By Rob Nikolewski │ New Mexico Watchdog
SANTA FE – 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 the Affordable Care Act, plus the decision by Gov. Susana Martinez to approve Medicaid expansion and creation of state health care exchanges, up to 172,000 uninsured New Mexicans are expected to receive medical coverage in the coming year.
But who’s going to treat them?
According to the University of New Mexico Health Sciences Center, New Mexico is short 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.
“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 Legislative Finance Committee warned.
Adding to the problem? New Mexico already has more older people than the general population of the United States:
“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.”
Something’s got to give, and it seems a virtual certainty there will be longer wait times for patients, especially new ones.
“Most New Mexicans will likely feel the pinch of an inadequate healthcare workforce,” the LFC report said.
How long people will wait is hard to tell, but when Massachusetts reformed its health care system in 2006 average wait times for primary care and specialty care appointments exceeded 40 days, the report said.
“I think access to care is going to be a very big issue,” Damron told New Mexico Watchdog. “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. That probably won’t sit well with patients who expect to see a doctor, not a nurse, to discuss their personal medical issues.
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.
To make things worse, nearly 40 percent of primary care physicians in the state are nearing retirement and there are fears there’s simply not enough young doctors to replace them.
“I think the medical profession is going to have to solve this problem,” John Franchini, the New Mexico Insurance Superintendent, told New Mexico Watchdog. “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.”
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 with (the ACA’s) complexity,” Zerbach said.
Here are excerpts of New Mexico Watchdog’s interview with Zerbach:
Contact Rob Nikolewski at firstname.lastname@example.org and follow him on Twitter @robnikolewski