How do we address language barriers between patients and primary care physicians?

Sears J, Khan K, Ardern CI, Tamim H. Potential for patient-physician language discordance in Ontario. BMC Health Services Research. 2013; 13: 535. Contact: Jennifer Miniota (Sears) (

Issue: Quality of care can be seriously compromised when primary care physicians and patients can’t communicate in the same language.

What we did: We used 2006 census data to pick out the top five languages spoken by people in Ontario who do not speak English or French. We also identified the municipalities (census divisions) where they lived. We then looked at the availability of primary care physicians in these municipalities who self-identified as speaking one of these top five languages, which were Chinese*, Italian, Punjabi, Portuguese and Spanish.

What we found:

  • There is a need for Portuguese-speaking primary care physicians in several municipalities. In particular, Waterloo has 1,470 Portuguese speakers who do not speak English or French, but no practicing primary care physicians who speak Portuguese.
  • We also found several municipalities in need of Italian, Punjabi, Chinese and Spanish-speaking primary care physicians, although, in some cases, the population in need was small.
  • For more detail, please access maps in the paper demonstrating language gaps for Chinese, Italian, Punjabi, Portuguese and Spanish-speakers.

Program and policy responses could include:

  • A database illustrating the geographic distribution of people who do not speak English or French and physicians who speak non-official languages.
  • In the process of obtaining a license in Ontario, international medical graduates are required to practice in ‘underserved areas.’ The definition of ‘underserved’ could be broadened to include areas that require primary care physicians who speak non-official languages.
  • Increasing enrollment of students proficient in non-official languages in Canadian medical schools.
  • Increasing availability of professional interpreters along with education for physicians on the use of interpretation services.

Future research could include:

For this study, we did not look at gaps within municipalities. Additional research is needed to examine gaps within larger urban centres.

*Due to the fact that the population census and our physician language database used different definitions of Chinese languages, we combined all Chinese languages together for the purposes of our study. As a result, we may have over-estimated the degree of language concordance in certain census divisions.