Note: Dede is Chairperson of the Interim Health and Human Services Committee
One of the most neglected issues when discussing health care reform is the question whether New Mexico has the health care workforce to provide services to every New Mexican if everyone has health insurance. As I travel the state I learn how many communities have no providers whatsoever. The interim Legislative Health and Human Services Committee, on which I serve as Chairperson, will be exploring this issue in depth at our July 18 hearing in Deming. As of 2006, New Mexico had only 3,858 practicing physicians within the state boundaries. That is one physician for every 518 New Mexicans. When the number of specialists is considered, that leaves far fewer primary care or family practitioners per New Mexican. In Grant County, for example, there are only 28 primary care physicians.
How can we address this shortage? New Mexico funds several health care recruitment and retention programs, for doctors, mid-level practitioners such as nurse practitioners, physicians' assistants, dental hygienists, physical therapists and nurses. There are programs that give incentives to doctors who choose to remain in New Mexico after completing their residencies. Yet many would argue that funding for these programs is woefully inadequate.
Another obstacle to getting care where it is needed is resistance in the medical community to the use of mid-level practitioners such as physician assistants, nurse practitioners and dental hygenists to provide care where otherwise there would be few or no providers. Last year, Pennsyvania passed legislation to broaden the responsibilities of nurse practitioners, clinical nurse specialists, nurse midwives, physician assistants and dental hygenists. New Mexico might consider doing likewise, though opposition may be fierce to such a change to our rules. I call some of the resistance to such scope of practice innovation the "guild mentality," whereby practitioners zealously guard their exclusivity at the peril of underserved New Mexicans. Of course there are situations where only physicians and dentists can treat the patient. But can't some of the routine care, and follow-up be provided by other health professionals who have more constant contact with the local population? Where do we draw the line? The New Mexico legislature is constantly asked to balance protecting the health and safety of New Mexicans with providing access to people who have none at all.
Treatment teams or medical homes that include a number of professionals may be the answer, and there are models right here in Southern New Mexico. Hidalgo Medical Services is breaking new ground with its clinic-based primary care network. And promotoras or community health workers are extending the services of more-skilled professionals in Dona Ana County.
These are some of the subjects to be covered in the interim Health and Human Services Committee hearings July 16-18 in Southern New Mexico. The committee is soliciting public comment on these and other topics at Memorial Medical Center in Las Cruces at 4 p.m. Wednesday July 16, at 3:30 Thursday, July 17, and in Deming at the Mimbres Valley Learning Center at 2:30 on Friday, July 18.
For more information call the Legislative Council Service at (505) 986-4600 or visit the Legislature's web site at http://legis.state.nm.us/lcs/agecalendars.asp.