California is facing a shortage of health professionals to meet the needs of its large, diverse, and aging population, and the situation is worsening. Shortages exist across professions and geographies, with sizeable urban and rural underserved populations. Despite increasing population diversity, California’s health professionals don’t reflect the increasing diversity of the state’s population. For example, in 2019, 39% of Californians identified as Latinx, but only 14% of medical school matriculants and 6% of active patient care physicians in California were Latinx.¹

Over the past two decades, studies have shown the importance of racial and social concordance between physicians and their patients as well as the need for intercultural competencies, which lead to increased trust and greater patient satisfaction. Particularly important, however, is the ability to speak the same language, which not only increases trust and patient satisfaction but simultaneously decreases poor clinical outcomes due to miscommunication.² According to the US Census Bureau, almost 44% of California households speak a language other than English, and nearly seven million Californians (19%) report speaking English “less than very well.”³ Although there are many languages spoken in California, the most prevalent after English are Spanish, Tagalog, Cantonese, Mandarin, and Vietnamese.⁴ It is essential to increase the number of health professionals in California who can effectively deliver health care services in a language other than English.

Currently, there are no data available on language proficiency among California’s health professionals. Physicians self-report to the Medical Board of California the languages they speak, but proficiency is not measured. Furthermore, the Medical Board data do not indicate whether a physician has sufficient knowledge of health care terminology to converse with patients in their own languages about health care needs.

This brief builds on a recent review of the evidence to identify long-term and near-term policy strategies to increase language concordance for health professionals and patients in California.

About the Authors

This issue brief was authored by Diane Rittenhouse, MD, MPH, senior fellow, Mathematica; Alicia Fernández, MD, professor and associate dean for population health and health equity, UCSF; Alexandra Ament, MA, independent consultant; and Janet Coffman, PhD, MA, MPP, professor at the Philip R. Lee Institute for Health Policy Studies, UCSF.

1. Alana Pfeffinger et al., Recovery with Limited Progress: Impact of California Proposition 209 on Racial/Ethnic Diversity of California Medical School Matriculants, 1990 to 2019, Healthforce Center at UCSF, December 2020; and Janet M. Coffman, Emmie Calimlim, and Margaret Fix, California Physicians: A Portrait of Practice, California Health Care Foundation, March 2021.
2. Richard L. Street Jr. et al., “Understanding Concordance in Patient-Physician Relationships: Personal and Ethnic Dimensions of Shared Identity,” Annals of Family Medicine 6, no. 3 (May 2008): 198–205; Lisa A. Cooper et al., “Patient-Centered Communication, Ratings of Care, and Concordance of Patient and Physician Race,” Annals of Internal Medicine 139, no. 11 (Dec. 2, 2003): 907–15; Rachel L. Johnson Thornton et al., “Patient-Physician Social Concordance, Medical Visit Communication and Patients’ Perceptions of Health Care Quality,” Patient Education and Counseling 85, no. 3 (Dec. 2011): e201–8; and Alicia Fernandez and Eliseo J. Pérez-Stable, “¿Doctor, Habla Español? Increasing the Supply and Quality of Language-Concordant Physicians for Spanish- Speaking Patients,” Journal of General Internal Medicine 30 (Oct. 2015): 1394–96.
3. “Limited English Proficient Consumers,” State of California.
4. “Languages in California (State),” Statistical Atlas.