Physicians fight for malpractice reform — and win

New Mexico has faced its share of health care challenges in recent years, but perhaps none has been more urgent than the loss of physicians, many of whom cite the state’s extreme malpractice climate as a major reason for leaving.

“Between 2017 and 2024, between 200 and 300 physicians left the state as a net negative,” says Aaron Snyder, M.D., a board-certified emergency physician practicing in Albuquerque. “It’s the only state in the country that actually had a net loss during that period.”

Snyder, who has been fighting for malpractice reform since arriving in New Mexico in 2021, believes the medical-legal risk of practicing there bears much of the blame. Indeed, surgical oncologist Amani AJ Jambhekar, M.D., says she left the state for mainly that reason.

“It wasn’t that I was personally worried I would be sued,” Jambhekar says. “It was the downstream impact of the malpractice environment on the ability to recruit collaborating plastic surgeons and provide the care our patients need.” In the two years that she practiced in the state, Jambhekar says that she didn’t see a single plastic surgeon move into her community.

Jambhekar advocated for malpractice reform by writing op-eds, sharing information on social media and visiting legislators before ultimately deciding to leave the state. “As a surgeon who treats patients with breast cancer, I had patients driving more than 250 miles to get comprehensive reconstructive care. The environment was very, very challenging because of these limitations.”

New Mexico’s malpractice climate

Both Jambhekar and Snyder note that New Mexico is the only state that doesn’t pay its legislators, resulting in a privileged group that can afford to take months off from work without pay, and includes a disproportionate number of trial attorneys. In 2021, changes to the Medical Malpractice Act, which was backed by the trial bar, made it easier for plaintiff’s attorneys to levy punitive damages against physicians, including filing punitive damage claims at the outset of the case, before discovery and without judicial screening; and effectively treating small group practices like hospitals for liability purposes.

Punitive damages are meant to punish gross negligence, willful misconduct or fraud rather than compensate an injured patient. According to Think New Mexico, New Mexico’s malpractice structure is an outlier: The state allows unlimited punitive damages and uses the unusually low “preponderance of the evidence” standard, whereas many other states either cap punitive damages, ban them altogether, or require the higher “clear and convincing” standard.

Few personal liability protections

New Mexico also differs from many states in what personal property is protected in a judgment. “Your house is protected only up to $300,000, which might have been reasonable back in 1970, but doesn’t make sense in today’s real estate market,” Snyder says. “Vehicles are covered up to $10,000. You can’t buy a car for that today.” Personal assets are protected only up to $75,000, and while retirement accounts are federally protected, distributions from those accounts can still be subject to judgment.

“Attorneys file these cases and essentially force settlements in matters that probably would be defensible,” Snyder says. “Except that if you have to roll the dice on punitive damages, you’re willing to settle because you don’t want to take that chance.”

He notes that some physicians have chosen early retirement rather than continue practicing under that level of personal financial risk. “The most poignant example was a husband-and-wife primary care team who had served their community for more than two decades,” he says. “They wrote a letter to their patients saying they were moving to Missouri because they could no longer afford to practice in New Mexico.”

‘Nuclear verdicts’

Recent “nuclear verdicts” have only intensified the pressure. Think New Mexico reports that New Mexico has the highest rate of malpractice payouts per capita in the country and that malpractice premiums are roughly twice as high as in neighboring states. Snyder says many practices became effectively uninsurable, and several carriers exited the market.

“A GI [gastrointestinal medicine] group in my community was told by its insurance company that it wouldn’t be covered for any amount,” Snyder says. “The company said there was no premium that could adequately cover the risk.” He says a three-way conversation among legislators, the practice and the insurer ultimately led to a special legislative session to carve out relief for independent practices.

Jambhekar says malpractice premiums were a significant factor in the state’s inability to recruit plastic surgeons. “For them, being able to afford overhead, including malpractice premiums, was almost impossible,” she says. That shortage, in turn, increased the strain on hospital-employed surgeons. “Because there were no private-practice plastic surgeons in the market, hospital surgeons had much higher patient volume, which limited their ability to provide complete reconstructive care.” Jambhekar adds that at the time of this writing, there is not a single plastic surgeon offering the full spectrum of reconstructive services in the entire state of New Mexico.

Fighting for reform

Snyder says he never expected to become a health care advocate. “I was complaining to a friend about the problems in health care, and he said, ‘Why don’t you do something about it?’”

That friend, then president of the New Mexico chapter of the American College of Emergency Physicians (ACEP), persuaded him to get involved. “I thought I didn’t have time,” Snyder says. “But he twisted my arm a little. Before long, we had revamped the organization, rewritten the bylaws, hired a new executive director and got the chapter functional again.”

Through his work with ACEP, Snyder joined physicians from multiple specialties during the New Mexico Medical Society’s White Coat Day at the Capitol. “I started meeting people and created a president’s roundtable with leaders from other medical specialties,” he says.

He found that cross-specialty advocacy was especially effective. “It matters because if an ophthalmologist says optometrists shouldn’t be using lasers, legislators may think, ‘You’re just protecting your turf,’” Snyder says. “But if emergency medicine says, ‘We oppose this too, because we see the complications when patients are harmed and end up in the ER,’ that carries weight.”

