At the end of 2021, New Mexico was short three hundred thirty-four (334) primary care physicians and five thousand eight hundred sixty- three (5863) nurses. Why do these shortages exist and can anything be done to alleviate them?
These statistics are from an important Errors of Enchantment podcast, in which Paul Gessing interviewed Drs. Sandra Whisler and Howard Gogel about the healthcare provider shortage that we have in New Mexico. Here are some of the other major points raised in the interview:
1 The doctor and nurse shortage is especially acute in rural New Mexico;
2 New Mexico has great difficulty attracting health care workers, in general, and physicians in particular. A 2021 Medscape report ranked New Mexico as the third worst in the country to practice medicine. Only Louisiana and West Virginia had worse rankings;
3 New Mexico physicians make substantially less than their peers in nearby states. There are a variety of reasons for lesser pay. One is that nearly 50% of New Mexicans are covered by Medicaid, and Medicaid’s reimbursement rates are often abysmal. There is also a substantial administrative cost in processing Medicaid claims. New Mexico also has a pernicious gross receipts’ tax that levies taxes not only on the sale of goods, but also on services. New Mexico is one of just 4 states that taxes medical services. In some counties in New Mexico, the combined state and local gross receipts’ taxes on medical services can be over 8%. These taxes cannot be passed on to the patient;
4 The average debt of a recent medical school graduate in the U.S. is a staggering $241,000. State sponsored loan repayment programs have proved to be a very effective way to attract young physicians. Nearby states have much more generous loan repayment programs for health care workers than New Mexico. The New Mexico legislature recently awarded 1.6 million for health care loan repayment. The maximum award is for $25,000 per year for two years for a total of $50,000. In contrast, Arizona can award $25,000 per year until the loan is paid off. In Texas up to $160,000 can be paid over four years and in Colorado, $90,000 over three years;
5 An additional enormous storm cloud for physicians considering coming to or staying in New Mexico is the cost of malpractice insurance. This year the Democrat controlled state legislature passed HB 75, which removes New Mexico hospitals and outpatient health care facilities (OPHF) from the protections of the medical malpractice act. Hospital and OPHF malpractice cap limits will rise from $600,000 to 6 million by 2026. It is expected that medical malpractice premiums will skyrocket as a result.
Additional reasons for the lack of attractiveness of New Mexico for everyone, not just health care workers, are a miserable public school system and high crime.
On October 24, the Nation’s Report Card published post-lockdown reading and math test score results for all states and the District of Columbia. New Mexico students ranked 51st for fourth-grade math, fourth-grade reading, eighth-grade math, and eighth-grade reading. New Mexico eighth-grade math scores showed a proficiency rate of just 12.69%.
FBI crime stats show that New Mexico is #2 in the country for violent crime per capita and #2 for property crime per capita. Between Q3 2021 and Q3 2022, among the nation's 50 largest cities, Albuquerque had the sixth highest increase in homicides.
So, what can be done to try to attract more health care workers to the state? Clearly the state sponsored loan repayment program has to be improved. We have to match or better Arizona’s $25,000 per year until the loan has been paid in full program. Granting an exemption from the gross receipts’ taxes would be another. The legislature should also reconsider the long-term impact of SB 75, and what it will do to the medical services industry in the state.
Because our public schools are so bad and crime is such a problem, I think that healthcare workers are going to have to be paid a lot more than they would receive in surrounding states to attract them. New Mexico may have great weather and be an outdoor sportsman’s paradise, but those things don’t pay the bills.
Charles Sullivan is a retired attorney who has lived in New Mexico for over 40 years.