Doctors are leaving rural communities across the country at alarming rates.
A study published by Avalere and Physicians Advocacy Institute, a nonprofit healthcare professional advocacy group, earlier this year reported that between Jan. 1, 2019 and Jan. 24, 2024 rural areas lost 2,500 physicians and nearly 3,300 medical practices closed. Patients had access to 11% fewer medical practices overall and the number of independent doctors in rural communities declined by 43% during the study.
Gallup, New Mexico, a small city of about 20,000, sits near the Arizona border and is flanked by tribal lands. Two doctors, Lawrence Andrade and his wife Aedra Andrade, who recently left Gallup, took out a full-page ad in the local paper to thank their community for its support and to apologize for leaving.
“I definitely have a sense of, I don’t know what the right word is, not guilt, but you know as a medical provider, you have a great sense of responsibility,” Dr. Aedra Andrade said. “There is definitely a sense of sadness that we have let the people down in some way.”.
The Andrades aren’t the only ones to leave. Urologists, cardiologists, oncologists, pediatric specialists, and many others have packed up too.
“When we first started, there were 51 doctors and 10 mid-level providers. Now that we’ve left, there’s only 19 doctors and 13 mid-level providers left,” said Lawrence Andrade.
The common theme, he said, is the bottom line. “It’s been almost impossible to make ends meet in private practice.”
Patient-led NM, a patient-focused nonprofit, has been tracking the trend – not just in Gallup, but across the state. The group reported that 248 physicians have left in the past five years. This month, the group launched a campaign to highlight the causes.
The organization is working to create change in three areas, said Troy Clark, the president and CEO of the New Mexico Hospital Association and a founding member of Patient-led NM. The medical malpractice environment, low levels of Medicaid reimbursement and the gross receipts tax on healthcare providers.
Between September and the next legislative session in January, Patient-led NM members will meet with legislators and the public to discuss the state’s healthcare needs including the revision or rollback of the 49-year-old Medical Malpractice Act (MMA).
“We believe these issues are the largest contributors to our inability to recruit and retain doctors,” Clark said. “The consortium joined together to educate New Mexicans about the doctor shortage and its causes. And to make the public aware of not only the access to care crisis that we have but the drivers behind that.”
The Western Governors Association also recognizes the importance of the physician exodus in Mountain West states. During their June meeting in Santa Fe, the members drafted and approved the bi-partisan Policy Resolution 2025-5. The resolution presents 24 policy points calling for state and federal collaboration and coordination to address healthcare challenges in rural communities.
Despite efforts by Western Governors to address the shortage of qualified health care workers, significant challenges remain, according to Lauren Cloward, senior policy advisor for the WGA.
“For years, the Western Governors have been addressing the shortage of qualified healthcare workers in their states. This resolution that we have geared specifically at those federal efforts and how those federal programs are already underway,” Cloward said.
The bipartisan resolution lists 24 points of concern including recommendations to:
● Urge the federal government to examine and implement programs to ensure states have an adequate health care workforce.
● Urge the federal government to consider payment models that recognize the critical role of community health centers and for their position as the only access point for health care services in many areas.
● Encourage Congress to adopt legislation that would empower states and local governments to address persistent economic and social conditions-like limited access to health care providers, stable housing, reliable transportation, healthy foods, and high quality education-that often hinder health outcomes.
Reimbursement rates under federal Medicare insurance for low-income Americans has declined substantially in recent years, falling below the cost of care, said Lawrence Andrade. And, in New Mexico, malpractice insurance cost was another concern. The New Mexico legislature changed the Medical Malpractice Act (MMA)law in 2021, 2023tying independent provider caps to the Consumer Pricing Index (CPI).
“I think the tipping point has definitely been the malpractice issue,” said Andrade. “When they changed our malpractice issue caps, that really contributed to a mass exodus of so many different providers.”
New Mexico is one of only four states that taxes health care providers on monthly sales or gross receipts. Andrade said private practice doctors cannot increase patient copays because they are set by the insurance companies. For Andrade this means his state sales taxes often equal his monthly federal tax payment.
Neither the Andrades, Gallup city leadership or groups involved in the call for change see rural healthcare improving in the short term.
All of this leaves a situation for those who aren’t leaving Gallup – the residents who need health care. Gallup’s mayor, Louie Bonaguidi, is concerned about that. He sees the doctor drain as a health care issue but also as a social and economic issue.
The first thing people want to know about when they consider relocating to Gallup is employment, followed by schools, said Bonaguidi. After that, they ask about hospitals and doctors.
Bonaguidi is concerned that healthcare accessibility in Gallup will become a persistent challenge.
“I’m not optimistic anywhere in the near future. I figure probably, maybe, possibly in ten years the hospital will be a hospital, but they have no doctors, so it just seems to me it’s going to be long term.”
In Joplin, Missouri, where the Andrades recently relocated, Dr. Adrea Andrade said she believes it will take time for rural healthcare to improve.
“It’s likely that the situation, at least for New Mexico, for rural health, will probably continue to get worse, and I hope it doesn’t get much worse before significant change is made at the statewide leve.l”
