In critical condition

NM lawmakers need to stop doctor exodus to resuscitate health care system

If you’re experiencing a long wait to see a physician, you may want to call your state senator and representative. Or the governor, for that matter.

Gov. Michelle Lujan Grisham in her State of the State address last month proposed a New Mexico Healthcare Authority to “consolidate services in one agency and move the state closer to universal health care.” We would point out there’s a big difference between health care coverage and actual health care — you need doctors for the latter.

And New Mexico is shedding doctors, and fast. The state had 700 fewer primary care physicians in 2021 than it had in 2017, according to a 2022 New Mexico Health Care Workforce Annual Report. Doctors say departures have been picking up after lawmakers overhauled the state’s medical malpractice law in 2021, raising the cap on all medical malpractice claims.

“So right now, in New Mexico, there’s a shortage of every kind of health care professional — nurses, respiratory therapists, advanced care providers, techs, everything,” Dr. Howard Gogel of Albuquerque’s Southwest Gastroenterology told Journal reporters and editors recently. “And in every venue — hospitals, clinics and that sort of thing.”

Not enough physicians

New Mexico, ranked by health information website Medscape among the worst five states to practice medicine, was already below national providerto-population benchmarks. The state is 334 primary care physicians below national provider-to-population benchmarks, which isn’t news to New Mexicans — especially those living in rural areas. Virtually every county is short of primary care physicians, with the worst hit being rural Guadalupe, Harding and Union counties.

The doctor shortages are likely only going to get worse with sharp increases in medical malpractice insurance kicking in next year. Meanwhile, the average age of a physician in New Mexico is 53, suggesting further shortages are likely as doctors retire. And unfortunately, only 40% of residency graduates stay in New Mexico.

Too-long waits for appointments

The doctor shortage hits home when there is no doctor to see you now. Albuquerque physician Dr. Kristina Chongsiriwatana of Women’s Specialists of New Mexico says one of her patients, who had a golf-ball sized mass in her intestines, had to wait more than six months to be seen at a local hospital after being diagnosed by a gastroenterologist.

While the governor can head to Washington, D.C., for her knee replacement, most New Mexicans don’t have that option.

Malpractice ‘reform’ needs reforming

The hotly debated 2021 medical malpractice overhaul was pitched as a way to deliver justice to patients and their families who have suffered from medical errors. Change may have been warranted, but it has led to increased malpractice insurance rates for physicians. And the law, as written, will lump many clinics in with hospitals, raising monetary caps to numbers no insurer will cover. These changes are convincing new doctors to bypass New Mexico and many of those already here to leave.

Dr. Todd Williams of San Juan Plastic Surgery in Farmington, who is also president-elect of the New Mexico Medical Society, says his malpractice insurance has increased about 30% in the last two years because lawmakers raised the cap on malpractice damages. Williams says he’s currently paying about $65,000 per year for malpractice insurance. He says the costs would be about $18,000 if he practiced a few miles away in Colorado or Arizona, and $38,000 in Texas.

“I’d like to be here, but it’s really hard to justify staying here when I can almost double my take-home income by going to a different state,” Williams says.

Low reimbursement rates and GRT

Skyrocketing malpractice premiums between 30% and 80% are compounded by having close to half the population on Medicaid, with low reimbursement rates that haven’t kept up with inflation for over a decade, and New Mexico being one of two states that levy gross receipt taxes on medical services, which can not be passed on to patients.

The governor’s proposed budget includes an increase to Medicaid provider and facility reimbursement, but GRT reform is a more complicated fight, with calls to limit carve-outs that chip away at state revenues.

What lawmakers, governor can do

Many local doctors say unless changes are made, the situation will become much more dire. Steps they suggest include:

■ Shoring up the state’s patient compensation fund. Qualified health care providers pay fees into the fund, which covers all or some of large malpractice damage awards. The system is designed to make medical malpractice premiums affordable, while providing adequate compensation to patients injured by medical malpractice.

Former Insurance Superintendent Russell Toal – who retired last month – has asked the governor and Legislature for $32.5 million to help support the financial health of the patient compensation fund. That’s doable with a $3.5 billion budget surplus.

Democratic Sen. Martin Hickey, a retired Albuquerque physician and former CEO of Lovelace Health Systems, says the fund faces an “actuarial death spiral” if changes aren’t made.

■ Eliminate classification of outpatient health care facilities as hospitals, enabling them to retain a $750,000 liability cap and better afford malpractice insurance. They otherwise face a $5 million cap set to go into effect Jan. 1, 2024, and have told legislators they can’t get insurance for that level of coverage. Senate Bill 296 would keep outpatient clinics that aren’t owned by hospitals under a $750,000 cap – plus an inflation adjustment – for injury or death due to malpractice.

■ Raise Medicaid reimbursement rates.

■ Eliminate the hidden GRT on medical services that physicians have to absorb.

■ Increase support for medical residency programs and improve loan forgiveness programs.

■ Require timely credentialing by insurance companies and hospitals so physicians get reimbursed in a timely fashion.

Medical care in New Mexico is in critical condition. Doctors are fleeing or passing us by because of our high costs of maintaining a private practice. This is one of the most important issues in the Roundhouse this session. Lawmakers need to act, STAT!