Copyright © 2023 Albuquerque Journal
SANTA FE – Abelardo Garcia is a Roswell pediatrician who’s spent years trying to recruit doctors to rural New Mexico.
Jeffery Greene was an Albuquerque dentist until he lost an eye after a botched surgery.
They sharply disagree over legislative proposals to reshape New Mexico’s medical malpractice law.
But their ideas for addressing the state’s chronic doctor shortage also share surprising common ground, illustrating a complex debate at the Roundhouse this year.
Despite conflict over medical malpractice legislation, a host of other proposals intended to boost the health care workforce are drawing bipartisan support.
They include substantial increases in the reimbursement rates for serving Medicaid patients, an explosion in funding for student-loan repayment programs and other ideas.
But time is running out. Just three weeks remain in the session, and it’s unclear which measures will make it to the governor’s desk.
Garcia, a pediatrician and part owner of several medical clinics in the Roswell area, said it’s vital for lawmakers to take action making New Mexico more attractive to doctors.
Increased Medicaid rates, expanded student loan repayment and – yes – revising the malpractice law to reduce insurance costs would all help, he said.
“Our closest neighbors – like Texas, Colorado and Arizona – they beat the pants off us,” Garcia said. “Any person that wants to come here, they start comparing with other places. We usually lose out.”
Greene said the botched eye surgery that cost him an eye ended his dental practice, resulting in $10 million in economic losses, by his estimation. But the state’s medical malpractice law at the time capped recovery at $600,000.
The caps on damages have since been raised.
Greene said New Mexico can “absolutely” make the state a more attractive place for doctors without revisiting the malpractice law to reduce compensation to patients harmed by medical errors.
Like Garcia, he said increased Medicaid reimbursement rates are critical for health care providers. He also suggested removing the gross receipts tax on medical services and broader efforts to make New Mexico more attractive.
“I don’t think one piece of legislation would fix the problem that we’re having,” Greene said. “It’s going to take multiple pieces of legislation, and it’s going to take a concerted effort of making our city a place where people want to come to practice medicine.”
Medicaid
With some bipartisan support so far, the state budget proposal moving through the Legislature includes substantial funding intended to help physicians who serve Medicaid patients.
It includes $83 million in state matching funds that – when combined with federal funds – would provide $330 million for rate increases, according to legislative analysts.
The funding is enough to bring the Medicaid reimbursement rate to 120% of the Medicare rate targeted areas, such as behavioral health services. It would be equal to Medicare for other services.
Rep. Gail Armstrong, a Magdalena Republican and ranking member of the House Appropriations and Finance Committee, said the proposed reimbursement increases would help doctors throughout the state, including in rural areas.
“I fought really hard for that,” she said.
Medicaid is a critical part of New Mexico’s health care landscape. About 72% of babies in the state are born under Medicaid coverage, the highest rate in the nation.
Raising the rates, lawmakers say, is an effective strategy for better compensating doctors.
The budget legislation, House Bill 2, won House approval 52-17 and is now under consideration in the Senate.
Loan repayment
The budget also includes extra money to support programs that help physicians repay their student loans. It has $4.7 million in ongoing funding and $10 million in one-time money for the health professional loan repayment fund.
The bump is substantial compared with this year’s budget, which has just $1.7 million in recurring funding.
“It’s vital to keeping people in our state in the health profession,” Rep. Joy Garratt, D-Albuquerque, said of the increase.
Lawmakers are also weighing a bipartisan proposal, House Bill 209, to expand eligibility for the loan program. It would open eligibility to all physicians, not just primary care doctors, but also require three years of service, not two.
“A lot of doctors coming out of school have all these loans to repay, and they can’t afford to start their own business,” said Rep. Armstrong, a co-sponsor of the bill.
Doctors say loan repayment influences recruitment.
Stacey Dimitt, chief of staff at Cibola Family Health Center and Cibola General Hospital in Grants, where she is heavily involved in recruiting, said New Mexico’s incentives badly trail nearby states.
In Kansas, Dimitt said, she signed up for a program that paid for a year of medical school for every year she worked in an under-served area.
Four years of work, then, covered the cost of medical school. In New Mexico, Dimitt said, the incentives pay for one-quarter of the cost for two years of medical school.
Dimitt is a family practice doctor, in addition to her role as an administrator.
Expanded loan repayment “is a no-brainer,” she said. “When we compare to the states around us, we are either tied for some of the lowest or among the lowest in the amounts we offer.”
Malpractice debate
New Mexico’s oil-driven revenue boom has given lawmakers more budget flexibility and helped facilitate bipartisan support for spending to help physicians.
But the medical malpractice law remains a point of intense conflict.
New Mexico overhauled the law in 2021, enacting higher damage caps that increased the legal exposure for hospitals and doctors as part of a complex set of changes.
The revisions were intended to balance the need for justice by families harmed by medical mistakes while ensuring doctors could afford malpractice insurance.
But this year lawmakers have heard from physicians at independently owned outpatient clinics who say they won’t be able to afford insurance – and will be forced to close or sell to a corporate hospital – because of the higher damage caps that go into effect next year, phased in under the 2021 law.
They’ve also heard from patients who have offered heartbreaking stories about grave medical mistakes that inflicted permanent damage on children.
Earlier this week, Democrats on a key House committee rejected a proposal backed by the independent outpatient clinics.
Still, potential changes to the Medical Malpractice Act are circulating at the Roundhouse, though it’s unclear whether any will gain traction.
Republican lawmakers – who have been most aggressive about pursuing malpractice changes – say they are open to compromise if Democrats in the majority will listen.
“We’re in a crisis already that’s just going to get worse,” Sen. Mark Moores, R-Albuquerque, said.
‘Generational commitment’
No one disputes the need to bring more doctors into New Mexico. The number of physicians in the state fell 30% between 2017 and 2021, according to a workforce committee.
House Speaker Javier Martínez, D-Albuquerque, said addressing the shortage is a priority for Democrats. He cited the cash infusion outlined in the budget proposal to help compensate and recruit doctors.
But New Mexico, he said, must “make a generational commitment as a state to train, develop, educate and retain health care professionals, not just medical doctors, but all the way to clinical social workers, nurses, pharmacists.”
Senate Minority Leader Greg Baca, R-Belen, casts the debate in more immediate terms.
“This is a crisis that needs to be addressed,” he said.
A host of ideas remain in play.
In separate interviews, Garcia, the Roswell physician, and Greene, the ex-dentist, each said there’s no single solution to New Mexico’s doctor shortage.
But increased Medicaid reimbursement is a source of agreement.
A lasting solution, Garcia said, will take “a combination of several things.”
Greene said changes outside the medical system would also help: Crime and schools are factors in whether a health care provider makes New Mexico home.
“Unfortunately, I don’t think one issue solves the problem,” he said.
Lawmakers face a noon March 18 deadline to send bills to Gov. Michelle Lujan Grisham.
