"No available appointments": What's going on with healthcare?

Guest essay by Dr. Angela Bratton

Introducing Boomtown Guest Essays

We’re excited to announce a new feature on Boomtown: Guest essays. This series will spotlight voices from across our community and beyond, offering thoughtful perspectives on issues that shape Los Alamos and its residents. Our first essay, penned by Dr. Angela Bratton, delves into New Mexico’s healthcare access crisis and its profound local impact.

Public policy and your healthcare access

by Dr. Angela Bratton

For Los Alamos County residents, healthcare access has become an unexpected challenge. We live in a relatively wealthy and educated community, and most of us have good health insurance coverage. Yet coverage and cash do not get you access to medical providers if they have no available appointments. By the end of this year, Los Alamos will lose two more local specialists and a physical therapy option. We will all wait longer and travel further for appointments, if we can get one at all. I recently saw a patient with symptoms, who had been diagnosed with a brain aneurysm at a regional emergency room. A month later she still had not been given an appointment for the recommended evaluation by a specialist. If “brain aneurysm” doesn't get you an expedited appointment, what does? I have heard similar stories from my colleagues about patients with broken arms and heart issues. What is driving this loss of access?

New Mexico’s healthcare workforce shortage has reached crisis proportions. By our own state’s numbers, between 2013 and 2021 New Mexico lost 377 primary care providers, gynecologists, surgeons, and psychiatrists, putting us below benchmark numbers per population in most counties and most provider types. There is a nationwide shortage of physicians, predicting that the U.S. will be 86,000 doctors short of those needed by 2036. However, New Mexico still stands out. According to the Physician Advocacy Institute, our state lost 248 practicing physicians between 2019 and 2024, while nationally there was a net gain of 44,272 doctors. No other state experienced a net loss in that time frame. 

To further exacerbate the problem, the average age of physicians in New Mexico is the highest in the country and many practices are having great difficulty recruiting young doctors. My practice alone currently has eight unfilled provider positions. Over the years, we have closed seven rural offices due to inability to fill positions. The community of Los Alamos has seen wait times to get an appointment for routine care stretch from three weeks in 2019 to four to six months in our local office now. 

As a result of the lack of primary care providers and specialists in the state, people have difficulty finding a physician taking new patients. Even established patients wait for appointments and spend more time in the office as the provider manages increased patient panels and tries to accommodate urgent needs. Disparities and delay in treatment occur and lead to poor health outcomes, anger, and frustration. Recruitment and retention of our healthcare workforce is critical.

When you Google “best states to practice medicine,” you will find multiple rankings that physicians rely on when deciding where to relocate or start a practice. These rankings are based on metrics such as employment opportunities, wages, taxes, quality of the existing healthcare system, malpractice liability, and quality of life. Rankings for New Mexico range from 24th (2023 Physicians Practice) to 46th (March 2024 Wallethub). Forbes ranked New Mexico 32nd, largely based on low wages and high malpractice liability, which it assessed as the 3rd highest in the U.S. 

The good news is that there are public policy initiatives that can improve New Mexico’s ability to recruit and retain new doctors and other healthcare workers, help our practices thrive, and enable them to serve the medical needs of our communities.

The list below is not exhaustive nor detailed, but it serves to demonstrate that a multi-pronged approach is needed and possible as we compete with all other states for a limited supply of physicians.

1. Increase medical education funding at all levels. Medical schools and residencies turn out new doctors; fellowships for new specialists. We need nurses, EMTs, pharmacists, and office staff, so high schools and colleges should prepare students for their next goals. Compensate preceptors who give learners hands-on experience, and cover their liability.

2. Increase student loan repayment funding in return for years of service. Many physicians are over $250,000 in debt when they graduate. $30 million is required to fully fund the healthcare workers we need to attract right now at all levels. Current legislative funding covers less than half of this need and newcomers applying for loan forgiveness (using legislative funding) from Los Alamos are being passed over for areas assessed as being “greater need.”

3. Make it easier for new health care professionals to come to our state by joining interstate medical licensing compacts, centralizing credentialing to be part of insurance panels, and enforcing credentialing timelines. The medical board can look into methods to safely allow well-qualified physicians who were trained outside the U.S. to enter our workforce.

4. Support the rural healthcare delivery fund, which expands health services outside New Mexico’s urban centers. The current definition of “rural” includes Los Alamos County.

5. Address quality-of-life issues by decreasing poverty and crime and improving education and economic opportunities to attract new residents. Fantastic jobs go unfilled when a spouse cannot find adequate employment or the school system is not up to a family’s expectations.

6. Improve the financial viability of medical practices with tax reform. Repeal the gross receipts tax on all medical services, since practices cannot, and should not, pass this cost to patients nor increase their prices. Expand the Rural Healthcare Practitioner Tax Credit to decrease state income tax liability for those practicing in rural areas.

7. Increase Medicaid reimbursement to providers to equal reimbursement rates paid by private insurers. New Mexico has the highest percentage of the population (close to 50%) with Medicaid as their medical insurance coverage. While the state is making strides to improve reimbursement for medical services, there is still a disconnect between what it costs to provide care and what is paid to the provider.

8. Decrease administrative burdens by addressing prior authorizations required for medical care, testing, and drugs, as well as electronic medical record compatibility and “busy work.”

9. Address the high cost of professional liability insurance and the increased risk of being sued while keeping the Patient Compensation Fund solvent. 

1. Medscape, one of the most-used ranking systems by physicians, stated that in 2023, New Mexico had the highest number of lawsuits filed per capita. The Medical Malpractice Act, passed in 2021, has required two emergency legislative fixes just to keep doctors providing care in hospitals and ambulatory surgery centers. Dr. Michael Lopez, a physician practicing in Las Vegas, New Mexico, recently wrote an op-ed regarding the impact that the amended Medical Malpractice Act had on the delivery of healthcare in rural New Mexico. 

2. Providers pay into the Patient Compensation Fund to cover damages and all future medical costs for patients who unfortunately sustain injuries due to malpractice. The previous Superintendent of Insurance listed 10 changes needed to improve the actuarial soundness of the fund. 

10. Support employed physician protections. While the above changes will help independent physicians as well as corporate healthcare entities, most doctors in New Mexico are now employed. It is essential for patient safety and for physician retention for these doctors to be able to voice concerns and are afforded protections, such as the limit on non-compete clauses already passed by the legislature.

Think New Mexico published a 60-page policy report in September on New Mexico’s Healthcare Worker shortage. After two years of research, they have made ten legislative recommendations that cover many of the above points. 

In order to improve New Mexico's healthcare access, we need to make New Mexico the most attractive place to practice. Imagine a world where a person living in Los Alamos could make an appointment in their time of medical need — no excessive wait or travel — before a small problem becomes a big issue. 

---

Dr. Angela Bratton has been a private-practice ophthalmologist in Los Alamos for 30 years. She graduated from the University of Iowa College of Medicine and has over 35 years of experience in the medical field. She is a physician-owner of Eye Associates of New Mexico and currently practices at 1623 Central Avenue. She has served as a medical society councilor representing Los Alamos/Rio Arriba Counties, then as an officer of the New Mexico Medical Society.

Boomtown Guest Essays provide a platform for individuals with expertise, experience, or compelling stories to share their insights. Whether it’s a fresh take on policy, a first-hand account of community challenges, or a deep dive into underexplored topics, these essays are designed to enrich our readers’ understanding and spark meaningful dialogue. By creating space for diverse perspectives, Boomtown aims to illuminate the complex issues facing our town and foster a richer, more connected community.