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Doctor shortage increases

Sun 02/05/2023 Page: A1
Doctor shortage increases
Physicians say unless systemic changes are made, situation
will only get worse
Copyright © 2023 Albuquerque Journal
BY RYAN BOETEL JOURNAL STAFF WRITER
Last year, Dr. Kristina Chong, of Women’s Specialists of New
Mexico, was midway through a checkup with one of her longtime
patients when the woman started crying.
The patient had been seen by a gastroenterologist, who found a
golf-ball sized mass in her intestines and referred her to a local
hospital.
But it was now six months later, and the woman was still waiting
to be seen.
“If it’s a cancer. It’s been an extra six months that she has been
living with this,” Chong said in a recent interview with Journal
reporters and editors.
New Mexico for decades has dealt with a shortage of physicians
and other health care workers.
Now many local doctors say that — unless changes are made in
the system — the situation will become much more dire in the
coming years.
Among the reasons are high medical malpractice premiums, low
Medicaid reimbursements and having to pay gross receipts taxes
on medical services.
“The shortages that we’re talking about have been accumulating
over time, but they may be reaching a tipping point,” said Dr.
Howard Gogel, with Southwest Gastroenterology.
New Mexico in 2021 had 1,649 primary care physicians, 700 less
than the state had in 2017, according to the New Mexico Health
Care Workforce Annual Report. The state is 334 primary care
physicians below national provider-to-population benchmarks,
according to the report.
DOCTORS

From PAGE A1
The state lost 63 OB-GYNs during the same time period, leaving
just 219. The state would need 59 more OB-GYNs to reach the
national benchmark, and more than 100 psychiatrists to hit the
mark for that field.
Meanwhile, the average age of a physician in New Mexico is older
than 50, which suggests shortages will likely continue as doctors
retire.
The workforce report said the state has a shortage of primary care
physicians in virtually every county, but the problem is more
pronounced in rural Harding, Union and Guadalupe counties.
Hikes in medical malpractice rates
New Mexico doctors are facing large increases in the cost of their
medical malpractice insurance because of recent changes to the
Medical Malpractice Act, which raised the cap on damages. Some
lawmakers this year are expressing interest in trying to make
additional changes to complex state law.
Dr. Todd Williams, of San Juan Plastic Surgery in Farmington and
president-elect of the New Mexico Medical Society, said his
medical malpractice insurance is significantly higher than it would
be if he practiced in surrounding states.
Williams said he is currently paying about $65,000 per year. But he
said the insurance would be about $18,000 per year if he practiced
a few miles away in Colorado or Arizona, and $38,000 for coverage
in Texas.
The cost of his malpractice insurance has increased about 30% in
the last two years because the cap on such malpractice cases is
increasing, he said.
Medicaid and GRT a double whammy
But the trouble with finding affordable malpractice insurance is
only part of the reason doctors are leaving the state, several
physicians said in recent interviews. State tax policies and
Medicaid reimbursement rates are also becoming more daunting,
particularly for doctors who work in private practice.
Some of the recommendations from the report’s authors were to
increase Medicaid reimbursement.
Physicians in New Mexico treat a higher share of Medicaid patients
than doctors in surrounding states. More than a third of New
Mexico residents are insured through either Medicaid or the
Children’s Health Insurance Program, according to Kaiser Family
Foundation. By comparison, 21% of people in neighboring Arizona,
19% of people in Colorado and 17% of Texas residents are covered
by those insurance programs, according to the foundation.
New Mexico’s Medicaid rates haven’t increased in years, and those
patients bring in far less money to health care facilities compared
with treating patients who have traditional insurance, said Dr. Mark
Depper, a diagnostic radiologist in Albuquerque.
“Increasing Medicaid reimbursement is essential for my clinic’s
survival,” he said.
A spokeswoman for the New Mexico Human Services Department
said an increase to Medicaid provider and facility reimbursement is
included in the governor’s proposed budget.
Gogel said another factor facing New Mexico physicians is gross
receipts taxes on medical services. New Mexico is one of just a
couple of states that applies what’s essentially a sales tax on
medical services.
For physicians who work in private practice, there is a complex list
of reductions or exemptions that can lower parts of the tax bills
depending on how the procedures are paid for. Hospitals, on the
other hand, are taxed on 40% of their total gross receipts, said
Mark Chaiken, the tax policy director for the New Mexico
Department of Taxation and Revenue.
Williams said New Mexico’s malpractice insurance rates, coupled
with lower reimbursement for Medicaid patients and having to pay
gross receipts taxes to the state may cause him to look for
opportunities in other states.
“When you factor all of those things in, it’s hard to not look
somewhere else. And what that’s going to result in is patients are
going to have even decreased access to care in this state,” he said.
“I’d like to be here but it’s really hard to justify staying here when I
can almost double my take home income by going to a different
state.”

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