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F I S C A L I M P A C T R E P O R T

SPONSOR Varela

ORIGINAL DATE

LAST UPDATED

1-28-06

HB 221/aHCPAC

SHORT TITLE Expand Medical Residency Programs

SB

ANALYST Collard

APPROPRIATION (dollars in thousands)

Appropriation

Recurring

or Non-Rec

Fund

Affected

FY06

FY07

$300.0

Recurring

General Fund

(Parenthesis ( ) Indicate Expenditure Decreases)

Relates to HB 215 and its duplicate SB 163

SOURCES OF INFORMATION

LFC Files

Responses Received From

Department of Health (DOH)

Health Policy Commission (HPC)

Higher Education Department (HED)

SUMMARY

Synopsis of HCPAC Amendment

The House Consumer and Public Affairs Committee amendment to House Bill 221 transfers the

funding from DOH to the board of regents at the University of New Mexico to fund the UNM

School of Medicine’s medical residency programs.

Synopsis of Original Bill

House Bill 221 appropriates $300 thousand from the general fund to DOH for the purpose of

funding medical residency programs in Las Cruces, Roswell and Santa Fe to increase the options

and opportunities for residency placement and enhance recruitment and retention of residents

completing medical programs.

House Bill 221/aHCPAC – Page

2

FISCAL IMPLICATIONS

The appropriation of $300 thousand contained in this bill is a recurring expense to the general

fund. Any unexpended or unencumbered balance remaining at the end of FY07 shall revert to the

general fund.

SIGNIFICANT ISSUES

HPC notes physicians are central to the delivery of healthcare in New Mexico. This bill expands

an innovative program within the Family Practice Department at the University Of New Mexico

School Of Medicine that has had success in teaching residents who ultimately practice in under-

served areas of the state. HPC research shows this“1+2" program has established sites in Las

Cruces, Roswell and Santa Fe. The program’s retention record compared to rest of the School of

Medicine is positive. This bill expands the residency slots within these programs.

RELATIONSHIP

House Bill 221 relates to House Bill 215 and its duplicate Senate Bill 163 (UNM School of

Medicine Combined Degrees) which makes an appropriation of $800 thousand to expand en-

rollment in the school of medicine’s combined bachelor's degree and medical degree program to

increase the number of physicians practicing in the state.

TECHNICAL ISSUES

DOH notes there is conflict between the proposed recipient of funds and the proposed purpose.

DOH is not involved with medical residency programs. The state universities and other inde-

pendent medical training programs are the responsible entities. However, DOH is involved with

the recruitment and retention of health professionals specific to the primary care clinics in under-

served areas of the state.

OTHER SUBSTANTIVE ISSUES

HPC indicates New Mexico has a serious physician shortage in all counties except Bernalillo and

Los Alamos. All counties but these two are designated Health Professional Shortage Areas by

the federal government. Within Bernalillo County there is a shortage of physicians in selected

specialties. The Physician Supply in New Mexico study published in May 2003 by HPC con-

firmed the shortage in that the state has 169 physicians per 100,000 population compared with a

Health Resources Services Administration recommended number of 240 per 100,000 population.

Every New Mexico county has a type of Primary Care Health Professional Shortage Area classi-

fication, of which 16 have whole county designation and four have low income designations.

(NMHPC Quickfacts 2006). The shortage is particularly acute in the rural areas of New Mexico.

The UNM Health Sciences Center annually publishes its Location Report providing information

about the University Of New Mexico School Of Medicine’s graduates and residents. According

to the 2005 Location Report:

·

1,355 physicians who received their MD and/or completed their residencies at the UNM

School of Medicine are licensed to practice in New Mexico. This represents 25 percent of the

school’s total number of MD recipients and former residents.

House Bill 221/aHCPAC – Page

3

·

MD recipients who are also former UNM School of Medicine residents are twice as likely to

remain in New Mexico (50 percent) as MD recipients who train elsewhere (23 percent) or

former UNM School of Medicine residents who graduated from another institution (20 per-

cent).

HPC also notes the retention rate of the Family Practice Department at 50 percent is much higher

than the 25 percent the school has overall.

This bill proposes to expand an existing program within the Family Practice Department called

the “1+2” program. The “1+2” programs in Las Cruces, Roswell, and Santa Fe evolved in the

mid-1990’s to decentralize training of physicians from tertiary care sites in Albuquerque into

community settings like those in which they will be practicing. Current 1+2 Training Programs

are in place in Santa Fe and Roswell. Las Cruces and UNM offer complete three-year programs.

HPC states the Santa Fe One-Plus-Two Program is designed as a longitudinal- and block-based

experience in the second and third years. Jointly sponsored by the University of New Mexico,

St. Vincent Hospital, and La Familia Medical Center, training occurs at the community health

center, St. Vincent Hospital, Indian Health Services, the offices of local physicians, and in rural

settings. According to information from the program “over 80 percent of the Santa Fe program

graduates choose to remain in New Mexico after graduation. Of those who have left New Mex-

ico, all have worked in under-served settings.”

The Roswell One-Plus-Two Program trains its second- and third-year family practice residents at

Eastern New Mexico Medical Center, its sponsoring hospital, and in office-based experiences

similar to those of practicing family physicians.

Sponsored by Memorial Medical Center, the Las Cruces Family Practice Residency Program is

community-based and offers an innovative, non-rotational curriculum in the second and third

year.

HED gives an example of the southern New Mexico family medicine residency’s mission: to

train highly skilled family physicians who will practice in the underserved areas of southern New

Mexico; to provide the peoples of southern New Mexico compassionate, competent care regard-

less of their resources; to improve the health of the communities we serve through effective pub-

lic health activities; and to enhance the health and well-being of ourselves and our colleagues.

ALTERNATIVES

DOH suggests appropriating the funds to the Higher Education Department or to the UNM

School of Medicine.

KBC/nt