OPINION: Licensure counts distract from health care access problems

I have practiced surgery in New Mexico for 17 years. When my primary care physician retired, I spent the next 18 months without a doctor.

Patients don’t experience health care through workforce spreadsheets. We experience it through long waits, unanswered phones, closed panels and months between appointments.

You can call it a physician shortage, a workforce crisis or a system failure. But the reality is simple: In New Mexico, it is extraordinarily hard to get in to see a primary care clinician or a specialist, and for many people it has been that way for years.

That reality matters more than debates about how many doctors hold New Mexico licenses.

Licensure counts are a poor proxy for access. Many physicians maintain multiple state licenses. Some are retired. Some work in administration, industry, research or telehealth outside New Mexico. Some no longer see patients at all.

Prior workforce analyses in New Mexico have suggested that only about one-third of licensed primary care providers are actually engaged in regular, direct clinical care. If that is even approximately true, then raw license totals will dramatically overstate the care capacity in our state.

A more honest starting point is not “How many doctors do we license?” but:

How long does it take to get a new patient primary care appointment?

How long does it take to see a cardiologist, neurologist, psychiatrist or endocrinologist?

Which clinics are closed to new patients?

How far are rural patients traveling?

How many people give up and go to the emergency department because they can’t get outpatient care?

These are the measures patients and health care systems live with every day.

New Mexico is also a wonderful place to retire. By 2030, New Mexico is projected to have the fourth-highest proportion of seniors in the nation, trailing Florida by less than one percentage point. An older population appropriately uses more health care. That reality alone means our workforce must grow faster than population just to keep up — yet access continues to deteriorate.

We should absolutely improve workforce data. We should track who is actively practicing, how many hours of patient care they deliver, and where. But we should not allow imperfect data to distract from what New Mexicans already know: The system is not meeting basic access needs.

The policy conversation should begin with this question: Why is it so hard to get timely care in New Mexico?

From there, we can examine recruitment, retention, malpractice environment, reimbursement, team-based staffing, telehealth compacts, training pipelines, rural sustainability and practice conditions. All of those matter. None of them alone will fix the problem.

But arguing over license counts while patients wait months for care misses the point.

If people can’t see a doctor when they are sick, pregnant or scared, then we have a workforce crisis — regardless of what any spreadsheet says.

Rohini McKee is the chief quality and safety officer and professor at University of New Mexico Hospital. She is also a member of the Albuquerque Journal Community Council.