The effect of primary language on access to specialized orthopedic care

Abstract

Background

Language barriers can negatively impact the quality of care for non-English speaking patients. Lack of access to health-care providers who speak multiple languages or interpreters in medical offices can result in delayed appointment times, delayed treatment, and increased complications. Access to shoulder surgeons with subspecialty training is limited and this has been established which may further exacerbate the problem with access for these patients. The purpose of this study was to determine the effect of primary language spoken on access to specialty shoulder care in South Florida.

Methods

Three populous, diverse counties in South Florida were selected for data collection. Sixty-nine orthopedic offices were identified by Google search and selected via random number generator. Investigators used the Secret Shopper methodology to contact each office to schedule an appointment for a shoulder arthroplasty for a family member who spoke exclusively English or Spanish using a blocked phone number. The ability to schedule a new patient appointment with a fellowship-trained shoulder specialist, the waiting period for the scheduled appointment, and interpretation services for Spanish-speaking patients were collected.

Results

Of the 69 offices called, 35 met inclusion criteria. There were no significant differences in wait times for shoulder arthroplasty based on primary language spoken. There was no difference in wait time to see a shoulder specialist between Spanish (13.7 days) and English-speaking patients (12.9 days) (P = .835)). Wait times with a nonfellowship-trained orthopedic surgeon between Spanish and English-speaking patients was also not different (9.5 days and 11.96 days, respectively (P = .522). Similarly, no difference existed in phone call duration (P = .56), median income and wait times for a general orthopedic surgeon, with r = −0.26 (P = .105), or a shoulder specialist, with r = −0.19 (P = .22). Of the clinics accepting patients, 74.3% (n = 26/35) offered Spanish interpretation with 42.3% (n = 11/26) providing a multilingual physician, 26.9% (n = 7/26) a translating service, 23.1% (n = 6/26) had a staff member capable of translation, and 7.7% (n = 2/26) had an available professional interpreter.

Conclusion

While access to orthopedic specialty care may be similar for Spanish-speaking and English-speaking patients in South Florida, over 25% of clinics lack multilingual physicians or qualified interpreter access. This can negatively impact surgical decision-making, postoperative care and outcomes after shoulder surgery. It is essential the orthopedic community advocates for the proper resources to optimally assist surgeons and provide quality care for Spanish-speaking orthopedic patients.