By Elizabeth Dwyer Sandlin | September 07, 2023

Transforming Health Care in Rural New Mexico

In the heart of the American Southwest, The University of New Mexico is pioneering a transformative approach to health care. At the helm stands Jose Canaca, MD, assistant professor in Psychiatry and Behavioral Sciences, and director of the Rural Residency Program at UNM. Driven by a commitment to serve the unique health care needs of rural New Mexico, this program has evolved over the past two decades into a beacon of hope for underserved communities and an opportunity for UNM students to connect and understand the diverse needs of patients in the state.

“When you talk about minority groups – in this case, Hispanics, Latinos, and Native Americans – that comes with systemic inequity, right, so they don't have access, or the best access to behavioral health,” said Canaca. “And this is what we are trying to do with the rural program. We're trying to connect to our mission, to help to serve those communities in need.”

When you talk about minority groups – in this case, Hispanics, Latinos, and Native Americans – that comes with systemic inequity, right, so they don't have access, or the best access to behavioral health. This is what we are trying to do with the rural program. We're trying to connect to our mission, to help to serve those communities in need.

— Jose Canaca, MD, Director, UNM Rural Residency Program

New Mexico is a state defined by its vast rural areas and a diverse population, with more than 50% identifying as Hispanic or Latino and 10% as Native American. These minority populations often face significant health care disparities, including limited access to behavioral health services. UNM recognized its obligation to bridge this gap, ensuring that every New Mexican, regardless of their location or background, has access to quality health care.

The UNM School of Medicine Department of Psychiatry and Behavioral Sciences, under the leadership of distinguished professor and department chair Mauricio Tohen, MD, DrPH, MBA, has always been guided by a distinct mission. While most psychiatric departments focus on three core missions – clinical work, education, and research – UNM adds a fourth pillar: community engagement. This unique aspect of the department’s mission is closely tied to New Mexico's geographical and demographic landscape.

“We have an obligation with the community to provide care to those who need it. And we need to start by not only providing care, but also training the psychiatrists or psychologists who are going to practice in rural areas. And a very important way to go about it is to give the residents the opportunity to work in rural areas,” said Tohen.

UNM Rural Residency Program

The UNM Rural Residency Program did not emerge overnight. It owes its roots to the vision of Helene Silverblatt, MD, a pioneering figure in rural psychiatry who laid the foundation for what would become a transformative initiative. Silverblatt's dedication and leadership paved the way for subsequent generations of health care professionals to follow her lead.

Canaca's connection to the UNM Rural Residency Program runs deep. After completing his psychiatry residency at UNM, he became the director of the residency program’s rural component. Driven by a desire to give back to the community, Canaca embraced his role with passion.

“We are really very fortunate that we have Dr. Canaca in our department,” said Tohen. “He's no doubt a national expert in rural psychiatry. So having him in as part of the department enables us to train and provide services in rural areas.”

The program's core mission is to send residents to underserved rural areas in New Mexico to provide essential behavioral health care. In doing so, they not only meet the immediate needs of these communities but also receive invaluable experience as part of their graduate medical education. The ultimate goal is for these residents to stay and serve as health care providers in the very communities where they trained, fostering a sustainable health care ecosystem in rural New Mexico.

One key aspect of the program's success is its commitment to cultural competence. Recognizing that New Mexico is a state rich in diversity, residents undergo intensive training in cultural psychiatry. This includes an exploration of the state's cultural landscape and discussions on the importance of respecting and understanding the unique needs of each community.

Canaca emphasizes the importance of not approaching these communities as experts but rather as allies and listeners. This approach helps build trust, a critical element in providing effective health care in underserved areas. Over time, the UNM Department of Psychiatry has earned the trust of these communities, making them more willing to seek help when crises arise.

“I'm so proud of our program because we are out there in all these smaller communities in New Mexico, and they see our department through the presence of our residents and faculty,” said Canaca. “So, when there is a crisis, they don't hesitate to contact us. They come to us, and they ask for help.”

The Program’s Global Reach

While New Mexico remains the primary focus, the UNM Rural Residency Program has expanded its reach, not only nationally but globally as well. The program offers a training destination for medical students and residents from across the country who wish to specialize in rural psychiatry. UNM's reputation as a leader in this field continues to grow, making it a go-to destination for those passionate about rural health care.

“Most of the world is like New Mexico, where there are a lot of rural areas. So that's why we've also engaged in training. Psychiatrists are given the opportunity to train here and potentially to take what they’ve learned and work in rural areas in other places,” said Tohen.

UNM's partnerships extend beyond U.S. borders. The program collaborates with places like Guam, a U.S. territory with a unique demographic makeup. Additionally, UNM has developed rotations in New Zealand, providing residents with the opportunity to work with First Nations communities abroad. This global perspective enriches the training experience, helping future health care professionals understand the complexities of serving diverse populations.

UNM's commitment to rural health care also extends to telehealth services provided to Native American communities across the United States. As the main partner of Indian Health Services, the program offers clinical services and training through telehealth platforms. This initiative addresses the critical shortage of health care providers in these communities and exemplifies UNM's dedication to improving health equity.

As rural health care continues to face challenges across the nation, the UNM Rural Residency Program serves as an inspiring example of how dedication, collaboration, and cultural understanding can transform lives and communities. It is a testament to the power of health care to bridge gaps and create a brighter, healthier future for all.

“We have a wonderful program here. The commitment that our department has to our communities is incredible,” said Canaca. “The idea is that everybody in New Mexico feels welcome, and we're proud of that. It’s a beautiful thing.”