${alt}
By Cindy Foster

University of New Mexico Working to Double Medical Resident Training In Rural Areas

Go Big or Go Home.

New Mexico needs more primary care physicians in rural areas - but is it possible to fast-track the process to double the number of medical residents training in rural areas of the state within the next five years? A task force created by the 2019 New Mexico Legislature is working to find out.

"It is an audacious idea," says David Rakel, MD, chair of The University of New Mexico Department of Family & Community Medicine.

It has long been known that medical residents remain to practice in the areas in which they trained when opportunities exist, he says. But, in a large, empty state in need of physicians, what would training for residents, in say, Shiprock, Alamogordo, Las Cruces or Roswell look like?

"There are many moving parts," says Rakel, who also serves as the chair for the nine-member task force.

"It is not just a matter of placing residents in rural areas; we have to make sure any program adopted provides quality education with faculty support for sustainability," he adds.

New Mexico is not alone in this quest.

"Idaho recently was successful in their goal of doubling the number of trainees in their state and there are a number of programs nationally from which to draw inspiration," he says.

Greater investment in primary care is associated with lower costs, higher patient satisfaction, fewer hospitalizations and emergency department visits, and lower mortality. Yet today, only about 12 percent of internal medicine physicians go into a primary care practice. In pediatrics, it is 50 percent. Family Medicine trains the most primary care physicians of which 95% enter primary care. The state also has a need for more mental health services, Rakel says.

A national movement known as the "Quadruple Aim," seeks to increase primary care in order to provide better quality of care, better health outcomes, at a lower cost with greater clinician and staff satisfaction in delivery of that care.

"Today's health care system unnecessarily spends more money when we focus just on the parts and not on the person," Rakel says.

"Generally speaking, most symptoms have a story and the advantage of primary care is in knowing how to look at the person as a whole with an ear to their story," he adds.

Rakel gives as an example a patient who arrives complaining of severe headaches. Taking a step back to see the patient as a whole might lead to finding that those headaches began after a recent job loss, he says.

"That knowledge can lead to providing higher quality care while spending less. Otherwise, the tendency is to order more tests and prescribe more drugs," he says.

It will take a revolutionary shift to invest more resources to support greater access across the state to primary care, but it is possible, according to Rake

Funding new teaching health centers across the state will require collaborations with all the large providers. "UNM, Las Cruces Memorial, Presbyterian, Indian Health Services, FQHCs and others -We need to have a universal assessment of the needs of New Mexico," Rakel says.

Currently UNM has a program in which primary care medical residents spend their first year training on the UNM campus and their next two years in Santa Fe. There are opportunities to do that kind of program with other facilities, as well as within psychiatry, he says.

"We are trying to find where the opportunities and needs lie throughout the state by communicating with the communities we serve. This dialogue will provide insight into how we can fund the most effective inter-professional health training to address the health needs of our state, particularly for its rural communities," Rakel says.