Leslie Hayes, M.D., is a family physician in Espanola, New Mexico. Population: 10,029. Per capita annual income: $19,186.
It is hard country. “There’s so much beauty here and there’s so much pain,” Hayes’ fellow provider, Matt Probst, a physician assistant who is the medical director of El Centro Family Health, says in the documentary film The Providers, which will debut on PBS on April 8.
It is the story of Hayes, Probst and nurse practitioner Chris Ruge—all practitioners at El Centro—and the patients they care for in rural New Mexico. It is a tale of the struggles to help poor and drug and alcohol-addicted patients, of the constant turnover and shortage of healthcare providers and the constant worries about funding. The documentary is part of PBS’ Independent Lens series.
In an interview with FierceHealthcare, Hayes says she appreciates the platform the film has given her to talk about the need to treat patients with opioid use disorder. “I think it’s really an important message,” says Hayes, 54, who works in El Centro’s Espanola clinic.
“I like going out and talking to people about this. There are just so many misconceptions about opioid use disorder and about proper treatments. When people learn the facts, you can change people’s minds,” she says.
Treating addiction, making a difference
El Centro Family Health is a federally qualified health center made up of 25 clinics that serve northern New Mexico, an area that covers 23,600 square miles and treats all patients regardless of their income. insurance, or ability to pay. It provides medical, dental and behavioral health services to more than 19,000 patients.
The film’s directors and producers Laura Green and Anna Moot-Levin are the children of doctors. They spent three years filming the three healthcare professionals and many of their patients and accumulated close to 400 hours of film to complete the 90-minute documentary.
As Hayes remembers, they showed up on the clinic door one day hoping to get her into the documentary they were filming. They started out planning to tell the story of rural healthcare and the struggles to provide care to people in areas where there are too few doctors and other practitioners. They kind of stumbled onto their second theme—the ongoing opioid epidemic that has rolled through the country, leaving millions of people addicted and hundreds of thousands dead from drug overdoses.
Hayes was a doctor doing addiction medicine in primary care. She went through the first training in New Mexico to get licensed to use buprenorphine to treat opioid-addicted patients in a primary care setting. Drug addiction has been a problem in that area of New Mexico for nearly 50 years before the problem started making headlines as a national epidemic, Hayes says. “It seems like nobody really cared when it was people of color.”
In the documentary, she recalled going to Alcoholic Anonymous meetings with the grandfather she adored, who had beaten his drinking problem. “I always viewed addiction as a treatable disease,” she says, adding how she was so happy to finally have a medication to treat opioid use disorders. “I thought everyone would rush to do it,” she said, finding that wasn’t the case at all.
“Many physicians don’t view treatment of substance use disorders as part of primary care, which I disagree with,” she says in the film. “Physicians tell me they don’t want to see these patients in their waiting room. But sometimes it’s the patients who are struggling where we actually make more of a difference.”
Most years, Espanola has been in the top five communities in the nation for heroin overdoses per capita. “Right now, if I were to retire, there’s no one to take on my patients,” she says.
“One of the problems for me is that my patients who were doing really well, the ones I would have loved to have in the film, didn’t want to appear on camera,” she says. So viewers will see the patients who are struggling with their addiction, not those who are now working and raising their kids.
She finds a particular satisfaction in helping addicted patients. “What I found was once I started offering treatment, you make a difference like nothing else you do in medicine," Hayes says in the film. "I have been treating high blood pressure for 25 years now and I have never once had anyone come into my office and say ‘thank you so much for getting my blood pressure under 140/90, it means so much to me’. I have people come into my office several times a month and say, ‘Dr. Hayes saved my life’."
She has been honored by the White House as one of the country’s “Champions of Change” in fighting the opioid epidemic.
Not enough doctors, practitioners
Hayes was eight years old when she read a book about the history of medicine and how doctors and scientists were able to rid the world of smallpox. It was then she decided to be a doctor. December will mark 25 years of practicing medicine at the clinic in Espanola.
Hayes’ family moved to New Mexico when she was two years old. She grew up in Los Alamos, a community with the highest percentage of Ph.D.’s in the country per capita, she says. It is one of a few places in New Mexico where there is an adequate supply of physicians. When she decided to return to New Mexico after completing her residency to be near her parents, she wanted to be somewhere where physicians were really needed. “Espanola seemed a good fit,” she says.
As the medical director at El Centro, Probst regularly faces a shortage of doctors, nurse practitioners, and physician assistants. Evidence shows that healthcare organizations are more likely to retain someone if he or she is from that community.
That’s the case with Probst. “I love this community. Born and raised, and never left and never gonna leave,” he says in the film.
In 2016 there were 70,000 deaths in rural areas of the U.S. that could have been prevented with access to better healthcare, according to the film. That is 10 times the number of Americans who died in the Iraq and Afghanistan wars combined. Probst says in the film he is eight providers short and trying to recruit people to work at El Centro.
With not enough doctors, nurse practitioners, physician assistants, and midwives have taken on the role of providing primary care. “Someone had to do the work. The patients were still there. The illnesses were still there,” he says.
Probst has started youth clubs in the local schools to get young people interested in careers in healthcare in hopes they will stay in rural New Mexico. He also talks to students at the physician assistant program at the University of New Mexico in Albuquerque. “We’re in the trenches, on the frontline. The problem in underserved healthcare is there are no resources and you have to do a lot with nothing,” he says.
A connection with patients
The three providers featured in the film work with many people who would otherwise be left out of the healthcare system. They develop relationships with some of the most marginalized patients. Hayes is surprised by the reaction of some people to the film who marvel at the connections between the providers and their patients.
“This is what family medicine does. We take care of patients, we develop these relationships,” Hayes says.
Chris Ruge’s nurse practitioner’s position at El Centro is funded by Project ECHO (Extension for Community Healthcare Outcomes), a program being run there and at five other clinics. With the funding, Ruge is able to offer 24-hour access to care for the most in-need patients. They are patients whose needs can’t be addressed in a 15-minute office visit, he says in the film. The program allows him to make home visits.
His patients at times bring him to tears. There’s 33-year-old Cheri who is trying to get sober, but so far keeps relapsing, and her 13-year-old son. Ruge tells his wife, a nurse midwife at El Centro, that it’s like watching a patient sink in quicksand while he sits on solid ground.
If he thought it would make a difference, he’d take them into his own home, says Ruge, who is constantly wondering if funding for Project Echo will continue. “If it ended, it will likely lead to the early death of a lot of our patients,” he says.
In addition to the broadcast on PBS, Independent Lens and the Corporation for Public Broadcasting will present The Providers as part of Indie Lens Pop-Up, a neighborhood series that brings people together for free film screenings and community-driven conversations.