Increased fellowship fund could aid Nevada’s doctor shortage
Nevada ranks 45th in the U.S. for active physicians per 100,000 population, 48th for primary care physicians and 49th for general surgeons. When broken down by medical specialty, Nevada has fewer specialists than the U.S. rate for nearly every specialty or subspecialty.
During the past two decades, Nevada’s population has increased each year, by about 2 percent; however, the number of trained physicians has not kept pace. This limits timely access for patients and serves as a disincentive for new businesses contemplating a move to Nevada.
How did we get here?
Although Nevada has gone from having a single allopathic medical school in Reno to two allopathic medical schools, University of Nevada, Reno and University of Nevada, Las Vegas, and one osteopathic medical school, Touro University, only about half of Nevada’s medical school graduates eventually practice in the state. If we consider students who also complete residency or subspecialty fellowship training, known as graduate medical education (GME) in Nevada, that number increases to nearly 80 percent.
Put simply, we need more residency and fellowship positions in our state in order to grow our physician workforce.
Unfortunately, doing it is not that simple. The majority of GME is funded by the federal government through the Centers for Medicare and Medicaid Services (CMS), but the total number of funded spots was essentially frozen in 1997. As a result, Nevada has only 404 funded residency positions compared to more than 9,000 in California and more than 16,000 in New York. As you probably have noticed, our population is very different than it was in 1997. In fact, Nevada’s population has doubled from 1.6 million to 3.2 million people.
What can we do?
Last month, we – the deans of the University of Nevada, Las Vegas’ Kirk Kerkorian School of Medicine and University of Nevada, Reno School of Medicine – lobbied together in Carson City to increase lawmakers’ knowledge of GME and ask for increased state funding to support the training of residents and fellows. We noted that other states have set the precedent by investing in the growth of residency and fellowship programs.
Gov. (Joe)Lombardo and Fabian Doñate, chairman of the Senate Health and Human Services Committee, have offered nonpartisan support during the current legislative session, but to make a difference and to sustain the impact of GME, we need a greater magnitude and duration of funding.
Increased funding for GME must be a state priority. In addition to our overall shortage of GME positions in Nevada, there are specialty training programs that do not exist in our state. These include ophthalmology, urology, dermatology, nephrology, infectious diseases and pediatric subspecialty training programs. Without these programs in Nevada, trainees interested in them leave our state. And once they leave, they are not likely to return.
In our recent discussions in Carson City, we emphasized that there is a ramp-up period for GME expansion. Starting a new program requires several layers of accreditation and can take as long as three years. As a result, money reserved for GME must be allocated in a way that extends beyond the biennium. To achieve accreditation and ensure that our trainees can complete their three to seven years of training after medical school graduation, we are obligated to prove financial sustainability. Start-up funds alone, while helpful, will not ensure success.
Nevadans deserve excellent care. Our citizens should insist on improved access, timely appointments and the full complement of medical specialists necessary so that they do not have to leave Nevada to get care. State-supported GME expansion is the pathway forward.
Marc J. Kahn, M.D., MBA, is dean of the Kirk Kerkorian School of Medicine and vice president for Health Affairs at UNLV. Paul J. Hauptman, M.D.. is dean of the UNR School of Medicine and chief academic officer for Renown Health