Calculating New Mexicos Health Care Needs Paul B. Roth, MD, MS - PDF document

Calculating New Mexico’s Health Care Needs Paul B. Roth, MD, MS Chancellor for Health Sciences CEO, UNM Health System Dean, UNM School of Medicine proth@salud.unm.edu 505.272.5849

Calculating New Mexico’s Health Care Needs Primary Care Physicians and Background Certified Nurse Practitioners/Clinical Nurse Specialists = Primary Care Physicians = Certified Nurse Practitioners and Clinical Nurse Specialists The task of augmenting New Mexico’s health care SAN JUAN RIO ARRIBA TAOS COLFAX UNION workforce is a complex process that starts with - 4 - 45 - 5 0 + 11 - 1 - 3 - 3 - 1 - 1 Total PCP and CNP/CNS accurately gauging how many health providers the Shortages per 1,000 Population LOS ALAMOS MORA state has – and how many it needs. - 3 + 1 HARDING + 19 - 4 0 0 McKINLEY SANTA No shortage/surplus - 8 - 27 FE SAN MIGUEL SANDOVAL + 72 - 5 - 50 + 3 - 4 Mild shortage - 1 This year, the New Mexico Health Care Workforce (Lacking 1 - 10 providers) CIBOLA BERNALILLO QUAY Severe shortage GUADALUPE - 2 - 7 + 322 + 142 Committee was able to delve deeper than ever into 0 + 3 - 1 0 (Lacking > 10 providers) TORRANCE VALENCIA - 11 - 4 - 36 - 23 Shortage or Surplus Values: professional licensing board data to provide a fine- CURRY 0 PC Physicians DE BACA - 4 - 10 CATRON SOCORRO grained analysis of who is practicing in the state, and - 1 0 - 1 - 2 - 2 - 3 CNP/CNS 0 ROOSEVELT LINCOLN - 2 - 5 where. - 3 - 3 CHAVES + 21 - 13 LEA SIERRA In its October 1, 2014, report to the New Mexico - 24 + 2 - 5 OTERO - 13 GRANT - 15 - 26 Legislature, the Committee estimated that 1,957 + 9 - 5 EDDY - 9 + 4 primary care physicians, 1,089 certified nurse DOÑA ANA LUNA - 1 - 12 - 10 - 1 practitioners and certified clinical nurse specialists, 256 obstetrics and gynecology physicians, 179 HIDALGO - 2 - 3 general surgeons and 321 psychiatrists were practicing in the state. *In 2014 APRNs included Certified Nurse Practitioners and Certified Nurse Specialists in order to align with national comparators. As in its 2013 report, the Committee found above- average concentrations of some providers in urban Potential Solutions areas, along with a severe shortfall – or even absence of providers – in rural regions. With population The Committee has made a variety of recommendations growth and expanded health insurance coverage for enhancing the production of new providers that driving increased demand for health services, the focus on recruitment and financial incentives. provider deficiency will only worsen, underscoring the urgent need to solve this problem. These solutions included targeted recruitment and loan repayment programs to induce providers to practice in Shortages rural and underserved communities. Alternative care The Committee found that without redistributing delivery systems that rest on a foundation of inter- the current workforce, New Mexico would need professional teamwork also hold the potential to help an estimated 153 primary care physicians, 271 leverage resources. nurse practitioners and clinical nurse specialists, 40 obstetrics and gynecology physicians, 21 general The Committee’s recommendations include: surgeons and 104 psychiatrists to close the practice gap. These totals may not include some providers n State funding for increased production of health care who are licensed in other states but practice at providers should continue. federally operated health facilities in New Mexico. n Pipeline programs to attract New Mexico high school Although the number of medical students being and college students to pursue health care careers should educated both in New Mexico and the nation has be evaluated and best practices adopted. grown in the past decade, the number of graduate medical education positions has not increased n Financial incentives for recruiting health care substantially, creating a bottleneck that will limit the professionals should be maintained and expanded on the number of practicing physicians. basis of their demonstrated efficacy.

n The state tax incentive program should be evaluated Other UNM strategies include expanded rural for its impact on recruiting and retaining New rotations for residents, enhancing community Mexico’s rural health care workforce. recruitment efforts and making better use of telemedicine programs like Project ECHO. n Social and environmental barriers to successful recruitment should be addressed. Looking Forward The first phase of the Committee’s analysis focused The state needs to continue its support for workforce on collecting data from advanced practice registered training in the UNM School of Medicine and the advanced practice registered nurse programs at UNM nurses, primary care physicians, psychiatrists, general and New Mexico State University, as well as the New surgeons, OB-GYN practitioners and dentists, Mexico Nursing Education Consortium. accompanied by suggestions for recruitment and retention strategies for those specialties. The University of New Mexico Health Sciences Center seeks to fulfill its mission of increasing the supply of The second phase will be to enhance the Committee’s health care workers and facilitating their location in projections over the next 5 to 15 years. The scope rural areas. Its FY 2016 request to not only continue will also be expanded to include pharmacists, funding the residencies funded in FY 2015 but to also emergency medical services personnel and other fund additional graduate medical education residencies professions as data collection requirements are in general surgery, family medicine, general internal incorporated into their licensure procedures and medicine and psychiatry will help to achieve this goal. the data are submitted for analysis. Mental health professionals will be a focus for FY 2016. Longer-term measures, such as UNM’s Combined BA/ MD program and proposed BA/DDS track, will take Per the Health Science Center’s FY 2016 legislative more than a decade for their effects to be felt, but have funding request, the New Mexico Health Care the virtue of educating native New Mexicans, who Workforce Committee should be permanently funded are more likely to remain in state and practice in the so it can both delineate the state’s needs and offer communities where they grew up, as well as add to grounded, evidence-based recommendations for the workforce diversity. best path toward meeting them. Programs to Increase the Number of Physicians and Dentists in Underserved Areas of New Mexico Number of years required for programs to produce results 2014 Legislative Action Years 1 2 3 4 5 6 7 8 9 10 11 12 13 Loan for Service/Loan Repayment Programs Increased allied health Begin immediately loan for service funding WICHE Dental Funded additional slots 4 years in length BA/DDS Program No action 9 years in length Physician Residency Programs 9 positions funded 3 - 5 years in length Combined BA/MD Program 11 - 13 years from acceptance into Ongoing program to completion of residency BA/Nursing APRN Increased to 40 per year 4 years in length 2 years in length