Medical education in southern Nevada has had a rocky road to fruition, enduring several evolutions to get to where it is today. On seemingly the rockiest path of Nevada’s schools offering medical doctorates, which include Touro University, Roseman University and the UNR School of Medicine, is the Kirk Kerkorian School of Medicine which graduated its first class in 2021.
Former U.S. Congressman James Bilbray, who represented Nevada’s 1st congressional district from 1987 to 1995, recalled that, during his time as a Nevada System of Higher Education (NSHE) regent in the 1960s, there were sometimes acrimonious – “it got hot”– debates among public officials. The hot button issue at the time was whether the state’s medical school should be located in Reno or Las Vegas.
“Even then I saw the way southern Nevada was growing (it was nearly double Reno’s metro population in 1969). [That] meant a med[ical] school should be located in Las Vegas,” said Bilbray, who died at age 83 in 2021, a year before the October grand opening of the Medical Education Building (MEB), the first permanent structure on the Kirk Kerkorian School of Medicine at UNLV campus.
Bilbray said he stayed in touch with state officials who, like him, found it difficult to stomach the fact Las Vegas was the only metroplex of more than 2 million people in America that didn’t have a four-year public allopathic medical school, which not only trains physicians but also raises the quality of care through research and continuing education. He said he thought the votes for locating a school in Las Vegas were there nearly 60 years ago, but “hardball politics” and the promise of a sizable donation from a foundation, turned the tide in favor of a school in Reno, which opened in 1969.
Reno – its medical school ran a small clinical operation training its doctors in southern Nevada for many years – now has a metro population of 520,000.
“The fight for a [state] medical school in Las Vegas obviously went on for a long time – the board of regents had even passed a rule in 2005 prohibiting UNLV from opening a medical school until 2025 that regents later repealed,” said Bilbray, adding he was happy state officials “came to their senses” in allowing a state medical school to open in Las Vegas. He also said he hoped the school, which has graduated two classes since opening in temporary quarters in 2017, would create improved access to healthcare in a state that has ranked nationally near the bottom for physicians per capita in both primary and specialty care as the state’s growth exploded.
Developing Healthcare in Nevada
How Las Vegas, which grew from a metropolitan area of around 220,000 in 1969 to nearly 3 million by 2017, ended up with a medical school and its first permanent building with two more on the way, won’t be found in a “how-to” manual.
“It definitely wasn’t easy, “ said Maureen Schafer, president and chief executive officer of Nevada Health and Bioscience Corporation (NHBC).
The culmination of a public-private partnership, the medical building was made possible, by $120 million in philanthropic donations from Kerkorian’s charitable Lincy Foundation, the Engelstad Foundation, MaryKaye Cashman, the Boyd Family Foundation and Bank of America – and by $25 million in state funds.
Fed up with a Legislature that did not address medical issues in southern Nevada, former Las Vegas Mayor Oscar Goodman – dealing with the explosive growth that saw people complaining about six-month waits for medical appointments – spent the early part of the 21st century trying to bring satellite medical centers from the Cleveland Clinic and the University of Pittsburgh Medical Center to Las Vegas. While he was unsuccessful, the daily news reports on the mayor’s attempts to improve access to healthcare got the attention of physicians and community leaders who did not like the idea of outsiders taking healthcare dollars out of town.
Las Vegas ophthalmologist Dr. Mark Doubrava, a 1985 UNLV graduate who became chairman of the Board of Regents as well as a leader on a community advisory board for the school, was one of the voices arguing for the homegrown solution of a new medical school. Studies, particularly one completed in 2013 by the Tripp Umbach consulting firm, ultimately convinced the state Legislature to green-light a new medical school at UNLV.
“It made a big impact,” Doubrava said. The study found people would be less apt to leave Las Vegas for medical care and the school would have a $1.2 billion annual economic impact, adding 8,000 jobs to the southern Nevada economy by 2030. In 2015, Gov. Brian Sandoval signed a bill providing startup funding that saw the school, under the leadership of Founding Dean Barbara Atkinson, open with 60 students in 2017 in temporary facilities on UNLV’s Shadow Lane campus.
Though donors were ready to move forward on the medical school’s first permanent building, they felt stymied by NSHE. Three attempts to begin construction on a permanent campus fell apart amid tensions between UNLV donors and NSHE. Kris Engelstad McGarry, a trustee of the Engelstad Foundation, said donors were told, without credible explanation, their ideas wouldn’t work. According to Schafer, what finally made the project gain traction was advice from Robert Lang, PhD.
Lang, who died last year, had held the Endowed Chair in Urban Affairs at UNLV and served as executive director of both the public policy think tank, The Lincy Institute, and Brookings Mountain West, a partnership between UNLV and the Brookings Institution, a Washington, D.C.-based research organization. He suggested to donors that, through the creation of a nonprofit development corporation, which had been done elsewhere in the United States to overcome stifling academic bureaucracy, the project could move forward. He was right and the Nevada Health and Bioscience Corporation was born.
Donors to UNLV committed millions to build the medical school. With Schafer installed as NHBC’s chief executive officer, the funding arrangement set up by the development corporation would manage how the philanthropic dollars were spent – and it was approved by NSHE. In addition to managing the funding element, NHBC will also oversee the construction of the lab and ambulatory clinic. In addition to NHBC as a donor, school officials are identifying other government sources and donors to complete the buildings needed to round out the school by 2026.
