SOURCE: Albuquerque Journal
An “exciting opportunity” for a neurosurgeon awaits at the San Juan Regional Medical Center, according to an online hospital help wanted ad.
Unfortunately, the vacancy has been open for at least 18 months despite the eye-popping base salary of up to $750,000 and perks that include student loan repayment.
The good news is that the 194-bed hospital in New Mexico’s Four Corners area – which needs a total three neurosurgeons – has managed to hire two from out of state during its ongoing search.
“We beat the bushes and found them,” said hospital CEO Jeff Bourgeois. “We tell them, `You’re needed. You’re needed here. Come here and you’ll be appreciated … ‘ ”
New Mexico is suffering more than many other states from the national physician shortage, leading to long wait times for appointments and emergency room visits when waiting is unbearable. One national report ranked the state 48th in access to physicians in 2017. To make matters worse, the state’s physician work force is the oldest in the country and ranked near the top in the number of doctors surveyed who said they planned to retire in the next few years.
Some health care leaders say New Mexico faces additional hurdles to attracting and keeping physicians and other health professionals – including physician compensation, poverty, the poor reputation of some public schools and, in Albuquerque, the crime rate. Others say those are simply excuses.
Gov. Michelle Lujan Grisham told the Journal she wants to address the shortage in New Mexico “from a variety of angles,” including attracting health professionals to locate here and grow their practices by raising the Medicaid reimbursement rate.
And her administration is considering other ways to increase access and incentivize providers. She also wants to tap Medicaid funds to support more New Mexico medical residency slots – considered a key way to induce doctors to put down roots in the state.
“We’re all affected (by the physician shortage),” she said in an interview. “I’m affected. I have trouble getting in. We’re all having trouble. The system is broken, and we have to do everything in our power (to fix it).”
High vacancies
On any given day, a major Albuquerque-based recruiter can have between 400 to 600 vacancies for health professionals in New Mexico.
Jerry Harrison of New Mexico Health Resources says the actual number statewide is much larger since not all employers seeking health providers use his agency.
“I think that we know maybe half of the true vacancies at any given time,” he said.
As physicians from “snow states” look to resettle in the West, New Mexico has stiff competition from states like Texas, which has no state income tax and a physician-friendly medical malpractice climate. Or from more affluent communities that offer higher pay compared to New Mexico, which is near the bottom of one national ranking.
“Any primary care doc now has literally thousands of jobs they could take across the country,” said Dr. Donald Pathman, a researcher and teacher at the University of North Carolina at Chapel Hill.
Dr. John Cruickshank
But Dr. John Cruickshank, chief executive officer of Lovelace Medical Group based in Albuquerque, says, “we’ve got a lot to offer people. It’s not all ‘Breaking Bad’.”
“If you did watch the (television) series, in my opinion, it may have put us on the map, but it didn’t help us. Because it labels us as drug ridden and crime ridden, and I don’t feel that at all.”
“You could use those as excuses, but I think they’re only that. We all have our challenges. There are 10 times, 100 times as many things that outweigh those negatives in our community.”
In any case, New Mexico has a challenge in keeping doctors, especially because of retirements.
Executives of some major health care providers in New Mexico say their total provider turnover runs from 10 to 15 percent.
But Dr. Jason Mitchell, chief medical and clinical transformation officer at Presbyterian Healthcare Services, said the bigger challenge is getting physicians to New Mexico.
Prospective physicians and other providers “will always look at the statistics when they come here, and you see our school systems are inconsistent with their quality, depending on where you go to. And we also have a lot of crime here compared to other states, so I think that’s a challenge.”
And “Breaking Bad”?
“Yes,” Mitchell adds, “that did not do us a favor.”
So Mitchell points out to job seekers, “Here’s some schools that really do great.” As for crime, he will say, “When you look at their daily lives, most of us are not affected. We’re fortunate.”
“Once we get them here and talk to them and we kind of share the culture of what we’re doing and talk about the mission, we’re able to recruit pretty well,” he said.
“Once you show them what it’s like and they look at the beauty of New Mexico, you can really get a lot of them to stay. It’s just that you’ve got to get them into the state and you’ve got to have them meet us.”
New Mexico Medical Board chairman Dr. Steve Jenkusky recalled being at a national meeting when a physician from the East Coast asked where he lived.
