The number of physicians in Nevada is on the rise, but with an ever-growing population the state is still struggling to catch up to national averages, according to a new report from the University of Nevada, Reno’s School of Medicine.

The report, released by the school’s Office of Statewide Initiatives last week, found that the state has added 1,789 physicians over the last decade, a 31.7 percent increase, but because of population growth, the number of physicians per 100,000 Nevadans only grew by about 10 percent. And, when accounting for roughly 50 percent growth in the number of licensed but inactive physicians — meaning those who are retired, semi-retired, temporarily not in practice or otherwise not active — there was actually only a 1.7 percent increase in active physicians over the last decade.

John Packham, associate dean for the Office of Statewide Initiatives, calls it the “treading water effect.”

“There’s so much demand for health care in general so it’s part of a broader workforce problem in that they’re struggling with nurses now, struggling in mental and behavioral health,” Packham said. “You throw on top of that population growth, it makes it very difficult.”

The report relied on the most recent data, from 2015, collected by the American Medical Association and made available through the federal Health Resources and Services Administration to analyze the physician workforce in Nevada.

As of 2015, there were 7,429 licensed physicians in Nevada, or about 257 per 100,000 Nevadans, including 6,688 licensed allopathic doctors, better known as MDs, and 741 osteopathic doctors, also known as DOs. Of those, 5,284 are in Clark, Lyon, Nye and Esmeralda counties; 2,061 are in Washoe County and the surrounding counties, including Carson City, Churchill, Douglas, Humboldt, Lyon, Mineral, Pershing and Storey; and 84 are in Elko, Eureka, Lander and White Pine counties.

Of the licensed physicians 1,257, or 16.9 percent, are inactive. Southern Nevada has by far the highest rate of inactive physicians, with 31.1 inactive physicians per 100,000 compared to 11.2 inactive physicians for the northwestern counties and 0.5 inactive for the northeastern counties.

Packham said he’s not sure why Southern Nevada has the highest rate of inactive physicians but that it may be related to the data set researchers had to work with. He said that he is working on a bill with state Sen. Joe Hardy that would allow the state to collect more specific data on its physician workforce, including whether doctors speak Spanish, if they practice in the county in which they reside, how many hours a week they work and whether they plan to retire in the next three to five years.

“This is probably a function of a dataset that we’re still trying to get our arms around. This is the first time we’ve gone into that much depth with it,” Packham said. “We’re at the mercy of existing data to get best answers.”

Still, this year, Packham and his co-authors drilled down further into the data than they have before to try to paint a better picture of what Nevada’s physician shortage looks like. They took the numbers of various physician specialties here in Nevada and compared them to the national average to come up with the number of physicians Nevada would need in order to catch up.

“Every time I present to a legislative committee or at a conference or something, people will just say, ‘So what does it mean that we’re ranked 46th or 48th?' We tried to come up with a number that would take a per capita rate in Nevada, look at it as compared to the national rate and then just how many more docs would we need for our state to be average,” Packham said. “That’s kind of a good way to illustrate a pretty daunting task of catching up in some specialties.”

Nevada ranks 47th in the nation in terms of physicians per person with 228.2 physicians per 100,000 Nevadans, well below the national average of 373.1 per 100,000. The report determined that Nevada needs 2,561 physicians in order to catch up to the national average, including 289 in general practice, 1,038 in medical specialties, 540 in surgical specialties and 694 in other specialties.

The analysis determined that Nevada is fairly pretty close to the national average in some specialties. In anesthesiology, for instance, Nevada needs about 40 doctors on top of the 400 it already has in order to meet the national average.

But Nevada falls far behind in other specialties. Nevada has 183 psychiatrists but needs another 156 to meet the national average. It has 316 general pediatricians and 117 specialist pediatricians but needs another 240 and 124, respectively, to catch up.

Packham said drilling down to the data at this level will allow researchers to better examine what’s working and what isn’t. For instance, he said Nevada might not be that far behind in terms of its numbers of anesthesiologists because the hospitals are much more active about recruiting from out of state.

“Whatever is working in anesthesiology should inform things like what do we do to improve our residency programs in other areas where we’re losing [doctors],” Packham said.

The issue, Packham said, is a lack of fellowship opportunities. He said that more than half of the physicians who leave the state after they complete a residency program do so because of a lack of fellowship opportunities, which allow doctors to subspecialize, in the state.

The report also examined the average age of the state’s physician workforce, which ranges from 43.3 years old for physicians specializing in family medicine subspecialties at the lower end to 69.2 years old for general practice physicians.

An aging physician workforce is a problem particularly for Nevada’s northeastern counties which, in addition to having an already small population of just 66 licensed, active physicians, is facing the prospect of physicians retiring with no one to replace them. The average age of MDs in those counties is 61.2, compared to the national average of 52.9, while the average age of its DOs is 57.7, compared to the national average of 49.7.

“I wish I had better data, but my well informed hunch is that the workforce is a reflection of the larger population. It’s on average getting older,” Packham said.

But the report also highlighted one of the state’s recent successes. It determined that while the number of family practice physicians has largely stagnated, the numbers of advanced practice registered nurses and physician assistants have grown by leaps and bounds as the state has placed an increased emphasis on supplementing its physicians with advanced practice clinicians. For instance, a law passed during the 2013 legislative session allowed advanced practice nurses to operate independently of a doctor.

Between 2010 and 2015, the number of advanced practice nurses (APRNs) in Elko, Eureka, White Pine and Lander counties increased from 27 to 38.8 per 100,000 residents, while the number of physician assistants jumped from 18 to 23 per 100,000 residents. Counties in Southern Nevada and Northwestern Nevada (defined in the report as Washoe and eight other outlying counties) saw increases in both categories as well.

“I think that’s something that’s an unqualified success story in that we’ve almost numerically tripled the number of APRNs, for example, and more than doubled the per capita rates,” Packham said. “If you look at family medicine and pediatrics, you might see that treading water effect. That’s not the case with APRNs. Were it not for those growth in numbers we would have a primary care crisis. They’re really filling that void.”