According to the U.S. Census Bureau, there were roughly 63 million Hispanics in the United States as of 2021.¹ This total accounts for nearly 18% of the U.S. population, as opposed to 27 years ago (1996), when that number totaled just 11%.² In nearly 3 decades, this “minority” population has become the second largest ethnic group in the continental U.S. and Hawaii, with non-Whites overall representing 58% of the total populace. However, this increase in representation has not translated accordingly to all fields of the medical workforce. The current AUA Census data show that between 2014 and 2021, the number of practicing Hispanic urologists stagnated between 4.1% (2014) and 4.4% (2021; see Figure), with the majority of practicing urologists (83%) identifying as Caucasian.³ Considering nearly one-third of Latinos in the U.S. are of limited English proficiency (LEP), the immense language and cultural gap between the Hispanic/Latino patient population and the urological workforce will continue to expand at the expense of patient care.⁴ This egregious disparity in representation is not just a matter of social justice, but also an issue of health care quality.

Figure. The numbers of practicing Hispanic urologists stagnated between 2014 and 2021.

Cross-sectional data from a National Health Interview survey looked to assess the impact of English language proficiency on access to medical care. Even after controlling for health and other socioeconomic factors, the data showed that LEP individuals were more likely to postpone needed medical appointments and received less medical care when compared to individuals who were English-proficient.⁵ Considering that a mere 4.4% of urologists on average are of a Latino cultural background, only a minority of Latinos receive language-/culture-concordant care in states like Florida, where the population is nearly 27% Latino.⁶ In other words, nearly 96% of these Hispanic communities lack access to culturally congruent quality health care. The consequences of a shortfall of this nature are widely documented in the literature.

Studies examining the quality of provider care in a hospital setting demonstrated greater satisfaction with care and fewer emergency department visits post-patient discharge in individuals receiving language concordant care.⁷ A cross-sectional study using DISTANCE (Diabetes Study of Northern California) data found that the association between LEP and poor blood glucose control was affected by the presence or lack of concordant (language) services.⁸ Results showed that LEP Latino patients receiving discordant (language) care had 200% higher blood glucose levels when compared to LEP concordant patients. Undoubtedly, LEP and language-discordant care must be seen as a risk factor for a lesser quality of care. If health care practitioners are unable to provide language-concordant care, they will remain at a disadvantage when it comes to navigating the complexity of cultural attitudes and disparities pertinent to the health issues of the Latino community. In order to bridge this gap, change must begin to reinforce and appreciate the importance of language in providing superior quality of care.

Unsurprisingly, culturally and linguistically aligned services have been demonstrated to improve patient satisfaction, trust, engagement, clinical understanding, and even health outcomes.^9-11 In order to ensure equitable and optimal care for minority and LEP patients, the medical field will need to weight supplying patients with effective interpreter systems vs trying to connect them with health care professionals of similar ethnic backgrounds/language. Prior literature has shown that even though interpreters are beneficial in clinical scenarios, patients seem to vastly prefer language-concordant providers.^10,12 Overall, studies of the Latino community have underscored the overwhelming benefits of bilingual providers compared to third-party interpreting services. Bilingual providers were associated with improved physician-patient rapport, clinical understanding, and patient satisfaction, while simultaneously decreasing feelings/instances of insecurity and discrimination.¹³ Consequently, the urological field must strive to meet the needs of the Latino community and that of other LEP patients by actively increasing representation in the workforce.

Latinos account for 3% of medical school faculty, 4% of the medical student pool nationwide, 4% of all funded NIH investigators, 4% of topics for NIH-funded extramural research programs, and, as mentioned previously, 4% of practicing urologists.^14,15 The lack of Latino providers in urology is not an isolated finding, but this underscores the importance of pipeline programs that expose students to the possibility of exploring urology as a career. Previous examples of such programs have proven immensely effective.^16,17 Such initiatives have helped double the number of Latino premed applicants in certain regions of the U.S. and have even helped increase standardized test scores in first-generation Latino students.^16-18 Other fields have also utilized annual, no-cost camps for local underrepresented minority (URM) students interested in pursuing medicine as a profession. These programs exposed students to different medical subspecialities and helped provide each annual cohort with longitudinal college application resources and mentorship.¹⁸ The results of this initiative were impressive, with 85% of participants stating that the program made them more likely to pursue a particular career in health care.¹⁸

Moving forward with the help of the AUA, we must prioritize the establishment of fixed summer pipeline programs for URMs in each of the AUA sections. In doing so, we can begin setting the foundational elements needed for the urological workforce to bridge the current representational gap and reflect the community it serves. Continuing to nurture and create pipeline programs for Latino and URMs will allow urologists and health care systems alike to continue to improve patient outcomes and the quality of health care being offered.