URL: http://www.abqjournal.com/opinion/guest_columns/169470241opinionguestcolumns02-16-09.htm

Monday, February 16, 2009
N.M. Needs More Medical Providers
By Frank G. Hesse, M.D.
Chairman, Health Policy Commission
   
   
    New Mexico and much of the nation face a growing and aging population and rising demand for health care services. This increasing demand is coming at a time when the ranks of health care professionals have not only grown smaller relative to the population, but are aging toward retirement. In 2006, 62 percent of active physicians in New Mexico in 2006 were 50 or older, and the state has the 12th highest percentage of active physicians that are 60 or older.
   
    New Mexico has a long history of physician shortages. That chronic situation will likely grow worse. Absent any intervention by policy makers, the needs of a growing and graying population will increasingly be underserved by the dwindling number of graying physicians and nurses.
   
    Over the past two decades, enrollment at most medical schools has been essentially flat. It is now evident that those physician surplus predictions made in the 1980s and 1990s were dramatically wrong, in part because of the assumption that managed care would change the way that health care is organized and delivered.
   
    The Association of American Medical Colleges recommended in 2006 that medical school enrollments be increased by 30 percent from the 2002 level over the next decade. Without the increase, the association predicts a national shortage of 124,000 physicians by 2025. Universal coverage, if implemented, would create huge additional demand for health professionals.
   
    In New Mexico, the shortages are most dire for dentists, where the state ranks 49th among the states, and nurses. New Mexico would need an additional 4,900 registered nurses and 1,330 licensed practical nurses to come up to the national averages. The state would need an additional 880 physicians to meet the national average.
   
    One way to increase the ranks of health care professionals in New Mexico is to train them here. But it takes time and money to enlarge a medical school or start a new one. The University of New Mexico will expand the incoming class at the medical school from 75 to 100 in 2010. But it will take at least seven years before that larger class will work its way through medical school and residency and become a factor in reducing the physician shortage.
   
    The biggest problem facing us today in New Mexico in our health care is the shrinking number of family physicians. Only 2 percent of our graduating medical students elect to go into family medicine because of the shrinking reimbursement and longer workdays compared to most specialties.
   
    Graduating medical students, who on average carry student loan debts of more than $150,000, are also being enticed by higher salaries in surrounding states, causing them to be lost to New Mexico.
   
    Some states are offering free tuition for medical students who sign up to go rural areas and practice family medicine. Increasing federal payments to family physicians over specialists would do much to increase the number of family physicians.
   
    We have fewer dentists per capita than any other state in the union, and very few dentists accept Medicaid patients. The ideal solution would be to start a dental school in New Mexico, but that would cost $50 million initially — money we don't have at this time — and $11 million annually thereafter. Expansion of the dental hygienist training program would help the dental care in this state especially in the rural counties.
   
    Many hospital beds in New Mexico are unused because of the nursing shortage. The are multiple applicants for each nursing school slot, but a serious shortage of nursing instructors. Nursing faculty positions require a masters degree or a doctorate, and nurses with masters degrees get paid more in clinical nursing than in teaching.
   
    Increasing mid-level providers like physician assistants, nurse practitioners, dental hygienists and nurse midwives could do much to alleviate the provider shortages, especially since they can be trained in a much shorter period of time than doctors and dentists.
   
    There is a great hope that a universal health insurance program will be adopted, improving health care. But if New Mexico doesn't start paying attention to our provider shortages, the patients who can't get in to see a doctor or dentist may not benefit.