Date: May 20, 2016
Hispanics – Podcast
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Podcast 54: The Hispanic Practice
Hello, this is Scott McDonald and welcome to the Perfect Place to Put a Practice podcast. Here at DoctorDemographics.com, we work hard to keep our listeners informed about aspects of locations and their populations so you can make the important decisions that will influence your practice site selection for your benefit. Today, we are going to discuss Hispanics.
To be honest, this is a terrible complex and confusing subject. That is because the issue of what a Hispanic is, how their presence can define a practice, and the impact upon a doctor who is of this ethnic group may determine your happiness in working with this group. There are also many myths and assumptions that are frankly dangerous to the practice’s success that I wish to dispel.
Now, you may be saying “What do you know about Hispanics? McDonald is a Scottish name and you don’t seem to speak with any kind of an accent so what do you know about it?” Well, actually, I have a great deal of experience working with this group. A brief background orientation might be helpful. For two years I lived in Guatemala and El Salvador. I am a fluent Spanish speaker (as are my wife and two of my sons). I ran the Spanish language marketing program for Six Flags Magic Mountain in Los Angeles and served as a Spanish speaking representative of several organizations in the field of Public Relations. With all that in mind, it should be noted that very few “experts” in demographics understand the nuances of the term “Hispanic.”
Let me say a few things at the outset: Hispanic is generally misunderstood by ethnographers because it is something of an artificial construct. The U.S. Census Bureau uses the term to apply to people of “Spanish Influence.” It doesn’t mean that you speak Spanish. It doesn’t mean that you come from a Spanish speaking country or can trace your roots to South or Central America. Hispanic is not a race in the way that White (or Caucasian), Black (or African American), or Asian, or American Indian or Hawaiian/Pacific Islander does. Hispanic is an ethnicity which means you may be White, Black, Asian, or many other race and still be Hispanic. As an example, Cubans are Hispanic while more than 10% are Black and 28% are Mulattoes. The Philippines and Guam were both Spanish colonies where many people are considered Hispanic even though they have an Asian racial background. Are Brazilians Hispanic? True, they are from South America. But because they primarily speak Portuguese, they are considered “Iberian” which is not Hispanic.
To be blunt, the U.S. Census Bureau considers anyone who says that they are Hispanic to be Hispanic, regardless of their country of origin or familiarity with Spanish. And here is where things get a little weird. Hispanic actually refers to a culture more than it does an ethnicity. For example, people in Mexico are considered Hispanic regardless of whether they are White (Caucasian), Native American (there are several Central and South American tribes, many of whom speak Spanish only as a second language such as the Chiche, or a combination of these. In fact, Mexico is a truly mixed race country. But to hear the ethnic activists like La Rasa, one would assume that they are a monolithic group. And that is where I want to provide a cautionary note: Hispanics are not a monolithic body with a common ancestry or common traditions. In spite of what the makers of Tequila may want you to believe, Cinco de Mayo is a national holiday only in Mexico. And even then, it is not as important an independence day as September 16 when Mexico won its independence from France.
A growing percentage of Hispanics in America come from different countries other than Mexico. Because of its proximity and long association with northern Mexico, California is dominated by immigrants from Mexico. And that is a convenient cliché to television and movie producers. But at this writing the largest inpouring of Hispanic Immigrants are coming from Central America. Their distribution around the U.S. is certainly not even. For example, Los Angeles has the largest percentage and number of Mexican Immigrants. But immigrants from El Salvador tended to move to the Washington, DC area. Cubans and Dominicans are in Greater Miami. Puerto Ricans are in Massachusetts, Rhodes Island, and New York. Each has very different background and understanding of healthcare. But it is especially important to remember that their Spanish is a little different (think about the differences between how they speak English in Georgia versus New York versus England versus Scotland. Most importantly, if you are trying to appeal to them as a Spanish Speaker, your cultural background may matter most.
As a quick example, there was a war between El Salvador and Honduras. You probably don’t remember the animosity that existed but they certainly do. Peruvians consider themselves culturally more refined that Guatemalans, Southern Mexicans with their Indian Traditions see themselves as more pure than the rest of the Mexicans, and Argentinians see themselves as superior to them all. The “Melting Pot” concept never quite made it to the Hispanic World. Therefore, if you are an Hispanic yourself, it is wise to consider those from your particular country of origin and ethnic subculture before promoting yourself too much within the Spanish language media. Ironically, Caucasians who speak Spanish are generally considered a favored option over people from other races or groups who may have a conflict with. Still, there is certainly a benefit to promoting your particular group to a newly arrived immigrant population of the same group. We just recommend that you hold the line on offering discounts to “paisanos.” While this may attract a new patient base, it can also limit your production potential with this group.
For those doctors who do not speak Spanish themselves, it is always helpful to have a bi-lingual person at the front desk or even the back office who can translate when necessary. But it should be kept in mind that most Hispanics speak English. Obviously, those who are newly arrived or may be of an older generation may be more comfortable speaking Spanish but the majority of Hispanics have sufficient command of English to get by.
It should also be noted that there are many Hispanics who have no association with Spanish. Residents of Texas and Arizona may be descended from Hispanics but have been living in the U.S. for six generations. For them, they may not want to be associated with those who are newly arrive from another country and who are of a “lower socioeconomic class.” I remind those I meet with that South and Central America are much more class conscious that we who are long-term residents in the U.S. What surprises many American born professionals is that patients may be less offended by your lack of language ability and much more concerned about how you treat them in terms of social class.
For this reason, I recommend starting the conversation regarding where they are from. Avoid generalizations regarding their social class. Let them tell you. Also, never be surprised when they have a 10 year old child who comes to translate for them. And it is wise to recall that while the child may have English skills, the adult is still the patient. That is why staff who can step in will be most helpful. Lastly, on a politically incorrect note, it is helpful to recall that in many cultures, including many Hispanic groups, reading is not as common as you would suppose. That is why long forms with small type fonts may be a barrier to communication and trust rather than a help. Signs that use illustrations are always appreciated. This goes for advertising of a practice in a predominantly foreign language area, including where Spanish is spoken.
I find it amusing when people in the media seemed gravely concerned that Hispanics are an ever increasing percentage of the U.S. population. This is due largely to a higher than typical birthrate than native born Americans, regardless of race. Every longitudinal study on this subject suggests that in a generation or two, they will acculturate reasonably well. If their birthrate worries you, you might want to consider having a larger family yourself. While a little tongue in cheek, it is the only way that any ethnic or racial group can maintain itself. But I admonish my listeners not to be overly concerned about this type of trend. From what we can see, no ethnic or racial group has a lock on increased or decrease numbers.
This is Scott McDonald. And thanks so much for listening. Look for us at DoctorDemographics.com and take a look at our new State Briefings!