A program to train — and maybe retain — family medicine doctors at more than a dozen small clinics across Northern New Mexico is calling it quits after just 17 months.
The Médicos de El Centro Family Medicine Residency Program, which began in July 2024, will officially shut down Dec. 31, meaning current residents won’t get the full training they need for a family medicine specialty.
The program should have been a “golden opportunity” for Northern New Mexico, said Darren DeYapp, CEO of El Centro Family Health, which operates more than a dozen small-town clinics in the region.
El Centro’s clinics have been hosting the medical residents, boosting their own staffing levels while the residents completed their training through partnerships with Christus St. Vincent Regional Medical Center and Presbyterian Española Hospital. Meanwhile, DeYapp and his team would work to recruit the residents to join El Centro’s staff, enticing them to continue practicing in rural New Mexico after their training.
The program unraveled after Christus St. Vincent had its own recruitment and retention challenges, squeezing the program’s teaching staff.
Christus St. Vincent notified El Centro it would not participate beyond December. The affected residents are expected to scatter in search of other training programs, creating a loss of eight doctors for the Española Valley.
The residency program’s shutdown comes as New Mexico continues to wrangle with a severe doctor shortage. The solution to the problem lies not only in expanding the number of doctors in training but also ensuring training programs are sustainable in the long term, said Dr. Molly McClain of Albuquerque, president of the New Mexico Academy of Family Physicians.
“It’s heartbreaking. Nobody wants this to happen, and … these wonderful people who have come to New Mexico to become physicians in our state, no one wants to see them leave,” McClain said.
But, she added, “This is absolutely a problem that we all need to work on together. … The solution is just much more complicated than I wish it was.”
A medical ‘Swiss Army Knife’
More than 800 resident physicians across New Mexico are currently in training. They’re doctors in the third stage of their medical education, providing care to patients under the supervision of an attending physician.
After four years of undergraduate education and four more years of medical school, doctors advance to graduate medical education to complete residencies, which can last from three to seven years, and fellowships, which provide additional training in a subspecialty.
Because it lasts several years — and residents build their lives between shifts at a hospital or clinic — graduate medical education can play a significant role in retaining doctors in a particular place. They develop relationships with colleagues and mentors, McClain said, as well as personal relationships in the community.
“That’s a big network that you’ve created, and so leaving that sometimes can be really difficult,” she said.
New Mexico retains about 39% of the physicians who attend medical school in the state and about 70% who complete both medical school and graduate medical education here, figures consistent with the nationwide median retention rates, according to data from the Association of American Medical Colleges.
The data also shows New Mexico retains only about 40% of the doctors who complete only their graduate medical education here, a figure about 5 percentage points behind the national median.
The second most common specialty in the state for resident doctors is family medicine, according to data from the Accreditation Council for Graduate Medical Education. More than 100 family medicine residents, like those in Médicos de El Centro, are training in the current academic year across nine programs in New Mexico.
In a rural setting, a family medicine doctor serves as “a really good Swiss Army Knife,” McClain said. Their work can range from obstetrics to geriatrics, and they can serve patients at every age in between.
“Family medicine doctors can do so many things,” McClain said. “That’s one of the reasons I think it’s a great specialty for states like New Mexico.”
The accreditation council’s list of requirements for an accredited family medicine residency program — a crucial step in getting privileged at hospitals and working as a doctor — is nearly 60 pages long, with everything from providing inpatient care to effectively communicating with patients, managing mental illness and delivering a baby in a relatively uncomplicated birth.
To provide students the full spectrum of required training, some residency programs create partnerships with clinics, hospitals and other organizations.
That was the case for Médicos de El Centro, one of just a handful of programs in the state outside an urban center.
Of the 84 accredited residency programs in New Mexico, 72 are in Albuquerque.
Médicos de El Centro was the only one in Española or Rio Arriba County.
Program built on partnerships
The Northern New Mexico residency program took years of work, more than $1 million and partnerships with rival hospitals to get off the ground.
Staff at El Centro Family Health, established in the 1970s, had long harbored dreams of creating a residency program in the Española Valley, said interim residency program Director Tanya Reyes.
Médicos de El Centro, which opened to students in July 2024 and has taken on four residents in each of its two academic years, was established “with the hopes of training our own — training our own physicians, having them stay here, wanting to serve our community,” said Reyes, who is from Española.
El Centro is designated as a Federally Qualified Health Center, an organization that receives federal funds to serve underserved areas and populations. It has served as the resident physicians’ “host” institution, while the New Mexico Primary Care Training Consortium — a collaborative of primary care residency programs — has been the sponsoring institution for Médicos de El Centro, allowing for its accreditation.
