Copyright © 2019 Albuquerque Journal
Editor’s note: Today the Journal kicks off a three-part series examining the severe lack of timely access to health care in New Mexico. Stories will be published today, Monday and next Sunday.
On Feb. 5, all but three Presbyterian Medical Group primary care practices in Albuquerque were at capacity. The earliest appointments for the few providers available were three to four weeks away.
As of last week, not a single primary care physician in one of the state’s largest group of medical providers was accepting new patients in Albuquerque and Rio Rancho. During calls to Presbyterian schedulers, one suggested that prospective patients check with their insurance companies and find doctors elsewhere.
Meanwhile, urgent care centers in Albuquerque and Rio Rancho that traditionally serve walk-ins afflicted with minor illnesses and injuries were so booked, appointments were being scheduled for the next day.
And new patients referred to medical specialists like neurologists, gastroenterologists and surgeons for potentially serious medical conditions reported waits of up to several months.
With rural areas in a continuing “crisis” over the lack of health care providers, residents of New Mexico’s largest metropolitan area are also feeling the strain of the national physician shortage – and it hurts.
“I’m so upset. I am so, so, so upset,” said Judy Kaplan, a retired registered nurse who moved to New Mexico from California last fall.
Though a recent workforce study found that New Mexico has added primary care providers in recent years, Kaplan has faced one hurdle after another in her quest to find a physician in Albuquerque.
Last November, the earliest appointment she could get with a University of New Mexico primary care doctor was in March. Then she learned that appointment had been abruptly canceled and reset for June.
“Being in the health care system myself, that really hurt me,” Kaplan told the Journal. She finally landed an April 9 primary care appointment with another medical group. But she wonders whether that, too, will be rescheduled.
“What’s really bad is what if I’m sick before then, and here I am with no doctor.”
Dr. Jason Mitchell, senior vice president and chief medical and clinical transformation officer for Presbyterian Health Care Systems, said he understands that patients have expectations and are frustrated.
But he said change is inevitable as New Mexico copes with the national physician shortage. He said Presbyterian is meeting demand by building three additional urgent care centers and providing more access through online tools.
“There’s no way we can recruit our way out of this,” Mitchell said. “We can’t recruit enough doctors in New Mexico to meet (patient) expectations in the traditional sense. There’s not enough doctors in the United States, and there’s not enough coming to New Mexico. We have to do things differently.”
NM 3rd worst in U.S.
New Mexico was ranked 48th lowest of the 50 states for access to health care, considering 33 factors, including physicians per 100,000 population and percentage of those with insurance, according to a recent report by a national physician recruiter.
“I understand this is a hard conversation with people in New Mexico,” said Kurt Mosley, vice president of strategic alliances at Merritt Hawkins, a national recruiter that also compiles heath care data.
The forecast isn’t encouraging.
New Mexico in 2016 had the oldest physician population in the country. And the state ranked near the top in the number of physicians surveyed who said they planned to retire in the next few years.
Moreover, New Mexico by 2030 is predicted to have the nation’s fourth-largest population of people age 65 or older as a percentage of the overall population, according to a 2016 state Legislative Finance Committee report.
“Over 10,000 baby boomers (nationwide) turn 65 every day,” Merritt Hawkins said in a recent news release. “And those in that age group see a physician at three to four times the rate of younger patients.”
Dr. Lance Wilson, chief medical officer of DaVita Medical Group, says people are living longer with chronic disease and they need more care.
“If you are somebody who is 75, you are seen an average 4 times a year,” he said.
DaVita, formerly Albuquerque Health Partners, is a 140-provider physician-led medical group that primarily offers primary care and outpatient services in Albuquerque and Rio Rancho.
Wilson said established family practice physicians are now seeing their patients get older.
“They’re of a certain age, and their patients are of a certain age, and they (doctors) don’t have time in their schedule to see kids and to see young healthy people,” Wilson said. “So it’s really shifted what primary care is these days.”
And as the population ages, more specialists are needed.
Ten years ago, experts thought there would be a 50-50 mix of primary care physicians and specialists required in the future. Now projections tilt toward a greater need for specialists.
Dr. Janis Orlowski, chief health care officer for the Association of American Medical Colleges, said the nation is facing a shortage of up to 121,000 physicians by 2030 – 72,000 specialists and 49,000 primary care providers.
With demand increasing, the supply of new physicians educated in the U.S. isn’t keeping up.
Congress has frozen the primary federal funding for residencies required of MDs and osteopathic doctors at 1997 levels. Bills to lift the cap on residencies, which are traditionally funded through Medicare, have been proposed at least six times since 2007 and have failed every time.
Earlier this month, a bipartisan bill was introduced in the U.S. Senate to increase funding to support an extra 3,000 residencies per year.
Some states, including New Mexico, have used state funds to augment residency slots, but that can be expensive. A bill pending in the current state legislative session would create nine extra residency slots for $1.2 million annually.
“We have the best health care system in the world, but we have lousy access,” Mosley said. “We just don’t have enough doctors.”
To deal with the long waits to see specialists, the Journal found some New Mexicans opted to find care out of state and have been seen within days.
A cancer survivor who had unexplained bleeding last year tried to see numerous gynecologists in Albuquerque but couldn’t get an appointment less than two months away. While in Southern California on business, she was seen within a week.
An Albuquerque resident who needed lung cancer surgery and had weeks to wait before she could see a New Mexico specialist opted to go to M.D. Anderson Cancer Center in Houston. She got an appointment, underwent required tests and had the surgery by the time the appointment in New Mexico rolled around.
Sharon Gross, of Albuquerque, said she was “extremely frustrated” at the months of delays to see a gastrointestinal doctor for a continuing digestive condition, so she opted to travel to the University of Colorado Hospital in Aurora. There, she said she got an appointment with little difficulty. She also went to the Mayo Clinic, and her primary care medical team in New Mexico has helped coordinate care.
