Cut medical students a break if they’ll stay in NM

Taxpayers now subsidize tuition with no guarantee of more providers

The much ballyhooed $61 million Medicaid pay increase will do little to increase or retain primary care physicians in rural New Mexico.

That is because the majority of primary care physicians in New Mexico are employees of large medical corporations, and their salaries are already 50% to 75% of primary care physician salaries nationwide. The increase will only enrich their employers and independent specialists. New Mexico needs primary care physicians in rural locations, not more specialists.

Significantly, in spite of the state’s need, UNM Medical school is not in the top 10 of schools whose graduates chose primary care. UNM is a top-tier medical school, and its 75 graduates each year are in demand nationwide. Why they choose employment, specialization and jobs in other states is complex, but the short answer is lifestyle and student debt.

There is a proven way to provide primary care physicians to rural areas of our state. The actual cost of educating a new physician is $50,000 to $100,000 each year for four years. UNM medical school tuition is $16,000 per year, while tuition at the private osteopathic medical school in Las Cruces is a more realistic $56,000. Therefore New Mexico taxpayers are subsidizing over $40,000 of each student’s education each year and, since fewer than 40% of graduates’ stay to practice in New Mexico, one can say that we are providing some 45 new physicians for other states each year, to the tune of over several million dollars annually. In spite of its low tuition, the average UNM medical student’s debt on graduation is $160,000.

The way to meet New Mexico’s need for primary care physicians is to offer prospective students the option of paying the real cost of their education, perhaps $50,000 per year, or pay no tuition and receive a reasonable living allowance for four years in exchange for a commitment to practice in underserved areas of the state for two or perhaps four years following completion of residency.

In the 1960s such a military-sponsored option was very popular and provided the physicians the military needed at that time. After completing their commitment some recipients will stay in place, some will move on to specialty training, and some will continue as primary care physicians but move elsewhere, hopefully within New Mexico. This same option should be offered to nurse practitioners.

While there are currently both federal and state programs that provide loans or debt relief in exchange for public service, they “are competitive, with no award guarantee and subject to legislative appropriation” and are not as robust as the above proposal. Most of all they lack the condition that students who do not choose the service option will pay a higher tuition, reflective of the real cost of their education.

Dr. Arthur Vall-Spinosa has practiced in New Mexico for 50 years, served on the first N.M. Health Policy Commission and helped create the first managed Medicaid program, which preceded Salud and Centennial.