Dr. Patricio Larragoite travels almost two hours north from Santa Fe to Tierra Amarilla once a week. It's the only way people in the remote villages of Northern Rio Arriba County can see a dentist.
"It was always my goal to be a provider for people without access," says Larragoite, a Santa Fe dentist for 26 years.
When Larragoite headed the now-defunct Health Policy Commission, the independent-research organization that reported to the New Mexico Legislature about severe provider shortages that were expected to worsen over time. It was 2003, and the commission was particularly concerned with the lack of mental-health providers, nurses, dentists and physicians.
"I'm scared to death because this is not just a New Mexico issue," he says. "The forecast we put together was not bright, and it's not changed."
The Tierra Amarilla clinic where Larragoite works once a week has tried to recruit a full-time physician and dentist there for more than a year, says executive director, Darren DeYapp.
Las Clinicas del Pueblo de Rio Arriba serves 15 tiny communities like Chama, Dulce, Lumberton, Los Ojos, Casa Blanca, Los Brazos and Tierra Amarilla. It is the only medical facility from Ghost Ranch off of Highway 84 north to the Colorado border.
DeYapp, a Chama native and city councilor, faces the same recruitment challenges as the rest of New Mexico — lower wages and high uninsured — in addition to rural limitations. There are no private-school options, few employment opportunities for spouses and the closest city, Espa?ola, is 90 miles away.
"It's a hard sell if they aren't looking for this lifestyle," he says. "I look more at the family and sell the family on what we have to offer."
DeYapp, like other clinic directors, solves health-care access problems creatively. Promotoras, or health-care workers, visit patients to manage chronic diseases like diabetes without doctor visits. Clinic workers drive patients to and from their appointments when they can't get there on their own. Temporary or part-time providers travel to fill gaps in care. When the local pharmacy announced plans to close, DeYapp researched ways to expand his clinic's in-house pharmacy.
"We are always trying to stay ahead of the curve," says DeYapp. "We measure our success by meeting community needs."
It's these kind of efforts that may help sustain New Mexico through a national and local provider shortage that's likely to worsen when more people can get health insurance through federal health-care reform.
Educational institutions are another key player. Southern New Mexico Family Medicine Residency Program in Las Cruces recruits students who have local ties to southern New Mexico, which has proven effective in keeping providers here, says Dr. John Andazola, program director. In the last three years, 79 percent of graduates have stayed in New Mexico, Andazola says.
"There's also good data that show where a physician finishes his training is where he's more likely to practice, so we offer rural experiences," he says.
Medical residents are required to spend time in such rural communities as Silver City, Hatch, San Miguel, Chaparral or Do?a Ana, he says. Many placements turn into full-time jobs. The University of New Mexico's medical school has a similar rural residency program.
Andy Lopez, executive director of Las Clinicas del Norte, manages clinics in Ojo Caliente, Abiquiú and El Rito. Instead of trying to recruit physicians, he says he relies on nurse practitioners who can do 90 percent of the work physicians do.
Both Southern New Mexico's and UNM's residency programs have shifted away from competitive practice toward physicians working in collaborative groups with other providers, such as psychologists who can prescribe medicine and pharmacists who can manage complicated diseases like diabetes.
"It makes a big difference for accessing care," Andazola says. "Instead of the physician having to do all of the care, they partner with other professionals to provide the care."
UNM and New Mexico State University partner to provide health-extension agents, similar to promotoras who help locals get their health needs met, in 10 rural communities, says Dr. Arthur Kaufman, vice chancellor of community health at UNM.
One health-extension agent in Silver City helped set up a tele-pharmacy program after a local pharmacy closed, Kaufman says. A pharmacist in a remote location reviews the prescription, and a local pharmacy tech dispenses the medicine.
New Mexico has the advantage of being a small state with a low population, able to partner and adjust to new needs, Kaufman says. "I think change is going to be real slow, but sometimes change doesn't occur until there's a crisis."
It may be time for New Mexico to change the way medicine is traditionally practiced, including giving mid-level professionals, like nurse practitioners and dental therapists, more authority to care for patients, says Jerry Harrison, who has recruited providers to New Mexico since 1979.
"I think the most highly educated folks will be concentrating on the most serious conditions and that we may see different varieties of mid-levels evolving, which may lead to some pretty tough legislative battles because each professional trade group will attempt to maintain its economic position," Harrison says.
Until last January, the pistol-qualification course required agents to participate in quarterly exercises in which they fired 50 rounds, more than half of them from between 15 and 25 yards. The new course involves 60 rounds, with 40 of those fired from between 3 and 7 yards.
The new exercise also requires that agents draw their weapons from concealed positions, usually from holsters shielded by jackets or blazers, to mimic their traditional plainclothes dress in the field.
Training analysts say the FBI's new emphasis reflects a growing movement by law enforcement agencies across the country to prepare for encounters with armed suspects in schools, office buildings and other locations where officers are now being trained to pursue shooters — often in close quarters — in an attempt to limit potential casualties.
"After Columbine, it became very common for law enforcement agencies to speak about the need for active shooter training," says Scott Knight, former chairman of the International Association of Chiefs of Police's Firearms Committee. Knight, also police chief in Chaska, Minn., referred to the 1999 Columbine High School shooting in Colorado that left 12 students, one teacher and the two gunmen dead.
"With their findings, the FBI has determined that they are confronting these (close-range encounters) and need to be prepared for them," Knight said.
The new live-fire training is separate from the virtual simulation unit, housed in a converted storage room in Quantico since its launch in February. But the missions of both training units underscore the new emphasis on armed confrontations in close quarters.
The simulator can host up to six agents at a time, each fully "immersed" in scenarios in which agents' movements are captured by a network of ceiling cameras. Immediately after the exercises, video is displayed on large screens in an adjoining classroom where agents' performances are subject to detailed critiques by instructors.
For now, the system serves to teach agents the proper way to enter and clear rooms in search of potential suspects, confront armed assailants and determine when deadly force is appropriate.
"When you are in these exercises, people forget that these are virtual scenarios," says Tom McLaughlin, Motion Reality's chief executive. "The brain believes this is real. We make these to be as close as you would find in the real world."
In the screening room, there is no hiding from poor decision-making and improper technique, because almost every angle of each exercise scenario can be analyzed.
Wilson says the simulation has been invaluable. But he is just as excited about the technology's untapped potential.
The system can build in blueprints and schematics of any known suspect hideout or hostage location.
Once built, the system would allow agents to train before launching operations against suspected targets. Until now, rehearsals for some major operations required the full or partial physical construction of target locations.
No comments:
Post a Comment