"How pleased I am that the UNM School of Medicine chose Silver City as a place to celebrate your 50th anniversary," Shepard said. "New Mexico is the fifth largest state in size, but has only one medical school. I came here from Florida, which has nine medical schools. I see in the future physicians being urbanized. But one of the attractions of Silver City for me was a hospital and fine physicians in town. I know I can get good care. We are making sure we recognize what is going on in our state right now."
He introduced José Herrera, the WNMU Dean of the School of Arts and Sciences.
The next speaker was Dr. Art Kaufman, UNM Health Sciences Center vice chancellor for Community Health.
"I think people are not aware of how much of an effect this area of the state has had on our medicine in New Mexico," Kaufman said. "We entrench students for four months in rural areas. One of the best sites is in Silver City. Drs. Bell and Dye were one of the original private practices here in Silver City. They mentored medical students for many years. This also has one of the biggest impacts on where students practice.
"We are one of the highest in medical schools with students going into primary medicine," Kaufman continued. "Silver City is taking the lead in becoming the best destination for medical careers. Silver City has the highest rate for retaining practitioners in medical careers-not just M.D.s, but physical therapists, nurses and other medical practitioners. The model out of Silver City is becoming the model for the state for Hobbs, Farmington and Santa Rosa. You have the model for community health workers here. It's not done in most places, but in the state, it is being replicated in Albuquerque."
He pointed out that Charlie Alfero set up Hidalgo Medical Services, because he had worked in state government, in a university setting and knew the medical needs of the state.
"He came to us with a shopping cart to get resources to come here, because he knew the system," Kaufman said. "There are now 12 sites across the state, and it is becoming a national model. Research we think happens in an academic setting, but we're doing community-based research here and have a true partnership. We've learned when academia has to listen to community partners. Our success is the health of the state."
Alfero, as the next speaker, said his 38 years in rural health began in 1978. "I ran a community-based clinic in Albuquerque. In 1995, I joined with Kaufman in a contract for Hidalgo Medical Services to open a clinic in Lordsburg in partnership with UNM and with the Southwest Family Practice. The clinic was a direct result of UNM, and it saved the Deming hospital."
He described the history of health in Silver City as "interesting. Silver City and Grant County have not had a health care shortage like the rest of the state. Drs. Bell and Dye had begun their practice. Gila Regional Medical Center was devised and built, continuing as the leading force in rural health care. We had surgical resources, hospital-based resources and primary care. The makeup of the community gave people access to health care. Fort Bayard Medical Center gave its employees medical insurance, as did Western New Mexico University, the Forest Service and the mines. We were rich in health coverage. It helped us build viable medical services."
"The area services a regional population of almost 50,000, including Luna County, 38,000 without Luna," Alfero continued. "Relatively, we are a rural center, with 2.4 people per square mile. A so-called frontier area is 7 people per square mile."
"We are primary care-based, but with subspecialty resources," he said. "This place is accepting of new ideas. The history of medical service in Silver City is incredibly rich. In 2007, HMS hosted a summit on health profession careers. The career pipeline at the Center for Health Innovations works with junior high school students. Every summer at Western, we have a Summer Career Academy, under Forward New Mexico, which hosts 50 kids."
In rural economics, most smart kids cannot find jobs where they're from. "We have to try to keep them here. Health careers are one-fifth of the economy." He said students from the area can return, make a living, thrive and make a difference.
Dr. Brian Robinson, orthopedic surgeon, the next speaker, said, when he looked at the video of the history of UNM, which was shown to guests prior to the event, "it brought back a ton of memories. I always thought I wanted to be a doctor, because of my grandfather, Dr. James Robinson, who practiced here."
In orthopedics, he said the instructional learning was usually traditional with classes, but the first year in medical school at UNM, "we had clinical experiences outside class. The healthcare innovations of UNM have made the medical education innovative. My graduating class was the last class to choose between traditional/conventional learning or through experiential learning. It was primary care-focused, but you could also go into a specialty. From my standpoint, I received an excellent education at the University of New Mexico, undergrad, medical school and residency."
"After completing my studies, I came back to Silver City, thinking I could do anything for two years. Fifteen years later, I'm still here. We have a unique patient population. It's diverse, and we get the opportunity to educate patients. It makes it rewarding for physicians."
For those attending UNM, part of the educational system is the practical immersion experience-PIE.
"I wanted to work with my grandfather, but he didn't want to fill out the paperwork, so I worked with other physicians locally," Robinson said. "When I began my practice, we could get high school students to shadow us. Then HMS started the residency program to serve underserved areas.
"We are unique in Silver City," he continued. "We are isolated, but we have a global presence. We serve four counties and get some from Sierra County and even some from Doña Ana County.
"I built my own office, after spending time at Dr. Montoya's practice," Robinson said. "We have a 21,000 square-foot facility, with four providers. We serve 300 patients per week and 700 cases a year. Joint replacements are my specialty. We were the first in New Mexico to perform navigation knee surgery, and the first to purchase a navigational machine. Eighty percent of our practice is non-operative management, with a lot of time spent counseling patients about obesity and smoking. I know each physician you see before I take you to surgery. I see my patients at the grocery store. I'm part of the community. What I am able to do can make a huge difference to a patient and to the community."
