Collaboration crucial for competent rural health care

Getting health care access to rural/low-income New Mexico requires creative collaboration.

It happened when psychologists were given prescribing privileges like their M.D. psychiatrist colleagues. And when Gov. Susana Martinez put together incentives to attract more nurse practitioners. And when various provider groups embraced telemedicine.

Because expecting throngs of doctors and dentists, specialists and oral surgeons to take their expensive educations and medical equipment to communities with one stoplight is a false expectation.

There are plenty of those communities. After all, New Mexico is the fifth-largest state in the nation, at 121,298 square miles.

So it is important that realistic cost efficiencies are included when the 2015 Legislature once again takes up the issue of dental therapists, as well as if the state Board of Nursing revisits its recent rule change on registered nurses and anesthesia.

Sponsored by Sen. Benny Shendo Jr., D-Jemez Pueblo, the dental therapists legislation would create this new category of midlevel oral health care provider. Dental therapists could fill cavities, perform basic extractions, diagnose irregularities from X-rays, adjust dentures and make treatment plans.

They could not practice without a supervision agreement with a dentist. Yet the New Mexico Dental Association is grinding its collective teeth, saying all that’s really needed is dentists relocating to rural New Mexico and the federal government increasing Medicaid reimbursements.

OK. While we’re waiting for those to happen, rural New Mexicans cannot only lose all their baby teeth but have their permanent teeth come in and get cavities.

But the dentists also raise valid concerns. It would be wise for the Legislature to work with all parties to approve a pilot program — complete with a status report on the number of patients served and a requirement that a significant number of them be Medicaid patients in rural areas — to see if dental therapists make a difference in rural oral health care.

As for the rule change to the New Mexico Nurse Practice Act that allows registered nurses to administer deep sedating drugs under the guidance of doctors, the American College of Emergency Physicians says that has been happening for years and the change simply codifies practice. It will be important to follow if concerns expressed by the New Mexico Society of Anesthesiologists are realized, and nurses begin administering anesthesia in clinical settings rather than just in hospital emergency rooms and intensive care units, and with negative results.

New Mexico is a rural state with many low-income patients who need realistic access to medical care. It’s important the state continues to embrace creative collaboration to make that happen.

— Albuquerque Journal