With his fair skin and American last name, some of Dr. Rob Fields' new patients have a hard time believing he is Latino.

But once the native-born Puerto Rican speaks to them in fluent Spanish, his Hispanic patients immediately relax, knowing they have found a doctor who understands them.

“I think certainly it's been demonstrated in studies that people are less afraid to seek out care if they feel comfortable in the environment, and it is especially true in terms of language,” Fields said. “They are more likely to come in earlier in the course of their illness if they feel comfortable and if they don't feel threatened. … To some degree, I don't blame them. It is not a friendly environment out there if you don't speak the language.”

In Buncombe County, there are few practices like Vista Family Health, which Fields helped to found in 2003 with an idea of specifically serving the Hispanic population.

The practice on Hendersonville Road has bilingual physicians and office staff, and more than 20 percent of its patients are Hispanic, compared with less than 1 percent in a typical family practice in the county. “Once people understood that we had a bilingual practice here, it grew rapidly,” Fields said. “Patients can identify with people in our office in a concrete, physical way that makes them feel more at home, more comfortable.”

While Buncombe County is home to more than 10,000 Hispanic residents, the Buncombe County Medical Society estimates there are fewer than 10 Hispanic doctors in the county out of a total of more than 800.

Of the more than 31,000 active physicians in North Carolina, 640, or about 2 percent, identify themselves as Hispanic, compared with a Hispanic population in the state that is nearly 7 percent.

“It is certainly a concern around providing culturally and linguistically appropriate services for a fast-growing Latino population,” said Barbara Pullen-Smith, director of the state's Office of Minority Health and Health Disparities. “I definitely think there is an increasing need for interpreters as well as recruiting bilingual, bicultural health care providers.”

There are many factors — including economics, education, genetics, environmental and cultural — that contribute to higher rates of chronic diseases and worse health outcomes among the Hispanic population.

But some say that having a doctor who speaks the same language and comes from a similar culture could help to improve some of these statistics. The language barrier could mean the difference between seeking out health care and not, or knowing how to manage a chronic disease like diabetes. “We try to teach our people, African-American and other people of color, how to take control of their health,” said Elaine Robinson, executive director of the Asheville Buncombe Institute for Parity Achievement. “They can't do that if they can't communicate what is going on.”

Providers who are Hispanic or have an understanding about Latino culture may more easily understand when Hispanic patients are reluctant to see a doctor for preventive care, which is not emphasized as much in some countries, or when a Hispanic woman doesn't want to see a male physician, said Ana Arevalo, lead interpreter at the Buncombe County Health Center.

“There are cultural barriers that we have to explain to them,” Arevalo said.

Some studies have shown that there are better health outcomes when the patient and provider share the same culture.

Mission Hospital trauma surgeon Dr. Abenámar Arrillaga said he notices a difference in how Spanish-speaking patients react to him. Arrillaga estimates 10 percent of the patients they see in the emergency room are Hispanic.

“I speak the language and so, although we have a tremendous interpreter service, no matter how good it is, it is going through a middle person,” said Arrillaga, who is originally from Puerto Rico. “I think they (the patients) really appreciate it when I am around.”

While there is a recognized need for more Hispanic physicians and staff, finding and recruiting them is a challenge. Although Fields helps patients with primary care, he said that he has trouble finding specialists to refer patients to.

“It is better than it used to be, better than five years ago,” he said, “but they are still limited.”

MAHEC Family Health Center has focused on increasing the number of Spanish-speaking staff in its practice, along with hiring bilingual faculty and residents, but it is difficult to recruit minorities to the area, said Sherry Weiland, administrative director of the practice. While MAHEC has six faculty members who speak Spanish fluently and eight out of 27 residents who are fairly proficient in Spanish, only one is Hispanic. “We have tried really hard to get minorities into our residency program and as faculty, and we find that there are not that many candidates,” she said.

Mission Hospital went on a recruiting trip to Puerto Rico in an attempt to hire more bilingual employees, but it did not hire anyone, said Lori Halula, who works in the hospital's human resources department.

She said the hospital has set aside money in its budget for bilingual recruiting this coming year. The hospital has one employed physician who is Hispanic, along with 14 Hispanic registered nurses and several others in other positions.

“We do definitely see a need to increase the number of bilingual employees, especially in the emergency room and labor and delivery and some other areas,” Halula said, but she added, “I would say that overall it has been a challenge.”

MAHEC and Vista Family Health both said that employing bilingual staff is also a priority, but it is hard to find people to fill those positions.

Fields is working on a grant to identify local, bilingual high school students who may be interested in careers in health care and help them to attend programs at Asheville Buncombe Technical Community College.

While hiring a native speaker may be ideal, some practices are hiring physicians and staff who are fluent in Spanish, which many say goes a long way in helping those who are non-native English speakers.

Dr. Dan Frayne, a physician at MAHEC, said more residents coming to the family health center are realizing the importance of knowing Spanish.

Frayne, who has been speaking Spanish since he was in medical school more than a decade ago, is not a native speaker, but he said he does not think that has been a barrier for him.

Frayne said even if someone is a native Spanish speaker, cultural differences still exist between people from different countries. “What I have found is that if you can speak the language, even if it is not perfect, there is a trust that develops that isn't there if you are using an interpreter,” he said.

Frayne said that while Hispanic physicians enhance the community overall, he is not sure a lack of Hispanic doctors translates into poorer health outcomes. He said the language barrier and lack of access to health care are bigger factors affecting the health of Latinos. “The goals of having increased diversity in the work force are different than increasing access and improving health disparities,” Frayne said. “The answer may not be to increase (the number of) Hispanic doctors.”