When Jenkusky told him Albuquerque, “He goes, ‘Oh, yeah. ‘Breaking Bad.’ It was not really a compliment.”
Money
As a recruiter, Harrison said the biggest issue he encounters is compensation.
“The escalation of the cost of health care education is striking,” he said, with the typical medical student coming out now with around $190,000 of debt.
And for relatively new for-profit schools, like Burrell College of Osteopathic Medicine that opened in Las Cruces several years ago, the final tab for a new osteopathic doctor could total far more than $200,000.
That means finding a high-paying job to help pay off education loans is key for some new doctors.
A state’s poverty is also a factor when a physician is seeking job opportunities, said the University of North Carolina’s Pathman.
“There are numerous studies that show physicians cluster around hospitals, and they cluster in more affluent communities,” he said. “Often jobs will pay more there, and more affluent communities are likely to have better schools for the kids.”
In cases of specialists for whom technology is important to their work, Pathman said bigger, affluent communities are more likely to “have that kind of scanner that allows you to do that kind of procedure.”
Some say that health care providers can be drawn to New Mexico because of its needs.
Dr. Lance Wilson, chief medical officer of DaVita Medical Group in Albuquerque and Rio Rancho, said, “I think the people that choose to come here and practice are people who really want to serve a community. The reason those things happen, like crime, (is that) we are in general a state that’s challenged with socioeconomic problems.”
“So the people that come here to practice – and the ones that stay especially – are doing it because they want to care for those people, and they recognize that being able to serve that population comes with some other things that just happen to people who are desperate … ”
Wilson says physician compensation here is actually “pretty good.” What brings providers to New Mexico has more to do with “ties to something culturally, or spiritually, or family or really the desire to be in nature and being able to do that pretty much whenever you want.”
“It’s really up to us to sell what NM is … to see what the potential is here.”
Major expense
Medical groups in Albuquerque and elsewhere are making up for the physician shortage by hiring physician assistants, who are attached to a doctor’s license and must be supervised; and certified nurse practitioners, who in New Mexico are able to work autonomously. The national average salary for either type of clinician is at least half the average pay for a physician.
“The other problem in this state, is that it is relatively poor and doctors, even if their salaries are in the average range, are expensive,” said the Medical Board’s Jenkusky. “So doctors are a big expense for companies (like hospitals) that hire them. And over half the patients in this state are either on Medicare, Medicaid or are uninsured. So you don’t have this large percentage of commercial insurance to balance that out. So I think that makes it hard for many entities.”
Generally speaking, doctors and hospitals get higher reimbursements from private health insurance carriers than from either Medicaid or Medicare.
Nationally, the profile of health care has changed, with physicians increasingly looking to be employed rather than setting up their own offices.
“So you’re seeing fewer independent doctors, fewer entrepreneurial doctors,” Jenkusky said. “It’s just hard with all the paperwork you have to do, such as working with the insurance companies for payment. You’re seeing these smaller practices disappear and no new ones being opened.”
Physicians who take employment jobs “want to take a vacation, you want to maybe go home at a normal time. So that decreases productivity. Many of the new generation of doctors want work/life balance,” Jenkusky said.
Recruiter Harrison said there are also “tremendous” issues with electronic health records.
“That has been a real issue, particularly for physicians who are in their late 50s. I have heard of physicians walking away from their practices because they didn’t want to deal with electronic records or they didn’t like the (records) program their organization was using.”
Legal landscape
New Mexico malpractice premiums are lower than in most states, and New Mexico is one of only eight states that has set up a Patient Compensation Fund. The state’s cap on total damages a victim can collect is at $600,000 – excluding punitive damages and past and future medical care.
An attempt in 2011 to raise the cap on liability awards to $1 million was vetoed by Gov. Susana Martinez, but another one is pending in the current legislative session that would raise the cap to $2 million.
Some health care executives say current malpractice rates aren’t a major factor in why physicians don’t locate here.
But in Farmington, San Juan Regional Medical Center CEO Bourgeois said taxes and malpractice caps do matter.
Bourgeois, who moved here from Texas, contends that New Mexico’s physician shortage is “exacerbated due to the practice environment, despite all the wonderful amenities.
“If physicians feel like they can’t earn an income commensurate with other states,” he said, or they have to “pay more in taxes or risk practicing in an unfriendly litigious environment … it becomes a much less attractive place.”