Getting patients involved in advocacy

In addition to meeting with lawmakers, Snyder and his colleagues wrote op-eds, educated the public and worked through grassroots political channels. But he says what made the greatest difference was getting patients involved.

“Practices were so backed up that they had to stop taking referrals,” he says. “Patients were coming to the ER because they couldn’t get in to see a primary care doctor or specialist.”

He recalls one middle-aged woman with autoimmune hepatitis who came to the emergency room after being unable to get a timely GI follow-up appointment. “She was frustrated, and I explained the root of the problem and asked whether she knew who her legislator was,” Snyder says. “She said, ‘Yes — she lives three doors down, and we’re going to knock on her door tomorrow.’”

To help channel that frustration into action, the New Mexico Medical Society created a QR code patients could scan to identify and contact their legislators. The movement gained further momentum when Think New Mexico, a nonpartisan advocacy organization, published a policy paper outlining the state’s health care workforce crisis and recommending malpractice reform as part of the solution. The group later reported that in a December 2025 Legislative Finance Committee poll, 65% of New Mexico physicians were considering leaving the state, with 83% citing the malpractice system — especially unlimited punitive damages — as the top reason.

Malpractice reform passes

With growing pressure from physicians, patients and advocacy groups, legislators eventually acted. House Bill 99, which was signed into law in March 2026, placed caps on punitive damages, raised the evidentiary standard to “clear and convincing,” and required discovery and judicial review before punitive claims could proceed.

While Snyder and others still believe the caps remain too high — $900,000 for independent physicians, $6 million for groups and $15 million for hospitals — he views the law as meaningful progress. “It’s not a perfect bill,” he says, “but hopefully it will help dissuade some physicians who were considering leaving.”

Jambhekar agrees. “There’s still a lot of work to be done in New Mexico to make that environment inclusive and equitable for surgeons like me, but also for our patients,” she says. “Everybody should be able to get what they need in New Mexico.”

She notes that malpractice is only one part of the problem. New Mexico also faces a difficult payer environment, with heavy reliance on Medicaid and fewer privately insured patients. “Rural communities in New Mexico are really struggling,” Jambhekar says. “And not even having a functioning hospital is definitely going to make health outcomes much, much worse.”

New Mexico’s reform effort comes as other states consider expanding liability exposure. Jambhekar says policy makers elsewhere should pay close attention. “States like Virginia should absolutely look at New Mexico and realize how difficult it becomes to recruit physicians in this kind of environment,” she says. “When doctors leave, the ones who stay get more burned out, and then they leave too. It’s a cycle.”

Physician advocacy as an antidote to burnout

Both Snyder and Jambhekar say that helping achieve reform has been deeply gratifying.

“I honestly didn’t think the legislation was going to pass, and it’s rejuvenating to see your efforts actually start to make a difference,” Snyder says.

But he says the greatest reward was not just the legislative victory. It was the process itself: collaborating with colleagues, learning how the system works and contributing to something larger than his own clinical practice.

“When was the last time you really learned cool new things in medicine?” he says. “The process of learning has been more rejuvenating for me than the actual outcome.”

Snyder believes part of physician burnout stems from the fact that medicine is a profession built around striving. “The fulfillment was in climbing the mountain,” he says. “And this gave me something meaningful to work toward again.”

For physicians feeling disillusioned, New Mexico offers an important lesson: advocacy can be energizing. In a system that often leaves doctors feeling powerless, fighting for patients and for the future of the profession is a powerful way to take medicine back.

Rebekah Bernard, M.D., is a family physician and health care advocate practicing in Fort Myers, Florida.

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Editor's note: Episode timestamps and transcript produced using AI tools.

0:16 — Introduction: Aaron Snyder, M.D., on New Mexico's net physician loss from 2017 to 2024

0:37 — Amani AJ Jambhekar, M.D., on the plastic surgery access crisis and why breast cancer patients were driving 250 miles for reconstructive care

3:15 — History of New Mexico's Medical Malpractice Act and the structure of the Patient Compensation Fund

5:00 — The 2021 legislative overhaul: raised caps, uncapped punitive damages, and lumping independent practices in with hospital systems

7:52 — Personal financial exposure under New Mexico's limited asset protections

8:03 — Punitive damages attached to 92% of malpractice cases and the forced-settlement dynamic

9:42 — A $412 million nuclear verdict in a urology case accelerates the physician exodus

10:00 — A husband-and-wife primary care team closes after two decades and relocates to Missouri; insurers exit the state

15:00 — Emergency physicians absorbing primary care volume; a jaundiced patient's story prompts real-time legislator outreach in the ER

16:27 — QR codes for constituent contact, rallying major health systems, and the emergence of HB 99

18:26 — What HB 99 actually does: caps on punitive damages, raised evidentiary standard, and post-discovery sequencing

20:00 — Jambhekar on leaving New Mexico, feeling relieved, and the state as a cautionary tale for Virginia

22:54 — Jambhekar on missing her New Mexico patients; the outsider trial bar's structural grip on an unpaid legislature

25:00 — Resident retention rates, incentive gaps, and what it would take for Jambhekar to return; Snyder on how advocacy became an antidote to physician burnout

30:00 — Closing from host Rebekah Bernard, M.D.

30:40 — End