Physician shortage, soaring costs are major challenges

It’s his job to train physicians for the workforce, but Paul Roth says the state will continue to struggle with a shortage of doctors.

“New Mexico has a lot of challenges. We have a much older population with a stagnant birth rate, so demand for more intense medical care as we all age will increase. At the same time, the average age of physicians in New Mexico is much higher than the rest of the country. We know we have a doctor shortage and that it will only get worse.

“We have to do everything we can to address both the doctor shortage and maximize what nurse practitioners and other clinicians can do and produce more of those as well. We are going to the Legislature now to request an expansion in college of nursing.”

Keeping UNM medical school graduates — the total official enrollment is 412 — in New Mexico is challenging. Historically, only about 25% to 30% of graduates stay in New Mexico to work. Various reasons draw them away, such as higher pay, lower taxes and a more favorable legal climate.

The rural nature of the state and professional isolation are also problems, Roth said.

In larger centers, if “you want a consult, you just go next door and get it. You have plenty of people backing you up, so you can go off to a conference or just have time off to be with your family. It’s hard to do that in a small town.”

Crime and public education are also challenges for recruiting.

Roth says the one thing that has made a difference is the bachelor of arts/medical doctor program he created 11 years ago.

“We saw data that students who come from rural communities will tend to return to those communities to practice.”

Medical costs

The costs of medical care continue to climb, pushing health insurance premiums and out-ofpocket deductibles ever higher.

Is a silver lining in sight? Not really.

When negotiating contracts with insurance companies “it’s not unusual to start a conversation where they say you’re doing a great job, now we want you to do it for 30% less.”

“We work just as hard and have to demonstrate better outcomes for less money.”

And work smarter.

For example, “we are looking at things like how long do patients with pneumonia stay in the hospital and why?”

A case manager would immediately become involved to help determine how long the patient needs to be in the hospital and start talking about a rehab or a nursing home.

“Doing it that way, we’ve been able to improve our quality and the experience for our patients … and we cut our costs, because patients aren’t just hanging out in the hospital,” he said.

But new life-saving technology and drugs are expensive. People are living longer and entering the system multiple times.

Despite best efforts, Roth said, the cost curve is still upward.

“No doubt about it.”