Public Health New Mexico
Wed February 5, 2014
Lawmakers Try to Address Physician Shortage
UPDATE Feb. 19 11:07 a.m.: The dental therapists bill and medical malpractice act and the NMSU mental health nursing program, are stuck in committee. The measure to expand the Nurse Educators Fund and expedited nurse licensure measure passed the House and are awaiting a vote in the Senate.
Several bills in the Roundhouse this session aim to add more health care workers to New Mexico.
Every county in the state except one has a shortage of providers, according to the federal government. And about 170,000 more people are expected to enroll in Medicaid this year. Increased eligibility under the Affordable Care Act will only sharpen the need, and lawmakers and the governor are scrambling to meet it.
Health Secretary Retta Ward said primary care physicians are retiring, which adds to the strain on resources. "The biggest concern that's being addressed during this legislative session by the governor's initiatives is the primary care workforce," she said. New Mexico is down somewhere between 2,500 and 3,000 nurses, she added, who provide a lot of primary care. "The shortages are the most critical in the rural areas."
A bill that would create a new category of dental practitioners—dental therapists—will be considered during this 30-day legislative session. They would be able to do teeth cleanings, scaling and root planing, routine fillings and extractions, and denture repairs.
Nine counties in New Mexico have either 1 or 0 dentists or dental hygienists, said Pamela Blackwell of Health Action New Mexico. "There's a shortage throughout the state, including on the Southwest side of Albuquerque." Thirty-seven percent of third-graders have untreated dental decay, she added, and that number's even worse for the Native American population.
Sen. Benny Shendo, a Democrat from Jemez Pueblo, said the Navajo Nation is supportive of this plan. "As a young Indian kid, all we remember about our dentist is extractions, and nobody wants to go to the dentist," he laughed. "That's the experience of a lot of people, not just Indian people, from rural communities who don't have consistent oral health care. These things get delayed to the point where, yeah, it does need to get extracted."
Communities would select a candidate to receive training to become a dental therapist, who would then be expected to return home and serve his or her region. Programs without the community selection process are less successful, Shendo said. "If I was a recipient of this and I told my elders and my community that I was going to come back, and I didn't, I couldn't live with that lie for the rest of my life."
Blackwell said dental therapists will be able to work in a variety of settings, including health care clinics and schools. "Dental therapist hygienist is going where patients are," she said. "They're really meant to be a community-based provider."
The New Mexico Dental Association is against the bill. Dr. Tom Schripsema, director of the organization's Council on Government Affairs, said while the NMDA is open to the idea of mid-level providers, the group takes issue with the fact that this model doesn't exist elsewhere, among other things. "We certainly have concerns about the educational level," he said. "We have some concerns about the scope of what they may be doing and under what circumstances they can do it with different levels of supervision, as well."
Schripsema added that the problem with practicing in rural areas is that Medicaid isn't funded adequately, he said. That makes it hard for dentists to take on patients using Medicaid for health care coverage. "Most private practitioners find that the amounts that are paid are less than what it costs to provide the services," he said. "It's really a charitable enterprise to see a Medicaid patient because you're going to have to pay something in order to do it."
Preventive measures, like fluoridated water, could also help with dental health in the state, he said, and a dental school would boost the numbers of providers.
"There are plenty of dental resources in most parts of the state," he said. "If Medicaid were actually tapping those resources that are available and making it a worthwhile endeavor for people to be able to provide those services, we believe those services would be available everywhere."
Rep. Terry McMillan, a surgeon from Las Cruces, said the malpractice climate in New Mexico is "volatile." The Republican is sponsoring a measure that would cap the amount a plaintiff could receive for pain and suffering at $300,000 and would limit punitive damages as well. Predictable liability reform will help attract doctors and nurses to New Mexico, he said.
McMillan's also backing a bill that expands the state's Nurse Educators Fund to allow any registered nurse access to those loans. The fund exists to allow people to pursue graduate degrees and become educators, but as things stand, it only applies to folks working in public universities or colleges. McMillan said the fund, which got $141,000 from the Legislature last year, hasn't really been tapped.
All New Mexico counties—except Los Alamos and parts of Bernalillo and Sandoval counties—lack an adequate number of mental health professionals, according to the Legislative Finance Committee. Sen. Mary Kay Papen, a Democrat from Las Cruces, is looking to boost funding to New Mexico State University for the mental health nurse practitioner program by $171,200. In New Mexico, these nurses can diagnose and treat mental illness, and have the ability to prescribe medication. They are often considered primary care providers.
Rep. Thomas Taylor, a Republican from Farmington, is sponsoring a bill that would expedite the licensure process for nurses coming in from out of state. With his legislation, it would only take five days for a new nurse to get set up. Twenty-nine states, including New Mexico, are part of a compact that recognize each other's licensure procedures, Taylor said, and this measure speeds up licensure for nurses in non-compact states.
His district experiences the shortage, he says, and there's a continual process of attracting health care professionals to Farmington. "Because of our location, we serve the health care needs of people outside of our state, as well," he said. "We have a high demand all the time."
The Board of Nursing assures that a more speedy process wouldn't lessen the scrutiny and vetting an applicant would receive. The board reviews academic credentials, national certification, past performance and previous disciplinary actions, and conducts a criminal background investigation.
This plan and others designed to increase the number of medical practitioners were part of Gov. Susana Martinez' 2014 State of the State address. She also spoke of helping to repay student loans for doctors and nurses who work in rural areas, and expanding tele-medicine, the practice of patients connecting with physicians via electronic communications or phone.
The last day of the 30-day legislative session is Thursday, Feb. 20.
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Public Health New Mexico