Community-focused programs, residencies aim to keep doctors in New Mexico

LAS CRUCES - Several clinics in Las Cruces welcomed medical students from the University of New Mexico School of Medicine this summer as part of a unique clinical training program. 

The Practical Immersion Experience (PIE) places first-year medical students in primary care and other medical practices for six-week rotations in 37 communities across New Mexico. 

According to UNM Health Sciences Center spokesman Luke Frank, eight UNM students were assigned to Las Cruces providers including Huerta Medical LLC, Memorial Medical Center, and Memorial Medical Center Cancer Center during the month of July. 

In addition to conducting examinations under physicians' supervision, students in the program were required to develop relationships with the community outside of their assigned clinics to evaluate local conditions that might affect the population’s health. The students were tasked with developing a community project based on researching local needs and proposing solutions. 

Retaining doctors in communities 

Similar to the PIE program's focus on community, residency programs such as MMC's Southern New Mexico Family Medicine Residency Program in Las Cruces place fresh medical school graduates in underserved areas to train, knowing many of them will remain in those communities as healthcare providers.

Since its founding in 1996, 104 physicians have completed three-year residencies at this center, and Dr. John Andazola, director of Southern New Mexico Family Medicine Residency Program, said 70 percent of them have remained in New Mexico. He counts 45 physicians in or near Doña Ana County who were residents here. 

Andazola, himself a Las Cruces native, now directs the program where he completed his own residency.

"Training people in a community keeps them in that community, and this program has demonstrated that over its 22-year history," Andazola said.

MORE: Dr. John Andazola receives 2018 Physician Leadership Award

After years acquainting themselves with a community and forming relationships, Andazola said maintaining their practice locally often makes the most sense. In addition, at this stage many physicians are also starting families.

By introducing community immersion between the first and second years of medical school, Andazola said UNM is bringing the concept "upstream," introducing medical students to communities early in their training. 

One of Andazola's newest residents is Dr. Amanda Provencio, a spring 2018 graduate of the UNM School of Medicine. When Provencio's time came to participate in the PIE program, she visited Las Cruces, her hometown, and after graduation she was determined to return for good.

How ZIP codes affect health

“The reason I became a physician is my personal experience, seeing all of my family members in the area suffering from chronic diabetes and dying at a younger age than should have been expected," Provencio said. "I came back here to try and improve the health of the city, the county and the state.”

While in the PIE program, Provencio presented free workshops for the Las Cruces community on heart health and emergency procedures. In her third year of medical school, she did a diabetes resource project, surveying existing community resources for diabetes patients in Las Cruces and connecting patients to those resources.

“They say your ZIP code has more impact on your health than your genetic code," Andazola said. "We sometimes focus on the biological, but we don’t realize it’s really where you live. If you get out into their neighborhoods and see where they live, as a physician you can make a bigger impact than just writing prescriptions.”

Unmet social needs, even a simple inability to afford utilities, combined with a lack of knowledge of available resources or linguistic and cultural barriers, all have health impacts. By getting doctors out of clinics and into communities, Andazola said doctors acquire background knowledge about their patients. 

Provencio's experience was not limited to immersion programs. The Las Cruces native was the daughter of a teenage mother and a father who was incarcerated for most of her childhood. She grew up drawing support from various community organizations and cited, in particular, the Excel career readiness program at Mayfield High School.

Provencio said it was her plan all along to return and serve her hometown. “The health of your patients is a direct reflection of where they work, live and play," she said.

Additionally, Provencio saw major gaps in access to specialty services across southern New Mexico.

"I can’t tell you how many of my patients (at UNM) were driving five or six hours just to see us, and the demand that puts on them," she said. "A lot of them had chronic medical conditions where they’re doing this every two months. Having to take a couple days off of work, staying at a motel, and the financial stress that puts on families who are already overwhelmed and stressed.”

Recruiting doctors with local roots

“Amanda is who we look for," said Andazola, noting that role models affect academic and career achievement in families and communities. "If you can show them someone who looks like them, talks like them, acts like them and is successful, it gives them permission to say, 'Wow, I can do this.'”

Selecting six residents from 1,400 applications, Andazola said regional roots matter more to him than an impressive resume. 

“We live in a community of limited resources and if I’m going to expend those resources, I need to expend them on individuals who are most likely to stay," he said. "Even if you went to the Ivy League school and have that incredible pedigree, if you don’t stay and serve my community then you’ve used my resources.”

MORE: Medical residencies increase in Las Cruces

For most of its 22 years, the Southern New Mexico Family Medicine Residency Program has been the only facility graduating residents in Las Cruces, but Andazola said there are four new residency programs at MountainView Regional Medical Center, developed in collaboration with the Burrell College of Osteopathic Medicine at New Mexico State University.  

With more programs training doctors with a community focus, Andazola said a new consortium, allowing the Las Cruces residency programs to collaborate and maximize their limited budgets, is currently seeking accreditation.

Algernon D'Ammassa can be reached at 575-541-5451, adammassa@lcsun-news.com or @AlgernonActor on Twitter.