Over 30 years ago the leadership at UNM Family and Community Medicine put into action a plan to decentralize post-graduate medical education to increase workforce in areas throughout New Mexico outside of the Albuquerque metropolitan area. Plans to develop 1+2 Family Medicine Residency Programs in Las Cruces, Roswell, and Santa Fe were developed over time and the Northern New Mexico Family Medicine Residency Program in Santa Fe (UNM-Santa Fe) admitted its first class of 2 residents in 1996. Efforts to integrate community partners including Santa Fe’s Community Health Center, La Familia Medical Center, and St. Vincent Regional Medical Center in this vision resulted in a UNM-sponsored residency program that identified La Familia Medical Center and it’s employed physicians as the continuity clinic site and core faculty, St. Vincent Regional Medical Center as its administrative hub and primary teaching hospital, and UNM Hospital as the sponsoring institution. For a variety of technical reasons, St. Vincent Hospital was unable to get Direct and Indirect Graduate Medical Education funding, mostly because of a federal cap on the number of residents claimed in 1986 reporting data which limited St. Vincent Hospital to 2 residents. Fortunately, after many years of advocating to change this barrier through federal legislation, this cap was later adjusted to allow 10% of unused residency slots from urban programs to be reallocated to community-based programs like the Northern New Mexico Family Medicine Residency Program. In the process the program grew to 4 and later to 6 residents in each cohort. This expansion required additional continuity clinic sites and consolidation of administrative functions to St. Vincent Regional Medical Center. For various reasons, including the process of adding an educational mission to the historic mission of Community Health Centers of clinical care for underserved populations, the sponsoring education has remained with UNM Health Sciences Center. At the start of this program, teaching health center funding options did not yet exist. Because of the successful multi-institution collaboration that launched this program, the structure has remained as a UNMH-sponsored education and has also remained a 1+2 program structure.
Because of the location, the opportunity to include NM Department of Health as a core educational partner allowed the Northern NM Family Medicine Residency Program to engage residents in real-life events with regards to disease outbreak management as part of their Department of Health rotation. This rotation eventually evolved to include a legislative advocacy and health policy component of the rotation. This opportunity allowed residents to develop and participate in the highly successful “Doctor of the Day” program at the NM State Legislature, an effort that is supported and organized by the New Mexico Academy of Family Physicians, ultimately resulting in the hiring of a part-time lobbyist through NMAFP.
In the course of the past 30 years, since the initiation of the Northern New Mexico Family Medicine Residency Program, I have had the privilege of serving as the residency program for 15 of those 30 years. The other 4 residency program directors brought new vision and direction to the program and have made incredible improvements to the quality of the residency program while retaining many of the foundational components and vision of the program that have resulted in the sustainability of the residency program with CHRISTUS St. Vincent Regional Medical Center.
It is my belief that the initial consistency of having a longer-serving director, like myself, and long-term residency administrator, like Deborah Weiss, at the beginning of the program contributed to the long-term commitment of the various institutional partners as institutional leadership changed within each of the organizations. Subsequently, new ideas and incremental changes to programmatic components by the firmly established program has allowed the program to grow and improve in a healthy and organic fashion. I believe that new and expanding community-based residency programs in New Mexico, and especially in programs striving to integrate the teaching health center model into their structure, can learn from this observation.
About the Author
Mario F. Pacheco, M.D. is a Board Certified family physician who has provided comprehensive family care to medically indigent populations in northern New Mexico. He is the founding director of the Northern New Mexico Family Medicine Residency Program, a rural training track in Santa Fe, NM sponsored by the University of New Mexico School of Medicine. A 1986 graduate of the University of New Mexico School of Medicine, Dr. Pacheco completed his residency in family medicine at the University of New Mexico Department of Family and Community Medicine. He completed a fellowship in Health of the Public at UNM and subsequently worked as a community health center physician at La Familia in Santa Fe for 10 years. He is a diplomat and fellow of the American Academy of Family Physicians. In 2000-2001 he was awarded a prestigious Robert Wood Johnson Health Policy Fellowship in Washington DC where he worked in the office of United States Senator Jeff Bingaman. He subsequently served as a District Health Officer for the New Mexico Department of Health prior to resuming the residency directorship in 2002. He currently serves patients at Pojoaque Primary Care and also serves as the Associate Vice President for Community Health at the University of New Mexico Health Sciences Center. In 2006 he was the recipient of the University of New Mexico School of Medicine’s Distinguished Alumnus Award.
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