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

SPONSOR Saavedra

DATE TYPED 02/27/05 HB 533

SHORT TITLE UNM Combined Medicine Degree Program

SB

ANALYST Williams

APPROPRIATION

Appropriation Contained Estimated Additional Impact Recurring

or Non-Rec

Fund

Affected

FY05

FY06

FY05

FY06

$805.8

Recurring General Fund

(Parenthesis ( ) Indicate Expenditure Decreases)

Duplicates Senate Bill 209

SOURCES OF INFORMATION

LFC Files

Commission on Higher Education (CHE)

Health Policy Commission (HPC)

Department of Health (DOH)

SUMMARY

Synopsis of Bill

House Bill 533 appropriates $805.8 thousand from the general fund to the board of regents of the

University of New Mexico for the purpose of expanding enrollment in the school of medicine

through a combined bachelor’s degree to medical degree program. The program is intended to

increase medical school enrollment by approximately 25 percent and would target enrollment by

native New Mexicans to promote retention of medical students to serve the state.

Significant Issues

According to the UNM Office of Government Affairs website, “the project would require a

multi-year commitment from the legislature and the university to continue to fund incremental

costs of the new program. The program will build on the School of Medicine’s educational pipe-

line directed toward middle school, high school, pre-college and college students interested in a

career in medicine. Students will be admitted from high school to both the UNM College of Arts

and Sciences and the School of Medicine. Local communities will participate in identifying, en-

couraging and mentoring potential applicants

.”

House Bill 533 -- Page 2

CHE notes this proposal was ranked fourth out of nine research and public service expansion

items submitted by the University of New Mexico for the FY06 funding cycle.

DOH notes University of New Mexico School of Medicine (UNM SOM) is the only school of-

fering an MD degree in New Mexico, and has adopted, as a part of its mission, the goal of in-

creasing recruitment and retention of physicians choosing rural/frontier practice in New Mexico.

UNM SOM initiatives such as rural residency programs (i.e. Northern New Mexico Family Prac-

tice Residency) have met with some success, but until recently, the number of slots for medical

students could not be increased because of federal requirements for lab space per student. An ap-

propriation from last year will allow expansion of the number of slots for medical students to in-

crease from 75 to 100 per academic year. This bill proposes that these 25 slots be earmarked for

students from rural/frontier areas, as research has shown that such students are more likely to se-

lect a rural/frontier setting for practice.

This bill would fund the first year of an 8-year plan to recruit high school seniors from ru-

ral/frontier areas and enroll them in a combined bachelor/MD degree program, while maintaining

their close ties to their rural/frontier home community through summer internships through out

their college and medical school years. Phase One funding, the undergraduate phase, would pro-

vide scholarships, recruitment activities, course development, tutoring and other student support.

In addition to expanding medical student slots, and recruiting rural and frontier area students

early in their schooling (high school juniors and seniors) for placement in a combined degree

program, this program would also help to address the exodus of top high school students to out-

of-state and private colleges by offering a UNM-based path to medical school.

HPC notes 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 confirmed the

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

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

HPC notes the bill does not address whether New Mexico natives are given an “affirmative ac-

tion” type of preference or exactly how graduates would be encouraged to stay in New Mexico

upon completion of their training.

PERFORMANCE IMPLICATIONS

HPC notes “neither the state nor UNM Medical School have committed to specific targets re-

garding the proportion of their graduates who will choose to practice in rural and other under-

served New Mexico communities. To deny the role of the medical school admissions process,

faculty incentives or lack thereof for retention in effecting where graduates choose to practice is

to deny a wealth of published research to the contrary. It is hard to hit a target for retention per-

centages when those targets have not been set. Recommend an amendment tying future state

support to demonstrated percentage target increases in graduates and residents who practice in

the future in New Mexico. Targets could be given to the school and individual departments to

meet for retention with the progress measured yearly…”

HPC suggests “an assessment of why graduates leave New Mexico to practice elsewhere be

House Bill 533 -- Page 3

added as well as a survey of incoming and graduating residents about plans for New Mexico

practice.”

HPC also suggests the bill require a multi-community physician mentoring program for upper

level residents and fellows to encourage them to stay in state.

HPC notes the track record of retention (UNM Location Report 2004 published by the School of

Medicine) shows the following:

•

1,302 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% of the

School’s total number of MD recipients and former residents (N=5,273).

•

From 1994 to 2003, the number of UNM-trained physicians practicing in New Mexico

has grown from 819 to 1,302, a 63 percent increase. Of the 3,991 physicians licensed to

practice and in New Mexico, 33 percent are MD recipients and/or former residents of the

UNM School of Medicine.

However, data provided by the UNM School of Medicine shows that while the number of UNM

graduates increased 40 percent from 1994 to 1999 there has been only a 4% increase between

2000-2003.

Data back to 1978 shows the retention rate of graduates in practice in New Mexico or in training

in NM as low as 21 percent.

Many studies of predictors of retention have suggested that the medical students and resident

trainees that are more likely to remain in that state to practice have the following characteristics:

•

Underrepresented minorities

•

Graduates from primary care training programs

•

Individuals from rural areas (practice in rural areas)

•

Graduates from programs in states with large populations (larger population states are

more likely to retain their student and resident graduates). (Source: UNM SOM presenta-

tion before Blue Ribbon Tax Commission 2003)

FISCAL IMPLICATIONS

The appropriation of $805.8 thousand contained in this bill is a recurring expense to the general

fund. Any unexpended or unencumbered balance remaining at the end of FY06 shall revert to

the general fund.

The CHE request for FY06 included $500.0 for the BS/MD Community Partnership Physicians

program, but did not fully fund the UNM request of $805.8 as reflected in this bill. Neither the

LFC recommendation nor the Executive recommendation for FY06 includes funding for the pro-

gram.

House Bill 533 -- Page 4

OTHER SUBSTANTIVE ISSUES

CHE notes three major factors that contribute to the current workforce environment include high

poverty levels, a largely government based economy and demographic changes. Demographic

changes include large numbers of people (aged 22-29) with college degrees leaving the state

while those coming into the state have much less education. Additionally, the state is losing peo-

ple in the 30-64 year age bracket, many of them highly educated.

CHE notes professionals move out of the state for numerous reasons, including low reimburse-

ment rates, high levels of Medicaid, poor work environments, rural populations and minimal pro-

fessional interaction. Additionally, the existing health care work force is aging (i.e. looking to-

ward retirement), and there are not sufficient replacement professionals in the pipeline.

Currently, several medical professional recruitment and retention programs are underway in New

Mexico. Oversight for the programs comes under the Department of Health, Rural and Primary

Care; the Commission on Higher Education; and the University of New Mexico, Health Sciences

Center, School of Medicine. Those programs are: J-1 Visa Waiver Program, New Mexico Health

Service Corps, Specialty Extension Services Program, Locum Tenens Program, Health Loan-for-

Service Program, Health Professional Loan Repayment Program, Western Interstate Commission

on Higher Education (WICHE), and Baylor Dentistry Program.

ALTERNATIVES

DOH notes the possibility of considering language to address Native Americans who reside in

New Mexico but were born out of state or who live on tribal lands adjacent to New Mexico. An-

other option would be to include resident New Mexicans but give priority to native New Mexi-

cans and/or Native Americans residing in rural communities.

ANA/rs