Craig Fritz/New Mexico In Depth
Dr. Patricio Larragoite travels almost two hours north from Santa Fe to Tierra Amarilla once a week. It’s the only way people in the remote villages of Northern Rio Arriba County can see a dentist.
“It was always my goal to be a provider for people without access,” says Larragoite, a Santa Fe dentist for 26 years.
When Larragoite headed the now-defunct Health Policy Commission, the independent-research organization reported to the New Mexico Legislature about severe provider shortages that were expected to worsen over time. It was 2003, and the Commission was particularly concerned with the lack of mental-health providers, nurses, dentists and physicians.
“I’m scared to death because this is not just a New Mexico issue,” he says. “The forecast we put together was not bright, and it’s not changed.”
The Tierra Amarilla clinic where Larragoite works once a week has tried to recruit a full-time physician and dentist there for more than a year, says its executive director, Darren DeYapp.
Las Clinicas del Pueblo de Rio Arriba serves 15 tiny communities like Chama, Dulce, Lumberton, Los Ojos, Casa Blanca, Los Brazos and Tierra Amarilla. It is the only medical facility from Ghost Ranch off of Highway 84 north to the Colorado border.
DeYapp, a Chama native and city councilor, faces the same recruitment challenges as the rest of New Mexico – lower wages and high uninsured — in addition to rural limitations. There are no private-school options, few employment opportunities for spouses and the closest city, Española, is 90 miles away.
“It’s a hard sell if they aren’t looking for this lifestyle,” he says. “I look more at the family and sell the family on what we have to offer.”
DeYapp, like other clinic directors, solves health-care access problems creatively. Promotoras, or health-care workers, visit patients to manage chronic diseases like diabetes without doctor visits. Clinic workers drive patients to and from their appointments when they can’t get there on their own. Temporary or part-time providers travel to fill gaps in care. When the local pharmacy announced plans to close, DeYapp researched ways to expand his clinic’s in-house pharmacy.
“We are always trying to stay ahead of the curve,” says DeYapp. “We measure our success by meeting community needs.”
It’s these kind of efforts that may help sustain New Mexico through a national and local provider shortage that’s likely to worsen when more people can get health insurance through federal health-care reform.
Educational institutions are another key player. Southern New Mexico Family Medicine Residency Program in Las Cruces recruits students who have local ties to southern New Mexico, which has proven effective in keeping providers here, says Dr. John Andazola, program director. In the last three years, 79 percent of graduates have stayed in New Mexico, Andazola says.
“There’s also good data that show where a physician finishes his training is where he’s more likely to practice, so we offer rural experiences,” he says.
Medical residents are required to spend time in such rural communities as Silver City, Hatch, San Miguel, Chaparral or Doña Ana, he says. Many placements turn into full-time jobs. The University of New Mexico’s medical school has a similar rural residency program.
Andy Lopez, executive director of Las Clinicas del Norte, manages clinics in Ojo Caliente, Abiquiú and El Rito. Instead of trying to recruit physicians, he says he relies on nurse practitioners who can do 90 percent of the work physicians do.
Both Southern New Mexico’s and UNM’s residency programs have shifted away from competitive practice toward physicians working in collaborative groups with other providers, such as psychologists who can prescribe medicine and pharmacists who can manage complicated diseases like diabetes.
“It makes a big difference for accessing care,” Andazola says. “Instead of the physician having to do all of the care, they partner with other professionals to provide the care.”
UNM and New Mexico State University partner to provide health-extension agents, similar to promotoras who help locals get their health needs met, in 10 rural communities, says Dr. Arthur Kaufman, vice chancellor of community health at UNM.
One health-extension agent in Silver City helped set up a tele-pharmacy program after a local pharmacy closed, Kaufman says. A pharmacist in a remote location reviews the prescription, and a local pharmacy tech dispenses the medicine.
New Mexico has the advantage of being a small state with a low population, able to partner and adjust to new needs, Kaufman says: “I think change is going to be real slow, but sometimes change doesn’t occur until there’s a crisis.”
It may be time for New Mexico to change the way medicine is traditionally practiced, including giving mid-level professionals, like nurse practitioners and dental therapists, more authority to care for patients, says Jerry Harrison, who has recruited providers to New Mexico since 1979.
“I think the most highly educated folks will be concentrating on the most serious conditions and that we may see different varieties of mid-levels evolving, which may lead to some pretty tough legislative battles because each professional trade group will attempt to maintain its economic position,” Harrison says.
Harrison says he remains positive about New Mexico’s health-care future. “Once it’s defined in which direction we’re going to go with Medicaid expansion, we will come up with solutions,” he says.
Editor’s note: Deborah Busemeyer, a freelance journalist, worked as communications director for the New Mexico Department of Health from 2005 through 2010.