Anson Stevens-Bollen
T here’s a trope about old, small-town doctors who answer the phone at two in the morning and work well into their 70s tending to pregnant mothers, croupy babies and workplace mishaps. In New Mexico, it rings true.
For the past two years, the state has led the nation in the percentage of doctors age 60 or older. It's not even close. The Association of American Medical Colleges says almost 36 percent of the state's doctors are in that category. New Mexico beats the national average by more than 20 percent. When the AAMC's next glimpse at the physician workforce is released this fall, the state will find out if it's found a cure for a systemic problem in the medical community.
From health care systems to medical schools to small towns, New Mexico has been trying to retain older doctors long enough to recruit younger ones. An aging population of doctors has to treat an aging general population that needs more medical providers, and states are competing against one another for a limited pool of docs. That's a particularly acute challenge in rural states.
"It certainly seems that physicians in rural communities don't wish to retire, in many cases, until they can find their replacement," says Dr. Richard Larson, the executive vice chancellor at New Mexico's only public medical school. "For most doctors, medicine is a calling. And they really don't want to let their community down."
The University of New Mexico's Health Sciences Center, where Larson works, has a nationally recognized family and community medicine program. But the school enrolled 102 students in its latest class and graduated just 88. Many of those graduates will leave the state.
Larson and his colleagues work hard to come up with innovative solutions to attract and keep younger doctors in New Mexico. That starts with residencies. New doctors are much more open to moving to a small town if they've already worked in one. In Hobbs, the university worked with the JF Maddox Foundation to build simple homes for medical residents. Within a year, Larson tells SFR, three new primary care providers were in town.
One of the biggest challenges is combating the loneliness that can come from being one of a handful of doctors in a smaller town. Larson says working with a community to provide a social network for doctors and spouses is a must for retaining younger medical providers.
Yet, the University of New Mexico can only churn out so many doctors. At some point, the state needs to find a way to attract younger physicians from elsewhere. That job falls to health care systems, and Presbyterian Medical Group is the state's largest.
"The problem is not that we have too many older doctors, it's that we don't have enough younger doctors. Older doctors are OK," Dr. David Arredondo, executive medical director for Presbyterian, tells SFR.
While the numbers aren't as striking when it comes to doctors under age 40, New Mexico ranks near the bottom of the AAMC physician workforce survey. Just 13.7 percent of the state's physicians are on the fairer side of 40. Only seven states have a lower rate.
To get younger doctors here, Presbyterian leans on the state's climate, culture and outdoor opportunities. It also sells its network of hospitals, an insurance program and a medical group. "Most physicians now are seeking employment within a health care system, which is different than it used to be," he says. Medicine has gotten more complex, and having a support system in place can be a big factor in where a doctor decides to practice.
But Arredondo says he's always competing for a piece of a pie that just isn't big enough. "This country does not train enough physicians to meet its needs," he says.
Dr. George Mychaskiw, an osteopath and anesthesiologist, is the founding dean of the Burrell College of Osteopathic Medicine in Las Cruces. The private medical college isn't technically a part of New Mexico State University, though its students are often affiliated with NMSU. He says the age of New Mexico's physician population is one of the first things he learned about the state.
"The old doctors are part of the baby boom generation themselves. The number of elderly people in the US is exploding," he tells SFR from his office. "You have this perfect storm of older people entering the health care system at a time when older doctors are retiring."
At the same time, he says, more effective geriatric care means the medical community keeps people alive longer. There's a ballooning need for medical care at a time when the country seems least prepared for it.
Mychaskiw says the college, which began its first classes last year, made a point of identifying an underserved border community in which to locate. Las Cruces, and New Mexico in general, fit the bill.
The college, which awards degrees after a four-year program and follows that up with internships and residencies, plans to enroll 162 students each year. It graduates its first class in 2020. It's a step in the right direction, but it comes at a time when New Mexico needs to make a leap.
"You could put 10 medical schools in the area," says Mychaskiw, "and it still wouldn't be enough."
This article has been updated to correct the name of the Association of American Medical Colleges.
