Doctor shortage could leave Las Vegas in critical condition

Dr. Howard Baron, a pediatric gastroenterologist, moved to Las Vegas in the early 1990s. At the time, there was only one other such physician in the state — the doctor whose practice he joined.

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Dr. Robert McBeath, president of Urology Specialists, says the physician shortage can be solved by building a strong medical school, which would be the foundation on which to build local residencies.

It’s not often that a major American city’s residents joke that for the best health care, you need to head to the airport.

But that’s the running quip in Las Vegas — a city in dire need of surgeons, pediatricians and almost every other type of doctor.

There is a shortage of physicians nationally, but Nevada has it worse than most other states, with one of the lowest shares of doctors and nurses in the country.

The local shortfall, dating back years and with no cure anytime soon, causes months-long wait times for appointments, dents the valley’s reputation as a quality place to live and crimps the economy, as many Southern Nevadans head to Southern California and elsewhere for health care.

No other major metro area misses out on as much local, medical-related spending as Las Vegas, said Robert Lang, director of Brookings Mountain West at UNLV, a public-policy research group.

“That took some effort,” he said sarcastically. “That’s not normal.”

The Silver State, as measured by the number of physicians for every 100,000 residents, is severely short on both generalists and specialists, including family practice doctors (46th lowest rate in the country), pediatricians (46th), orthopedic surgeons (51st), ophthalmologists (48th), psychiatric physicians (50th), OB-GYNs (40th) and registered nurses (50th), according to University of Nevada School of Medicine researchers.

Nevada’s highest-ranked fields include anesthesiology (21st in the country) and plastic surgery (27th).

Las Vegas has room to double the number of doctors in “just about any medical specialty on that list,” said John Packham, director of health policy research at the School of Medicine.

Doctors and researchers blame the shortage on several factors, including Las Vegas’ once-booming population, which grew too fast for doctors to keep pace; low levels of government funding for medical education; low payment rates from insurers; the lack of a four-year, M.D.-granting medical school based in Las Vegas; and Las Vegas’ reputation as a gambling and party town with bad schools, which makes it hard to lure doctors here.

One of the biggest problems, however, is the dearth of residency slots, which offer specialized training for medical-school graduates. These positions not only build a pipeline of future doctors, but odds are, those doctors would practice medicine here full time once they’re done. Residents often stay to work, at least initially, where they train.

As it is, most public medical school graduates in Nevada, faced with few options here, head elsewhere for residency programs.

“Once they’ve left the state for their training, they tend not to return,” said Howard Baron, a pediatric gastroenterologist.

When Baron moved to Las Vegas in the early 1990s, there was only one other such physician in the state — the doctor whose practice he joined. Since then, Nevada’s population has more than doubled, but there are just six pediatric gastroenterologists statewide.

His field is far from unique.

“We’re not deep in any of the specialists, really,” he said. “We have barely enough to keep our heads above water.”

• • •

Nevada isn’t alone in its shortage.

The United States, partly because a third of all doctors are expected to retire in the next decade, will need another 130,600 physicians by 2025, according to the Association of American Medical Colleges.

The shortfall comes at an especially bad time, as aging baby boomers will need more health care services in coming years. The U.S. Census Bureau predicts a 36 percent growth in the number of Americans over age 65 in the next decade, the AAMC says.

Unlike most states, Nevada has only one taxpayer-funded medical school, UNR’s, which is based in Reno and trains students in Las Vegas. The school mints about 55 MDs per year.

There also is Touro University Nevada, an osteopathic medical school in Henderson that, like other such schools, focuses in large part on training primary care doctors, nurses and physician assistants. Touro, which opened in 2004 and is privately funded, produces about 135 doctors each year.

Meanwhile, Roseman University of Health Sciences, a private school in Henderson that trains dentists, nurses, pharmacists and others, plans to open an M.D.-granting medical school in Las Vegas in the next few years. School officials have said they would start with 60 students in the inaugural class and eventually grow to about 100.

However, some industry experts say a public medical school at UNLV, the valley’s largest educational hub, would bring research funding and produce doctors who would stick around.

Nevada education officials have pledged to open an M.D.-granting medical school at UNLV. Such an institution would generate $1.2 billion in annual economic activity by 2030, according to a report by research firm Tripp Umbach for UNLV’s Lincy Institute.

Nationally, the average impact by established, university-affiliated medical schools is $1.7 billion a year. UNR’s generates a fraction of that, $285 million, Tripp Umbach said.