Residents could get the outpatient experience they needed at El Centro’s primary hub in Española or its satellite clinic in Embudo, Reyes said. The residency program partnered with Christus St. Vincent and Presbyterian to ensure residents satisfy other training requirements.
Crucially, Christus St. Vincent was a “core financial partner” in the program, Reyes said.
Funding for residencies largely flows from the federal Centers for Medicare and Medicaid Services. While New Mexico allows Medicaid funding — the second largest source of funding for graduate medical education — to go to Federally Qualified Health Centers, the facilities only receive “a fraction of the funding that’s available,” compared to hospitals, said Dr. John Andazola, chief medical officer at La Clinica de Familia in Las Cruces and a board member of the New Mexico Primary Care Association.
“What we did is we said, ‘OK, could we create a partnership between the hospitals and between the FQHCs, train the residents in the FQHCs so they learn the basics of working in a rural community, but get that funding flowing from the hospital?’ ” Andazola said.
That was the strategy behind Médicos de El Centro’s connections to the clinic and the hospitals, with the New Mexico Primary Care Training Consortium serving as a “central unifying organization” bringing it all together, Andazola said: “The partnership is required for the hospitals to maximize the funding.”
‘Proverbial nail in the coffin’
So why is Médicos de El Centro shutting down?
DeYapp, the El Centro health center’s CEO, said challenges in recruiting and retaining qualified providers to be the attending physicians who help train residents was a “major piece to the puzzle.” The former program director left the state in July for personal reasons, and one of El Centro’s teaching doctors left that same month.
“With the news that Médicos de El Centro Family Medicine Residency Program lost their Program Director and two of their three faculty members, we provided the required 90-day notice that we would not be able to continue participating beyond December,” Arturo Delgado, a spokesperson for Christus St. Vincent, wrote in an email to The New Mexican.
Delgado added, “We simply do not have the bandwidth to take on additional responsibility for the struggling program.”
Christus St. Vincent’s departure was the “proverbial nail in the coffin,” DeYapp added.
“The funding went away, and there was just no method or way to move forward with it,” he said.
Christus St. Vincent and the UNM Health System issued a joint statement in response to the program’s closure, saying it is “profoundly difficult — for the residents directly impacted, their patients, and the communities they serve.”
Both health systems “carefully evaluated” whether they could help sustain or manage Médicos de El Centro and determined they were “unable to do so” while continuing to meet accreditation requirements for existing residency programs, the statement continued.
Dr. Fernando Bayardo, medical director at Presbyterian Española Hospital, said in a statement the hospital has been “proud to serve” as a training partner for the residency program and “remains committed to being a teaching health system.”
“Supporting these physicians-in-training as they continue their education is a priority, and we will work with El Centro and other partners to identify resources and solutions,” Bayardo added.
With three core faculty members including herself remaining, Reyes said she believes the program could have continued to meet accreditation requirements through the end of the academic year.
But if recruitment of a permanent program director and core faculty proved unsuccessful, she acknowledged, “the program would have likely closed regardless.”
‘Not going to come back’
The human cost of the residency program’s closure is hard for DeYapp to swallow.
“There’s eight lives that were impacted and uprooted,” he said, referring to the eight residents.
Those doctors and clinic organizers are searching for alternatives, Reyes said, but options are limited in the middle of the academic year and in the middle of a residency program.
“Our program is committed to supporting each resident during this transition and will provide full verification of training and any documentation needed to facilitate their transfer to another” accredited residency program, Reyes wrote in a letter confirming Médicos de El Centro’s closure.
Andazola said doctor recruitment and retention efforts are essential to expanding training programs, as are regulatory changes to ensure Federally Qualified Health Centers can access adequate federal funding to run those programs.
McClain argued any expansion to medical training should be undertaken with long-term sustainability and realistic expectations in mind, not just good intentions or peripheral involvement.
“Any solution that’s going to be effective with anything as complicated as workforce expansion in an underresourced state has to have people who are on the front lines at the table from the beginning,” she said.
DeYapp said Médicos de El Centro was designed to serve as “an answer” to the clinic’s challenges in recruiting and retaining qualified providers.
“Many of our locations are very rural, and it’s hard to recruit providers, especially if they don’t have a local connection,” he said.
El Centro Family Health hasn’t ruled out the possibility of restarting a residency program in the future; DeYapp is already thinking about how the program would avoid a “repeat performance.”
Dr. Leslie Hayes, chief clinical officer at El Centro, said she had hoped to hire some of the program’s residents when they completed their graduate medical education — though the likelihood of that now seems slim.
“That’s one of the things I’m saddest about: Eight physicians, and we probably could have hired at least some of them to work in the area,” she said, adding, “They’re probably not going to come back here.”