UNM SOM student Adam Tolar asked if students were still allowed in the operating room to observe, because the opportunity meant so much to him and his choice of career.
"No to high school students, but yes to medical students," Robinson replied.
Another student asked if it was hard to go from medical school to the business part of a private practice.
"There was a time, when a doctor would hang a shingle and start his practice," Robinson said. "It is evolving. You need availability, affability and ability. You have to know how to delegate responsibility. I started as a sole physician with five employees. Now I have 30, with three other providers. We also have physical and occupational therapy inside the facility. You evolve and adapt to the situation. I would have done it the same way."
Trini Tolar, Adam's mother, asked if Robinson had any training in business management prior to setting up his practice.
"I had no formal business training," Robinson said. "My grandfather discouraged me from going into medicine. I idolized him. He told me I missed out on the golden age of medicine. But I encourage students-it's your golden age, and you get to make the decisions. My grandfather wanted me to go into business, and we sort of are in business. We are putting in the largest solar system in Silver City."
Alfero, after earlier speaking about the history of health care in Silver City, spoke again on the future of health care in Silver City. "Communities that are proactive in deciding their future are more likely to be successful. Rural areas have to learn how to keep the urban feel and how to keep an edge. People are not going to move here unless there is good health care. CHI will train and create our own pipeline. We have had students get training here from Australia, Kentucky, Nova Scotia and Scotland this year. We create a community of people interested in training, which creates a richer clinical experience.
"How do we keep building the idea that we want you to come here?" he asked. "There are four parts to health care, prevention, diagnosis, treatment and management. In America, we have focused on pain diagnosis and treatment. It's expensive to be focused on fixing things. We need a social system around prevention, coupled with a medical office visit. Every country in the world fails in management. We need to determine how to support patients when they leave the examining room and how to pay for management. We need to determine how to make a profit in health care, not just in diagnosis and treatment. A pilot study is underway this year, taking 2,000 Medicaid patients, the most expensive ones for emergency room use and pharmaceutical use. We will have three levels of prevention and management. With the University of New Mexico, we have saved $4 for every $1 spent. We have written 90 percent of the curriculum. It relieves primary care physician visits; there is better chronic disease management; and we need to have Medicaid pay for public health, as a separate payment. I think it holds a lot of potential. We will be able to generate income."
He said, as primary care positions get hard to fill, the proposed solution would relieve the rest of the medical system of unnecessary care. He gave an example of a veteran who was going to the emergency room every night, because it was warmer than sleeping in his car. With social management, the veteran got a job in Las Cruces, and has now only 1/10 the Medicaid cost.
To the students, Alfero said he looks forward to seeing them on rotation.
Jeffrey Hill, Ph.D. WNMU professor of biology said he sees the opportunity of focusing on really young people and the value of collaboration with Forward New Mexico, HMS and UNM. The summer Health Careers Academy serves high school students in math, science, health careers, and ACT preparation. He cited the example of Lozen Benson, 16, who increased her ACT score by 28 percent, and has been accepted to Bard College on a full ride scholarship of $48,000 a year. She wants to go to medical school to study proteins to attack cancer.
The SMASH program (summer, math, science and health care) serves eighth-graders. Roberto learned more algebra in eight hours with Dr. K., the shortened name of a Western professor with a difficult to pronounce name, than in the whole of 8th grade, Roberto reported.
"Everyone needs a Dr. K," Hill said. "Four more students said the same thing about Dr. K. Roberto used to be scared of math, and now he likes it, and wants to be a doctor. In the third camp for MCAT preparation, students saw an average 41 percent increase in their scores."
Adam Tolar said his Silver City foundation and "amazing parents" helped him decide to be a doctor. "As a high school freshman, I created my schedule. My mom took me back and signed me up for honors classes. It got me to be more focused, when I didn't have the drive. It got me on the right track. In my junior year in high school a representative from UNM of the BA to MD track came to our class. They served us free pizza and we found out about being a doctor. It really encouraged me. I was already taking classes at Western, and the first two doctors who took me in were Robinson and Dr. Roberto Carreon (the other orthopedic surgeon in Robinson's practice). I could watch surgeries, and I was fascinated. Other doctors who took me in were Dr. Twana Sparks and Dr. John Stanley."
"While I was still in high school, I earned 20 credits at Western," Tolar said. "I learned anatomy from Dr. Hill. That got me going on the right path. It got me in the BA to MD program. After my sophomore year, I did a practicum, and Dr. Robinson took me in again. Now I'm at the University of New Mexico School of Medicine for the PIE program. I chose Silver City and Dr. Robinson. Silver City has been instrumental in my education. I couldn't have done it without this community. I am thankful to everyone who contributed to that for me."
He then presented awards to Dr. Robinson and Professor Hill.
Kaufman said one of the next steps in the collaboration with Western is formalizing an agreement with Silver City. "We have developed memoranda of understanding with communities."
Jack Crocker, WNMU provost and vice president of academic affairs, signed the document, as did Kaufman.
"This is a collaborative effort," Crocker said. "I met with Charlie Alfero, and the next thing I knew I found myself in Kaufman's office. I'm looking forward to innovating and am more than proud to do this."