Introduction by Vice Chancellor Steve Goldstein
In this installment of the Bridging the Gap series that focuses on our commitment to health equity, Charles Vega, MD, reflects on the origins of the Program in Medical Education for the Latino Community (PRIME-LC). Now approaching its 20th anniversary, PRIME-LC was established to create leaders and physician-activists who aspire to work in underserved Latino communities.
The California Future Health Workforce Commission sounded an alarm in 2019 about shortages of physicians and other providers across the state and nation. Amplifying that challenge, access to healthcare is most often limited in marginalized and low-income communities. UC Irvine strives to address these compounding issues through programs like PRIME-LC.
A first-of-its-kind program, PRIME-LC was founded in 2004 by President Michael Drake, MD, while he was UC vice president for health affairs, and the late Alberto Manetta, MD, who oversaw UCI’s medical education programs from 1993-2007. Since its launch, PRIME-LC has fostered the education of physicians who want to serve the needs of Latino communities, often becoming leading voices for community health and well being. The five-year dual-degree program offers a curriculum that includes experiential learning opportunities throughout California and an international clinical rotation. Based on its success, the UCI PRIME-LC program has served as a model and by 2007 all the University of California medical schools had begun PRIME programs focused on specific underserved populations.
This exceptional mission-based program demonstrates the unwavering commitment of UCI Health Affairs to health equity and our mission to discover, teach and heal. We take tremendous pride in our PRIME-LC faculty, staff and students and the contributions they make to improving the lives of individuals within their communities. Dr. Vega generously offers us a glimpse into the program and the lives of some of the PRIME-LC students.
Celebrating Nearly 20 Years of Service to the Latino Community with PRIME-LC
By Charles P. Vega, MD
Clinical Professor, Family Medicine; Assistant Dean, Cultural and Community Education; Director, PRIME-LC Program, UCI School of Medicine
Anyone who has watched a medical drama understands that meeting the needs of patients often requires health professionals to make decisions grounded in immediacy. That concept drives the principles of triage — learning to instantly assess and then solve the most acute problem first, and then the next, and the next. But when it comes to meeting the needs of a changing and complex patient community, medical educators must look beyond today’s immediate priorities to plan for the future of the populations they serve.
Anticipating demographic evolution is part of that assessment. About 26 percent of Californians identified as Hispanic/Latino in the 1990 census — a number that has grown to just over 40 percent today, giving California the largest Latino population in the U.S. Still, only 11 percent of California’s medical school graduates are Latino — increasing the potential for disparities in care, even despite the best intentions of individual physicians who may simply be unequipped to meet the specialized needs of a Latino community that is diverse in and of itself.
UCI saw this coming, and long-ago set in motion an effort to bring to life a creative commitment to the Latino community. In 2001, the School of Medicine began to build the framework for an innovative program designed to create leaders and physician-activists who will work in underserved Latino communities. In 2004, UCI enrolled the first students in the Program in Medical Education for the Latino Community — known as PRIME-LC — a five-year, dual degree (MD / Master’s) program.
Each year, PRIME-LC enrolls about 12 Spanish-speaking students who have demonstrated a significant commitment to social justice and an intent to serve the needs of under-resourced Latino communities. PRIME-LC equips them for this task with not only rigorous coursework in the School of Medicine and the UCI Department of Chicano/Latino Studies in the School of Social Sciences, but it also grounds the learnings in experiential opportunities and clinical rotations in both Southern California and Latin America. The enhanced medical school curriculum includes coursework that emphasizes leadership, advocacy and service.
The powerful combination of practice and theory in PRIME-LC has enriched our larger cultural and medical communities, even beyond the state of California. But the individual students who participate are the catalysts that take this program from a good idea to an incredible differentiator in the broader Latino community. Their backgrounds, their skills as culturally-fluent clinicians, and their personal commitments to the Latino community are collectively changing lives, families and communities.
Testimonials from current PRIME-LC students are moving, deeply personal, and clearly validate the students’ abilities to apply their own experiences as individuals to enrich and inform their practice of medicine. Their backgrounds and stories are both highly specific and universal at the same time — representing a microcosm of the Latino experience, and broadly illustrating the commonalities among under-served populations in the U.S.:
My father lost his life this year to a lifelong battle with addiction. The stigma and shame that my family held against treatment for addiction and mental health, coupled with machismo in the Latinx community, impeded my father from receiving the help he deserved. Because of this, whenever I meet patients struggling with addiction, I understand they are multifaceted. These patients deserve medical help and support. As a future child and adolescent psychiatrist, I hope to focus on substance use prevention in Latinx and minoritized youth in underserved communities because addiction affects more than just the individual but families and entire communities as well.
Medical student Paula Mendoza
As the son of agricultural fieldworkers in Salinas Valley, I know that navigating the healthcare system is challenging, even in the best of circumstances. I see myself practicing in a location with strong ties to agriculture and food production because I understand that this occupation’s conditions, exposure to chemicals, and low wages also impact the long-term health outcomes of its workers. Practicing in this setting will allow me to apply my language skills to better serve patients who have not been able to treat their chronic conditions due to language or social barriers when accessing healthcare.
Medical student Saul Martinez
Growing up, my dad shared stories of his family’s migrant farmworker experiences, moving between Laredo, Texas, and various farming communities throughout California’s Central Valley. I wish I had known the special characters in these stories, because I felt the heartache of the suffering and loss that could have been prevented by access to healthcare. My goal is to become a community-based Family Medicine physician that is accessible to patients. I hope that my practice allows me to develop long-term, multigenerational relationships and help patients feel understood within their contexts while supporting their health goals.
Medical student Jenna Martinez
I chose UCI because of PRIME-LC. I wanted to be part of the mission to serve the Latino community, and I have been able to do precisely that. I grew up in a predominantly Latino suburb in southeast Los Angeles, where my family still resides. I cannot think of a better population to serve than the communities that shaped me. These communities need and deserve specialized care that addresses their individual and cultural expectations. I am applying to Internal Medicine and keeping an open mind to specialize further. Regardless of what field I end up in, I will serve the Latino community.
Medical student Otilio Castillo, Jr.
Growing up with my grandparents who spoke primarily Spanish and had no health literacy, I was responsible for being their voice at every doctor’s appointment. I saw firsthand how many physicians did not possess the skills or cultural background to address hurdles my grandparents faced in understanding their disease and obtaining care. By bringing my experience and acquired knowledge into practice as a future physician, I hope to bridge the gap in health literacy and re-build trust in medical providers for the Latino community.
Medical student Erika Peratoner
Part of the educational focus at UCI School of Medicine is instilling in tomorrow’s providers the importance of considering the unique needs of the patients served. When four of ten Californians today are members of the Latino community, it is clear that the need for tailored, culturally competent care — and the potential for positive impact — could not be higher for those that the PRIME-LC students aim to serve.
And serve, they do. The achievements and collective impact of the 160 PRIME-LC alumni are incredible. Nearly all (95%) of the alumni working as attending physicians practice in community settings with a high percentage of low-income Latino patients, and two-thirds report they perform leadership and advocacy activities to advance the cause of Latino health equity outside of their medical practices.
