Called to Serve
It’s no secret that New Mexico suffers from health provider shortages, especially in rural areas, where it’s hard to attract and retain physicians.
The full extent of the crisis attracted national attention last October when the New Mexico Health Care Workforce Committee reported to the Legislature that provider shortages – affecting every county in the state except Bernalillo – would likely worsen as doctors begin to retire. New Mexico has the nation’s highest percentage of physicians age 60 and older, nearly 36 percent.
The good news, hidden within the recommended solutions, is that a number of strategies for recruitment and retention advocated in past years have begun to show success: New Mexico increased its number of physicians overall from 2014 to 2015.
Whether this is a trend that will help address the state’s gap (relative to national benchmarks) remains a challenge for the state’s lawmakers and the University of New Mexico, which educates much of the state’s health provider workforce.
Recent School of Medicine graduates who have decided to return to New Mexico to practice offer some clues to the motivations at work. Key among these is being attracted to the idea of serving the underserved.
“For most physicians, that’s why they get into medicine,” says Chris Hawthorn, MD, an emergency medicine doctor who returned from a residency in Arkansas to practice at Presbyterian Healthcare Services. “It’s actually rewarding, because you’re doing a lot of people good.”
Hawthorn graduated from the School of Medicine in 2014. Barbara Cadena, MD, a family medicine physician in Doña Ana County, graduated in 2008 and cites “a sense of social justice” among her reasons for choosing to work with a mostly migrant population near the Mexican border.
“The gratitude they give me is very rewarding,” she says of her patients, echoing Hawthorn’s observation that “We don’t do it for the thanks, but it feels good that people feel gratitude for the care they’ve received.”
It is primary care providers that are most needed in New Mexico, especially in rural areas, where a third of the population lives. In areas that have the hardest time meeting benchmark standards for staffing – Lea, Luna, Otero, Torrance and Valencia counties – family ties might make the crucial difference.
That was the rationale behind developing the UNM Combined BA/MD Program, which fast-tracks New Mexico high school graduates into medical school with the explicit goal of preparing them to practice in the state. Students who come from rural areas are more likely to end up practicing in one, as are physicians who have been exposed to the experience during their residency.
The BA/MD program was funded by the Legislature 10 years ago, and its first graduates are just beginning their medical careers in New Mexico. Graduating students like David Hernandez, of Loving, often mention the desire to give back to family, friends and teachers who helped them succeed in school, and to do their community proud. The first doctor to come out of his high school, Hernandez says he would definitely go home to practice pediatrics.
Likewise, Hawthorn never questioned whether he would return to New Mexico after his residency in Little Rock, Ark.
“My whole family, all my siblings are here,” he says. Having trained as a licensed practical nurse in high school and worked as a nurse while studying at UNM, “I knew this was a good place to practice health care.” The patient population is similar to Little Rock, he adds, where “people will only take care of things when it gets to the tipping point of needing emergency care.” The difference for him was that, “with all my family here, I could do a lot of good and still be close to where I grew up.”
Cadena also cites “a sense of belonging” in Mesilla, where she was raised and her parents still live, for bringing her back to practice at La Clinica de Familia in San Miguel.
“The population is 80 to 90 percent monolingual (and) some may not be documented, so there’s a fear component of even going into Las Cruces,” she says. “That was part of it, because there’s such a need on the border. Seeing migrant people in the field working, and knowing that I’m the person there for them makes me happy. Just being witness to their despair helps them out.”
A decisive factor was receiving student loan forgiveness for practicing in a rural area, Cadena says. That helps make up for the lower pay of working in Doña Ana County than, say, Albuquerque or Santa Fe. Cadena, who did her residency at the University of California, Davis, says she certainly doesn’t earn as much as her colleagues back in Modesto, but the loan forgiveness made a crucial difference, and “comparatively the cost of living here is lower.”
Still, she acknowledges some of the considerable challenges of working in a federally funded clinic. When she arrived in 2011, a new clinic had yet to be built. The old building had rooms that were either extremely hot or cold and stray Chihuahuas crowding the front door. “I thought, ‘Whoa, I asked for this,’” she laughs.
Like Hawthorn, she often sees patients who do not seek care until gravely ill. One, “a real ranchero” who had experienced rectal bleeding for several years, had refused a recommended colonoscopy because he didn’t have insurance. “I admitted him to the hospital, and he was full of cancer everywhere. The hospital was required to treat him, as a patient with malignant cancer, and he went through rounds of chemo that probably cost several millions of dollars.”
Meanwhile, funding for her clinic is sometimes based on metrics like the number of patients who get colonoscopies. “They want us to do the screening, but people don’t have the resources to carry through.”
Helping doctors handle the stresses of working in such environments is part of the retention mission behind such programs as UNM Locum Tenens, UNM Physician Access Line and Project ECHO telemedicine clinics, which help ease rural physician workloads.
The Health Care Workforce Committee also recommended that the Legislature fund loan-for-service programs in a way that puts physicians in areas of greatest need. Exposure to rural practice is another priority, by funding the creation of residency programs in rural areas. Studies show two-thirds of students stay in the area where they do their medical residency.