By Frank G. Hesse, M.D.
Retired Surgeon
Although the health care problem of the uninsured has been getting all the national headlines, the lack of providers has received scant attention.
All of New Mexico counties except one (Los Alamos) are federally declared medically underserved. We rank 32nd in the nation in the number of physicians per population. We have only 1.54 full time equivalent physicians per 1,000 population.
Most of us know how difficult it is to find a physician and get an appointment in a reasonable period of time even if we have the best of insurance.
According to the Human Service Department's information, there are 432,000 people in this state, without health insurance. If they become covered, as they should, it will overwhelm our present medical providers.
No presidential aspirant, with a national universal health insurance program covers this eventuality.
The University of New Mexico Medical School has enlarged its student body from 75 students per class to 100, but that will not meet the need especially since over 75 percent of our graduates go to other states to practice.
Nationwide, medical students leave school with more than $120,000 in educational loan debt on average. They go where they can most easily make the money to repay their loans, and that most often means going to Texas, California, Colorado and Arizona.
Another problem: Medicare is scheduled to lower its fee payments to physicians by 10 percent on Jan. 1, unless Congress changes it before December 31,2007. Since Medicare fees are already below prevailing fees, that will result in 23 percent of New Mexico physicians limiting new Medicare patient enrollment, according to a recent physician survey. Private insurance companies usually follow Medicare in lowering their fee payments to providers.
Since physician assistants and nurse practitioners can do a great deal of the work of a physician it would help to alleviate the provider shortage to increase the number of training facilities and programs for PAs and nurse practitioners in the state.
A large loan forgiveness program for all these providers would help keep them in this state if they stipulate that they go to underserved areas of the state to practice.
Another problem in health care is the severe nursing shortage. Forty-seven percent of nurses are over age 50 and 72 percent are over forty. Many of them will retire in the next decade. There is no shortage of applicants for nursing schools but these schools cannot enlarge because of the severe shortages of nursing faculty.
It is a national requirement that all faculty must have a masters degree or higher, and nurses with those qualifications can make more money doing clinical nursing immediately out of school rather than teaching.
Other constraints are that many nursing schools have insufficient classroom and laboratory facilities, and insufficient hospital sites to practice. The Legislature needs to increase the funding for our nursing schools to overcome these shortcomings.
The shortage of adequate dental care is another serious problem in New Mexico especially in rural and poverty areas. New Mexico is ranked 49th in the number of dentists per capita. There are 33.8 dentists per 100,000 population, well below the national average of 63.6.
Forty-five percent of New Mexico dentists are above age 55, nearing retirement age. A limited number of dentists accept Medicaid in this state and the dental care for the poor and rural citizens is grossly inadequate. Studies have recommended a dental school with 30 students per class. That would cost $11 million a year after four years, after an initial capital outlay of $52 million.
An increase in the number of dental hygienists would also improve dental shortcomings.
So while all the political talk is about covering the uninsured— a tremendous need in our country and state— let us not forget the other health problems; the lack of medical providers, nurses and dentists.
Insurance coverage does not equal good access if there are few clinicians to see you.
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