According to Lang, Las Vegas is by far the largest region in the country without an M.D.-granting medical school, which tends to produce more specialists than osteopathic programs. Aspiring doctors across the country want to move to Baltimore, for instance, to attend Johns Hopkins University, or Los Angeles for UCLA, he said. The same can’t be said for Las Vegas.

Moreover, a medical school would be the foundation on which to build other graduate medical education programs, including residencies, said Las Vegas urologist Robert McBeath, who noted that Nevada does not have a residency program in his field.

Residencies generally are directed by physician professors who want a strong medical school as the anchor before they sign up to teach, he said.

“That’s the No. 1 solution to the physician shortage,” he said of a medical school.

Touro officials have been lukewarm to cold in their reaction to a possible competitor.

In an op-ed last spring in the Las Vegas Sun, Michael Harter, then-CEO and senior provost of Touro’s western division, and Mitchell Forman, dean of Touro’s College of Osteopathic Medicine, wrote that Nevada is “woefully lacking” in medical residents but the “claim” that another medical school will alleviate Nevada’s doctor shortage “is not true.”

Adding a school, they wrote, “will only exacerbate the problem” by pumping out more graduates who have to leave Nevada for residency programs, and the school would cost “hundreds of millions of dollars.”

“Southern Nevada does indeed already have a medical school,” they wrote.

• • •

If a doctor is looking for specialized training, odds are, he won’t come to Las Vegas.

Across the U.S., there were roughly 37 medical residents and fellows per 100,000 people by the end of 2011, the AAMC says. In Nevada, there were just 10 per 100,000, ranking 46th in the country.

UNR offers only 12 residency and 15 fellowship programs, the latter being for subspecialty training. Residents train in family, internal and emergency medicine; pediatrics; OB-GYN; psychiatry; and general, plastic and ear, nose and throat surgery. Fellows focus on sports medicine, child psychiatry, orthopedic trauma and colon-rectal surgery, among others.

Perhaps because of the dearth of programs, most UNR medical-school graduates leave the state.

Of the 54 graduates this year who are headed for residency, 12 are slated to stay with the university. Most of them will train in Las Vegas.

As the medical school itself noted when announcing the placements, residency training location “is a strong indication” of where doctors eventually settle down to work, and it has “strong implications for the future availability” of physicians in a given area.

Last year, 104 physicians completed residencies or fellowships through UNR, and 31 of them stayed in the state afterward, said Packham, the policy researcher. Almost 40 percent of the people who left did so for more training in other states.

“We’re losing a lot of physicians because more specialized training doesn’t yet exist (here),” Packham said.

Touro notes that it graduates about 135 doctors a year, and of the 29 residents starting at Valley Hospital Medical Center in July, 17 are Touro graduates.

Residencies provide up to seven years of on-the-job training for medical school graduates, and Medicare funds most of the positions, spending $9.5 billion a year for 94,000 residency slots, according to The Wall Street Journal. Medicaid, hospitals and other sources pay for another 10,000 positions.

Congress, however, capped the number of federally funded residency programs in 1997, allotting 26,000 slots for first-year trainees.

• • •

If Las Vegas can’t produce enough homegrown talent, then alleviating the doctor shortage, at least in the near-term, means recruiting from other cities.

But that’s easier said than done.

If a physician can persuade an out-of-town doctor to visit Las Vegas and see the city up-close, they’re a little more willing to move here, said Joey Adashek, a maternal fetal medicine specialist. But for the most part, prospective hires “get nervous” about living in America’s gambling capital.

“They think it’s all about casinos, strippers,” Adashek said.

Baron, the pediatric gastroenterologist, said a lot of doctors who come to interview have concerns about the struggling Clark County School District, and they wonder if they’d be “throwing their kids to the wolves, to some degree.”

Maurice Pockey, a former thoracic surgeon who retired in 2012 after 40 years in practice in Las Vegas and Oshawa, Ontario, dismisses the joke that locals have to leave Las Vegas to find the best health care.

Like any other city, he said, “there’s some (doctors here) who are very good, there’s some who are very bad, and there’s a large volume in the middle part of the bell curve where docs do a reasonable job.”

He said there are about 300 thoracic surgeons in the United States and Canada, and when he moved to town 20 years ago, there was only one other pure thoracic surgeon — someone who exclusively operates on lungs — in Las Vegas.

He doesn’t know of any big cities without such a surgeon, except, perhaps, Las Vegas. There are surgeons in the valley who will operate on a patient’s heart, lungs and veins, but as far as Pockey knows, nobody specializes in lungs alone, as he did.

“There’s nobody here,” he said.