Copyright © 2023 Albuquerque Journal
Last year, Dr. Kristina Chong, of Women’s Specialists of New Mexico, was midway through a checkup with one of her longtime patients when the woman started crying.
The patient had been seen by a gastroenterologist, who found a golf-ball sized mass in her intestines and referred her to a local hospital.
But it was now six months later, and the woman was still waiting to be seen.
“If it’s a cancer. It’s been an extra six months that she has been living with this,” Chong said in a recent interview with Journal reporters and editors.
New Mexico for decades has dealt with a shortage of physicians and other health care workers.
Now many local doctors say that – unless changes are made in the system – the situation will become much more dire in the coming years.
Among the reasons are high medical malpractice premiums, low Medicaid reimbursements and having to pay gross receipts taxes on medical services.
“The shortages that we’re talking about have been accumulating over time, but they may be reaching a tipping point,” said Dr. Howard Gogel, with Southwest Gastroenterology.
New Mexico in 2021 had 1,649 primary care physicians, 700 less than the state had in 2017, according to the New Mexico Health Care Workforce Annual Report. The state is 334 primary care physicians below national provider-to-population benchmarks, according to the report.
The state lost 63 OB-GYNs during the same time period, leaving just 219. The state would need 59 more OB-GYNs to reach the national benchmark, and more than 100 psychiatrists to hit the mark for that field.
Meanwhile, the average age of a physician in New Mexico is older than 50, which suggests shortages will likely continue as doctors retire.
The workforce report said the state has a shortage of primary care physicians in virtually every county, but the problem is more pronounced in rural Harding, Union and Guadalupe counties.
Hikes in medical malpractice rates
New Mexico doctors are facing large increases in the cost of their medical malpractice insurance because of recent changes to the Medical Malpractice Act, which raised the cap on damages. Some lawmakers this year are expressing interest in trying to make additional changes to complex state law.
Dr. Todd Williams, of San Juan Plastic Surgery in Farmington and president-elect of the New Mexico Medical Society, said his medical malpractice insurance is significantly higher than it would be if he practiced in surrounding states.
Williams said he is currently paying about $65,000 per year. But he said the insurance would be about $18,000 per year if he practiced a few miles away in Colorado or Arizona, and $38,000 for coverage in Texas.
The cost of his malpractice insurance has increased about 30% in the last two years because the cap on such malpractice cases is increasing, he said.
Medicaid and GRT a double whammy
But the trouble with finding affordable malpractice insurance is only part of the reason doctors are leaving the state, several physicians said in recent interviews. State tax policies and Medicaid reimbursement rates are also becoming more daunting, particularly for doctors who work in private practice.
Some of the recommendations from the report’s authors were to increase Medicaid reimbursement.
Physicians in New Mexico treat a higher share of Medicaid patients than doctors in surrounding states.
More than a third of New Mexico residents are insured through either Medicaid or the Children’s Health Insurance Program, according to Kaiser Family Foundation. By comparison, 21% of people in neighboring Arizona, 19% of people in Colorado and 17% of Texas residents are covered by those insurance programs, according to the foundation.
New Mexico’s Medicaid rates haven’t increased in years, and those patients bring in far less money to health care facilities compared with treating patients who have traditional insurance, said Dr. Mark Depper, a diagnostic radiologist in Albuquerque.
“Increasing Medicaid reimbursement is essential for my clinic’s survival,” he said.
A spokeswoman for the New Mexico Human Services Department said an increase to Medicaid provider and facility reimbursement is included in the governor’s proposed budget.
Gogel said another factor facing New Mexico physicians is gross receipts taxes on medical services. New Mexico is one of just a couple of states that applies what’s essentially a sales tax on medical services.
For physicians who work in private practice, there is a complex list of reductions or exemptions that can lower parts of the tax bills depending on how the procedures are paid for. Hospitals, on the other hand, are taxed on 40% of their total gross receipts, said Mark Chaiken, the tax policy director for the New Mexico Department of Taxation and Revenue.
Williams said New Mexico’s malpractice insurance rates, coupled with lower reimbursement for Medicaid patients and having to pay gross receipts taxes to the state may cause him to look for opportunities in other states.
“When you factor all of those things in, it’s hard to not look somewhere else. And what that’s going to result in is patients are going to have even decreased access to care in this state,” he said. “I’d like to be here but it’s really hard to justify staying here when I can almost double my take home income by going to a different state.”