforms the way a fundamental service—health care—is delivered. It is important to ground any proposal in serious research to ensure that the facts support your position.
- Good Timing. PRIME-LC benefited from a confluence of propitious factors, including demographic realities, the composition of the California state legislature, the high cost of healthcare and the right champions in the right places.
For more information about the PRIME-LC program, please visit its Web site, send an email to Jose Rea, Program Academic Coordinator (primelc "at" uci.edu), or call Mr. Rea at (949) 824-7136.