On another health matter, Gross said she was told that if she developed “certain symptoms,” she should consult a rheumatologist in New Mexico “right away.” She made the appointment in January and can’t get in until March.
“I don’t want to alienate doctors here. I think they are trying as hard as they can,” Gross said. “But we need more providers.”
Kaplan moved from San Diego to New Mexico for its “preservation of cultures,” open spaces and museums.
But she still has an internist in San Diego, and, as a backup, has made a March appointment to see her doctor there.
But Kaplan said she doesn’t believe it’s fair “for people to have to leave Albuquerque and seek medical attention out of state.”
“That’s quite a burden.”
Average new patient physician appointment wait times for 15 large metro markets surveyed nationally in 2017 showed 30 percent longer average wait times than in 2014 – an average 24.1 days, according to Merrick Hawkins. Appointment wait times are even longer in mid-sized metro markets, averaging nearly 33 days.
“It’s safe to say you (in New Mexico) are equal to if not worse than most of those (metro) areas,” said Merrick Hawkins’ Mosley.
The highest average new patient wait times of any city surveyed was 52.4 days in Boston, Mass. Yet Massachusetts has more physicians per patient population than any state in the union, Mosley said.
But an estimated 96 percent of people in Massachusetts “are insured some way or another and that’s why the wait times go up, when people have more access to it,” Mosley said.
Jerry Harrison, executive director of New Mexico Health Resources Inc., an Albuquerque-based nonprofit that recruits medical professionals, said he has heard for some time about long appointment wait times in New Mexico, including at oral health clinics in the state that have “two-year waiting lists to get in.”
“It (the problem) isn’t new to me. It’s just become more apparent,” Harrison said.
Orlowski of the Association of American Medical Colleges said access to health care nationally has improved with the rollout of the Affordable Care Act, including the expansion of Medicaid. That has contributed to the increase in demand for health providers, but only modestly, she said.
“The real big increase is from the general population and the aging,” Orlowski said.
But back in New Mexico, Harrison said he believes that Medicaid expansion “has really stressed the delivery system, particularly for working adults now being covered.”
An additional 250,000 people in the state became Medicaid members since the expansion, so that 40 percent of New Mexicans are now enrolled.
Technology to the rescue
Officials at DaVita Medical Group and Lovelace Health System, two leading Albuquerque-based employers of physicians, physicians assistants and nurse practitioners, say they have had success in ensuring timely access by instituting centralized scheduling of appointments.
Presbyterian, with about 1,000 providers, offers video visits, online scheduling of appointments, messaging of providers, and a “smart exam” for about 20 diagnoses.
During such exams, patients fill out a questionnaire online for review by a physician who in less than five minutes determines what should be done, including whether the patient needs to go to an ER or for more urgent treatment.
Mitchell said Presbyterian just last year recruited some 293 new providers, a substantial number from out of state.
Presbyterian officials say they don’t break out specific wait times for new patient appointments. But their recent data shows the average wait time for a primary care appointment for new and established patients is five days.
Creating more patient access through online tools helps free medical providers to see patients face to face, Mitchell said, and the website smart exam “increases capacity exponentially.”
But Jorja Armijo Brasher, former director of the city of Albuquerque’s Senior Affairs Department, says some senior citizens can’t adapt to the new technology.
“Some say it’s too hard, and they just forget about it. Then it (their medical condition) gets worse. Then they’re really vulnerable.” “You can talk online or get onto the computer, but to see an actual doctor is almost impossible anymore,” she said. “A lot of the elders were saying ‘it takes us forever, by the time they give us an appointment, it’s so far away and my need is now.’ ”
So, she said, they go to emergency rooms, “or clinics, rather than doctors.” And when they go to their doctor, she said, they often see an assistant.
A recent annual report from a University of New Mexico-led health care workforce group estimated that in 2017, New Mexico had a “substantial increase” in the number of primary care physicians – 284 more doctors over 2016. The study showed an estimated 2,360 primary care physicians practicing in New Mexico.
A large percentage of the new doctors located in just six counties, Bernalillo, Sandoval, Santa Fe, Doña Ana, Chaves and San Juan. Losses were reported in seven counties.
And Valencia, Otero, Lea, Eddy, and Luna counties would still need 91 primary care physicians to achieve benchmark practitioner to population ratios, the report found.
But reaching a national benchmark doesn’t ensure health access, the report stated.
“Health systems factors such as wait times to see physicians, insurance restrictions, and the distribution of PCP specialties within a county … may seriously hamper the population’s access to care,” the report stated. Harrison, who is a member of the workforce committee, cautioned that the report may overstate access because it doesn’t differentiate between primary care providers who work in an outpatient setting, versus those who work as hospitalists.
“We have no real way to sort those people out from those who are really taking appointments and seeing patients,” he told the Journal.
Harrison said he believes access issues are prompting the opening of more urgent care clinics, and combination urgent care/emergency centers in the Albuquerque area and elsewhere. And now patients are making appointments for such care.
“That’s a sign to me that people are not being able to get the urgent care they need to have without waiting for long periods of time.”
Another wait list
Kaplan, the 73-year-old retired nurse who moved here from San Diego, said she hoped to find a primary care doctor who specialized in geriatrics, so she called the University of New Mexico Senior Health Center in Albuquerque.
Last week, the center wasn’t accepting new patients and had a waiting list of about 70 people. Only those 75 and older are eligible.
“I figure maybe I’ll get on the list now,” Kaplan said. “Maybe by the time I reach 75, I’ll get an appointment.”
Coming Monday: Rural New Mexico struggles to find doctors – one town’s tale.