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Why New Mexico has become a refuge for gender-affirming health care

By Mark Brodie
Published: Wednesday, November 15, 2023 - 11:33am
Updated: Wednesday, November 15, 2023 - 1:49pm

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States across the country have been enacting laws affecting the transgender community, from bans on gender-affirming care to restrictions on changing drivers’ licenses to rules about bathroom use and who can play on which school sports teams. In some cases, that’s led transgender residents to leave their homes and move — oftentimes, in an effort to access better health care.

And, many of those families appear to be moving to New Mexico, which has a law restricting prohibitions on gender-affirming care.

Dr. Molly McClain has been seeing this first hand. She runs Deseo Clinic in Albuquerque, New Mexico, where she treats transgender patients.

She joined The Show to talk about her experience.

University of New Mexico
Dr. Molly McClain

MARK BRODIE: Good morning

DR. MOLLY MCCLAIN: good morning.

BRODIE: So are you seeing people moving from other states to New Mexico for the purpose of accessing health care?

MCCLAIN: We are, in fact, that's been happening over the past few years. I've had families come from Florida, Arkansas, but now more recently, we're getting quite a bit of families coming from Texas. The families that we've been talking to can get care at University of New Mexico. But unfortunately, it's long-term care and so it's going to be a really really big lift for a lot of families to be able to come here, get labs done, get the evaluation and be seen frequently over the years, as their particularly children continue to need care.

BRODIE: Well, so are they just uprooting from Texas or Florida or wherever they're coming from and settling in New Mexico or do they just keep coming back for appointments?

MCCLAIN: I've heard both. I think it's just really depends on people's access, resources. Some families can afford to do that. I have spoken with some families in Texas who are just heartbroken. They live in this community. They have lived in their communities in Texas for, for many years and they don't want to leave. On the other hand, their children are now being denied lifesaving health care. And so it's a very, very difficult decision. So we've seen both. We've seen families move. I actually had a family that came and actually purchased property in New Mexico without moving from Texas. Because I thought that that would be necessary to get care here. So families are really having to make take extreme measures just to get their kids continued health care.

BRODIE: Well, for the folks who are coming from out of state, either relocating or just coming for care, is there enough care for all of those people?

MCCLAIN: That's such a great question. New Mexico is a really special state. We've passed four laws this year actually in protection of LGBTQIA people, primarily transgender and non binary people. So that makes us actually the strongest refuge state in the country right now. And so I think it makes sense that they would want to seek care in a place that is affirming and they know that they, they will be safe from being charged with a felony. Their physician will be safe from being charged with a felony for getting their kids lifesaving health care. But I think the problem is that New Mexico has a shortage of primary care in general. And so I've been working alongside a lot of other people for many years to try to build capacity. So we actually just started a gender care Echo. The ECHO program is out of University of New Mexico. And before COVID, it was a very revolutionary way for rural areas to get access to specialty care. And so now we have started that to help build capacity. And we have there are probably about 10 clinics across the state that provide gender care, but only two and both are at UNM in Albuquerque that can provide gender care for people of all ages. So that the access to care for youth is actually even more restricted than access to care for adults, which is already pretty significantly lower compared to other states.

BRODIE: Well, have you had maybe phone conversations or email correspondence with people in other states who are looking to come and you have to sort of be upfront with them and say, look, you know, you can come, the laws are what they are, but also our availability is what it is.

MCCLAIN: Well, when you talk to people in medicine and people who do gender care already are doing it because they know how great the need is. So it doesn't, the conversation doesn't really go that way. The conversation usually goes, I will figure out a way to get you in and that's not just true for me. That's true for my colleagues. That also do this work. We are working really hard as an institution to do everything we can to accommodate folks just knowing how difficult this must be for them and how scary it must be for them to know that their kid could lose access to care. We know the ramifications of that for gender expansive youth is deadly. And so I think most of us will work to accommodate rather than say no.

BRODIE: Well, so you mentioned New Mexico has a physician shortage. I mean, Arizona has won lots of states, have them. Is there any hope of graduating enough physicians or recruiting to New Mexico from other places? Enough physicians to expand the care to where it's not a matter of, I will squeeze you in or I will do whatever I need to do to fit you in. But to actually have enough appointments for, for the people who need them.

MCCLAIN: I'm actually the residency program director for Family Medicine at University of New Mexico. So it's an interesting place to be able to see how powerful New Mexico's support and protection of bodily autonomy has affected our recruitment, particularly for family medicine and primary care. That's really the bottleneck, like you said in a lot of states including Arizona and New Mexico. So being able to recruit family medicine physicians to our residency is a really important part of recruiting physicians to stay here in New Mexico. And the fact that New Mexico has been so supportive of both reproductive justice including abortion and now gender care, I think is really gonna change the game in terms of recruiting folks to New Mexico and to be able to have this big of an impact is really different than other states. And I, I think people in family medicine really care about making an impact for people who really need the most assistance. And so I think with the laws that we have, we're going to have a pretty big boost in recruitment and hopefully that also will be a boost in retention.

BRODIE: So you think that because of the access to the kind of care you're talking about that will be a draw for potential physicians med students, residents to come to New Mexico and stay in practice.

MCCLAIN: Exactly. In fact, that's actually borne out in data this year, the rate of,, medical students applying to states that don't allow abortion care actually decreased twice the rate that it decreased across other states. So that could be from lots of different things. But a lot of people are suspicious that in states where even just abortion care isn't readily available during residency training that particularly people interested in family medicine will be less interested in going to residencies in those places. And that's certainly what we've heard. We are currently in our recruitment season and that's really primarily people are leaving from Texas. People are leaving from Ohio. People are coming here specifically because they can get training in abortion care and gender care.

BRODIE: Interesting. All right, we'll have to leave it there. that is Dr. Molly McClain, who runs the Deseo clinic in Albuquerque, New Mexico. Dr. McClain, thank you so much for your insights.

MCCLAIN: I appreciate it. Thank you.

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