For years, New Mexico has suffered from a chronic shortage of doctors, especially in the rural communities of the state. Now, with the rollout of President Obama’s health care law, plus the decisions by Republican Gov. Susana Martinez to approve Medicaid expansion and proceed with creation of state health care exchanges, up to 172,000 uninsured New Mexicans are expected to receive medical coverage in the coming year.
The question is: who’s going to treat them?
New Mexico has struggled in the past with an inadequate number of physicians to meet the needs of its citizens. According to a state report, the state’s long-running doctor shortage will continue to worsen as aspects of Obama’s law kick in.
“The number of healthcare professionals and their maldistribution throughout the state cannot adequately meet current demand, let alone the additional pressures brought about by the newly insured in 2014,” a report from the state’s Legislative Finance Committee warned.
Rural and New Patients Hit Hard
According to the University of New Mexico Health Sciences Center, New Mexico is currently failing to meet the demand for physicians, with a marketplace short of an estimated 2,000 physicians and roughly 400-600 primary care specialists.
The problem is especially acute in sparsely populated counties in the southern and northwestern parts of the state. In 2006, more than half the physicians in New Mexico were located in the state’s largest county, Bernalillo County, where Albuquerque is located.
According to the report, prepared by the Department of Health and Allied Agencies, there will likely be longer wait times for patients, especially new ones, in the coming years. How long people will wait is difficult to predict, but the report draws conclusions based on the similar reforms instituted in Massachusetts.
“Most New Mexicans will likely feel the pinch of an inadequate healthcare workforce,” the LFC report said. “New Mexico should anticipate wait times will increase with the expansion of insurance coverage, as was seen in Massachusetts following healthcare reform; despite a greater physician supply, average wait times for primary care appointments and some specialty care exceeded 40 days.”
Few Real Solutions
According to Dr. Kathryn Zerbach, a Santa Fe surgeon who specializes in the treatment of breast cancer, the challenge is not yet being addressed by any changes in policy.
“It’s a big problem and there’s nothing in place to address that issue,” Zerbach said.
Adding to the problem, Zerbach notes, is the fact that New Mexico already has a larger percentage of older people than most states, and more than the general population of the United States, with 22% of the state population over the age of 60.
“A lot of the hospitals in the state are trying to recruit [doctors],” Zerbach said. “The bigger hospital companies have more financial fortitude to do those kinds of things, but a lot of the smaller community hospitals really are struggling with that issue. And there’s nothing in place with the new health care law, or any of the things that are happening on the state level, that are going to fix that problem.”
Nurses, Assistants Fill Gap
Dr. J.R. Damron, a radiologist who serves as chairman of the newly-created New Mexico Health Insurance Exchange, concedes the problems will likely get worse as Obama’s law rolls out. He notes the problem could be exacerbated considering that nearly 40 percent of primary care physicians in the state are nearing retirement, and there may not be enough young doctors to replace them.
“I think access to care is going to be a very big issue,” Damron said. “We can build this exchange, we can have the framework … but are we going to have enough health care providers to take care of those individuals?”
To help fill the need, some providers are already using nurse practitioners and physicians’ assistants to pick up the slack by having them take over some duties, such as conducting initial consultations with patients. There are also programs in place requiring recent medical residents to work in New Mexico’s rural communities, but health care experts admit long-term solutions are needed.
“I think the medical profession is going to have to solve this problem,” said John Franchini, the New Mexico Insurance Superintendent. “We can’t solve it from our end. We can’t demand that doctors don’t retire … Let (doctors) have more freedom to decide how to do this.”
No Clear Answer
Dr. Deane Waldman, a pediatric cardiologist in Albuquerque and the consumer advocate on the board of the New Mexico health exchange, suggests that hospitals and clinics could be encouraged to expand their hours, but admits that given a finite number of doctors, it will take an array of solutions to make a dent.
“The answer is, if we just keep doing business as usual we will not accomplish the goal,” Waldman said.
For now, there are suggestions and theories but not many specific programs to tackle New Mexico’s doctor shortage.
“It’s not being talked about and kind of being pushed under the rug for now because nobody knows what’s going to happen,” Zerbach said.
Rob Nikolewski ([email protected]) writes for New Mexico Watchdog, where a version of this article previously appeared. Reprinted with permission.
Department of Health and Allied Agencies, “Adequacy of New Mexico’s Healthcare Systems Workforce”, May 15, 2013.