Commentary: Struggling to find a doctor? Help is on the way!

David R. Scrase, M.D and David Rakel, M.D.

The COVID-19 pandemic has made it clear that expanding New Mexico’s primary healthcare workforce has never been more important. Many people go to emergency rooms because they do not have access to a primary doctor. Exacerbating the situation, New Mexico has the oldest physician population in the U.S., according to the Association of American Medical Colleges.

As physicians retire, the shortage of doctors in our state expands, particularly in our rural and frontier communities – where residents travel long distances for healthcare.

Funding the growth of graduate medical education (GME), the physician training period between medical school and independent practice, is key to expanding the primary care physician workforce. Research illustrates 55 to 75 percent of doctors practice in the state where they did their training. Recruiting more New Mexicans into primary care and keeping them here is a priority of the state. 

Physician shortages exist across all specialties in New Mexico (not just primary care). Primary care practitioners are the bedrock of our state’s healthcare system, serving as patients’ first point of entry into the healthcare system. These physicians, nurse practitioners, and physician assistants, in partnership with their patients, provide health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses.

To grow the primary care physician workforce, Governor Michelle Lujan Grisham enacted the Graduate Medical Education Expansion Program in 2019 to create and expand primary care physician residency programs.

In collaboration with community based GME training directors and staff, the New Mexico Human Services Department (HSD) developed a strategic plan for GME expansion. From 2019 to 2025, we expect to start five new accredited GME primary care training programs, projecting that the total number of primary care physicians-in-training will more than double to 291.

This is monumental growth for our state, and we are already making progress. In 2020, the number of GME programs increased from 8 to 10. Further, HSD approved GME program development funding for three programs in 2020 totaled $1,000,035:

• Burrell College of Osteopathic Medicine (Las Cruces) to add a total of 12 new Family Medicine residency positions. Anticipated arrival date of first resident: Summer 2021.

• Memorial Medical Center (Las Cruces) to add a total of 12 new general psychiatry residency positions. Anticipated date of first resident: Summer 2022.

• Rehoboth McKinley Christian arrival Health Care Services (Gallup) to add a total of 12 new general psychiatry residency positions. Anticipated arrival date of first resident: Summer 2024.

Another program in development, supported separately by a federal grant, is a partnership between the University of New Mexico, Indian Health Service and Shiprock Service Unit on the Navajo Reservation in Shiprock. This will add nine family medicine positions. Anticipated arrival date of first resident: Summer 2022. 

These and other new program growth mean there will be 46 new primary care and psychiatry physicians graduating yearly, starting in 2025. If we can recruit these doctors to stay in New Mexico, this expanded workforce will serve an additional 100,000 New Mexicans every year. In addition to further organizing our state efforts to support primary care, as outlined in proposed legislation for the 2021 session, we need to expand training for nurse practitioners and physician assistants.

Our state’s investment in the primary care workforce will yield significant returns for both local economies and population health. For example, each physician supports $3,166,901 in economic output, an average of 17 jobs, approximately $1.4 million in total wages and benefits and $126,000 in state and local tax revenues. Further, an increase in 10 primary care physicians per 100,000 individuals results in:

• An 11 percent decrease in emergency room visits

• 6 percent decrease in hospital inpatient admissions

• 7 percent decrease in surgeries because of providing timely care to address medical issues before they become emergencies.

So, help is on the way. And once this plan and other solutions are fully enacted, we will have a permanent solution to our chronic primary care access problem in New Mexico.

David R. Scrase, M.D., is the cabinet secretary for the New Mexico Human Services Department. David Rakel, M.D. is the GME Expansion Review Board chair and professor & chair of the Dept. of Family Medicine in the University of NM School of Medicine