OPINION: A plan to address New Mexico's physician shortage

Is the doctor in? For a close friend, the doctor was not. And the friend is dead.

Through the tears and loss of her best friend, his wife laid out the details of his inability to be seen due to lack of physician access until it became too late. This is not a one-off situation in New Mexico, it now seems the norm. The root cause is a heavily unbalanced medical legal environment since passage of the 2021 malpractice legislation.

While average then, New Mexico now has some of the highest malpractice suits per capita in the country and is losing physicians. There is an opportunity to rebalance this situation in the upcoming legislative session, but the current reputational harm will take years before physicians feel it is legally safe and balanced to practice here. In the meantime, there are specific measures that can assist in increasing providers. I call on my fellow legislators and the governor in her legislative message to enact the following.

• Pass the medical compacts for all medical caregivers, including social workers, to enhance the unmet need for mental health.
• Establish substantial medical school loan repayments. While New Mexico is a leader in physician shortages, it is a growing issue for the rest of the nation. Most states are now looking at substantial legislation, but for New Mexico to succeed it must be one of the top reimbursing states. This would require $75,000 per year of practice in the state for a minimum of four years, and a maximum payment of $300,000. Location in a rural area should have an additional $100,000 payment. The cost for 30 new physicians with ongoing funding for four years would be $15-18 million annually. Affordable!
• The University of New Mexico Health Sciences Center does not have physician faculty salaries near the 50th percentile of the American Academy of Medical Colleges. Talent is leaving. The 50th percentile should be the floor per specialty and rank. How are we to train excellent students and residents and induce them to stay if we can’t offer outstanding teaching and mentoring?
• Similarly, residents should be paid at the 60th percentile. About 60-70% of medical residents enter practice in the state they finish their training in, New Mexico is closer to 30%. Excellent and consistent faculty, resident appreciation and loan repayment are a continuum the state must engage in to help heal the wound caused by the 2021 malpractice legislation which has led to the physician exodus.
• Physician compensation in surrounding states is 30-40% greater than New Mexico. The payment issues are that New Mexico has the largest percentage nationally of Medicaid patients, almost 40%; is near the top in Medicare — 18% — the lowest payer; and has a poor percentage of commercial payments, the highest-paying segment, of about 25%. Most states are well above 50%. The only solutions here are economic development and a floor of commercial payments tied to a standard.
• Repeal the gross receipts tax on care.
• Rebalance medical malpractice.

All the above will assist but will never make up for the current malpractice imbalance. Even with the substantial loan repayments, a well-supported UNM Health Sciences Center and compacts, few physicians are likely to make a long-term commitment to practice in our state. Doing so doubles to triples the risk of being sued, almost always for frivolous nonmeritorious issues, and almost always with the threat of senseless punitive damages. Let’s fix all of this.