Minding the Care Gaps
A new wave of programs takes aim at New Mexico’s health care shortcomings
New Mexico has options for addressing its health provider shortage, one of the worst in the nation. Since a 2013 analysis of the state’s health care workforce revealed shortages of doctors, nurses and other professional staff in 32 of 33 counties, lawmakers have appropriated more than $36 million aimed at boosting provider numbers.
Each year, the Legislative Finance Committee analyzes the state’s health care workforce and makes recommendations on how to fill the gaps.
Since 2013, the state has acted on those recommendations in the following ways:
- Tripled the number of colleges offering Bachelors of Science in nursing, from two to six, to meet the increased need for nurses. By 2018, the state will offer BSNs at 17 nursing programs. Nurses with bachelor’s degrees can help provide more primary care in rural and underserved areas at a fraction of the training cost required for primary care doctors. The state also increased the number of nursing education slots open to students.
• Expanded training programs and job openings for nurse practitioners and physician assistants. These advanced practice nurses are less expensive to train and pay, and are qualified to handle most primary care needs. Half of New Mexico’s population is relatively healthy and only requires preventive care, such as vaccinations and periodic treatment for acute illnesses. Nurse practitioners and physician assistants are therefore an economical way to meet needs in rural areas.
• Increased graduate medical residencies in primary care. Doctors tend to stay where they complete residencies, according to an analysis by the Legislative Finance Committee. But the number of graduating physicians outpaced the number of available residencies in New Mexico, which are paid through Medicare. State lawmakers are working with the University of New Mexico Health Sciences Center to expand residencies in primary care by nine per year for the next seven years.
Keeping the program going will require ongoing investments by the Legislature, and residencies aren’t cheap. Each residency costs about $150,000, according to the LFC.
• Enhanced funding for medical loan repayment programs. The LFC and a national study found that offering to repay the medical loans of doctors and other health providers after they work for two years in a rural area was more effective than offering scholarships to medical students who commit to working in underserved places. The scholarship students defaulted on their agreements more frequently. But the loan repayment program could use a lot more funding — 89 percent of applicants did not receive money.
• Funded expanded “pipeline” programs to introduce middle school and high school students in rural areas to health care professions and opportunities. Studies show health care providers from rural areas are more willing to practice in rural locations.
• Provided a $3,000 to $5,000 tax credit to health providers who work in rural and underserved areas. For 2015, 1,763 rural providers qualified for the credit, according to the state Department of Health. The UNM Health Sciences Center has recommended extending the tax credit to pharmacists, counselors and social workers in rural areas.
• Established a 16-member task force to prepare a bill that will allow dental therapists to serve areas that lack dental services. In New Mexico, 32 of 33 counties are federally designated as lacking dental health services. The state also increased funding to help students attend dental schools out of state, since New Mexico lacks a program.
• Offered state funding for a UNM service called Locum Tenens, which provides temporary doctors and nurses for rural hospitals and clinics that face a sudden shortage of providers. A similar program administered by the Department of Health, called NurseAdvice NM, connects people by phone or online to veteran nurses.
- Launched health extension offices in several rural locations around the state. The extension offices, created by UNM’s Office of Community Health, are based on the same educational model used for decades by the U.S. Department of Agriculture’s extension offices. Hidalgo Medical Services is one of the Health Extension Rural Offices.
While the programs are good, experts say, they can only go so far. Rural New Mexico communities themselves will have to figure out how they can entice health care providers to their towns — and keep them there.