Photo courtesy of Josh Hawkins/UNLV
The School Today
Less than two years after the groundbreaking for the five-story, 135,000-square-foot Kirk Kerkorian MEB, its completion was celebrated with fireworks set off in the Las Vegas Medical District that were seen in the night sky for miles.
The school is named for Kirk Kerkorian, the late founder of MGM Resorts International who, no doubt, would have appreciated the thoughtful design of the new building. Flexibility is a key feature of the structure. While the school now admits 60 students each year, the building is designed to handle a new class of 120 annually.
Visitors to the building pass through gardens before entering on the second floor. There, a multi-story space will act as a gathering place, as well as a space for lectures and TED-style talks. Common to levels three and four is a learning resource center operated by UNLV libraries, group study rooms, and flexible classrooms that open to each other. Level four also houses the student lounge and fitness center. Administration offices are found on the fifth floor.
The first level of the building houses critical training functions that include 15 typical patient rooms allowing mock examinations using trained patient actors. Rooms equipped with microphones and cameras monitor the interaction between students and actors. Evaluations and debriefing of students by faculty will be carried out in adjacent conference rooms that are shared with a simulation suite, where students can practice on mannequins that breathe, cry, sweat, and respond to medications.
Nearby is a simulated operating room with appropriate surgical equipment and virtual anatomy classrooms allowing students to explore cellular structure, anatomy, and physiology. A prosection lab, with space for eight cadavers, offers students a tactile anatomical experience.
Dr. Barbara Atkinson, the planning and founding dean of the medical school and the only woman to head three medical schools in the United States, played a large role in the building’s design. She says the super-floor, which will also be used by licensed professionals to maintain certifications, is unique in medical education. “Having many program elements on a single floor in close proximity to one another encourages human interaction through circulation patterns, free of the formality found in large lecture halls that can stifle learning give and take.”
High Hopes for the Future
Dr. Marc Kahn, the current medical school dean, was one of the hundreds on hand for the building’s grand opening. He was ecstatic, envisioning better days ahead for healthcare in Las Vegas, when a planned academic health center – a network of medical and research facilities staffed by caring healthcare professionals working together to provide the best evidence-based care for patients – is a reality.
“The NHBC gift is a gift that will keep on giving by training new generations of physicians to serve the needs of the ever-growing Las Vegas Valley,” he said, predicting “the gift should be a catalyst for attracting new biomedical and pharmaceutical companies to our community and the Las Vegas Medical District (LVMD), another step in helping our region diversify its economy.”
In August, Kahn learned expansion was already on the way for the new medical school which will anchor the medical district. Gov. Steve Sisolak and the state interim finance committee awarded the medical school $40 million for an ambulatory care clinic and $30 million for a pathology lab at the school, seed money for the buildings that will cost far more.
He said the clinic will “help change the paradigm of care” in southern Nevada, providing coordinated care to patients all in one place, including mental and behavioral health. There will be operating rooms for outpatient surgery, and offices for mental health patients to see specialists. The ambulatory clinic is slated to be built on the same 9-acre parcel of land as the MEB.
“The lab will allow us to turn around test results faster, as well as provide valuable training opportunities for young doctors performing original research,” Kahn said.
That more building activity is on the way to the medical district is music to the ears of Ward 1 Las Vegas City Councilman Brian Knudsen, who has been working for years to grow the district, which already has a major medical presence, including University Medical Center (UMC), Cleveland Clinic Lou Ruvo Center for Brain Health, Valley Hospital Medical Center, Grant-A-Gift Autism Foundation Ackerman Center, Horizon Specialty Hospital, Desert Radiology, Steinberg Diagnostic Medical Imaging, and the Milan Institute.
Knudsen says the district has nearly $400 million worth of projects currently underway, including building renovations, future apartment development, the construction of a medical building and hotel, and the completion of a memory care senior housing community.
“We will have a safer, walkable, living community for both healthcare workers and visitors,” said Knudsen, noting that $130 million in infrastructure work that includes widening sidewalks, planting mature trees, and designing open space and areas for retail centers is also underway.
According to Tripp Umbach, a consulting firm, the medical district will have an economic impact of $3.6 billion by 2030, including the generation of more than 24,000 jobs.
Residency
Helping to grow the number of physicians in physician-short Nevada is obviously a critical part of the medical school’s mission. In an effort to bolster the number of students who stay in the state to practice, the Kirk Kerkorian School of Medicine primarily only admits students from Nevada or who have family ties to the state.
What many people don’t realize, however, is that after four years of medical school, graduates must complete at least three more years of graduate medical education (GME) called residency in their chosen specialties before they can practice. To further specialize, they must complete a fellowship that lasts an additional one to three years. Studies show that a majority of young doctors stay where they complete residencies or fellowships. According to researcher John Packham of the University of Nevada, Reno School of Medicine, more than 70 percent who have completed both medical school and graduate medical education in Nevada remain in the Silver State.
Unfortunately, Nevada is woefully under-resourced from a residency-fellowship perspective. Funded in large part by the Centers for Medicare & Medicaid Services (CMS), the number of residencies and fellowships in a state was capped in 1997 by the federal Balanced Budget Act.
“Nevada, and particularly southern Nevada, was a very different place back then,” Kahn said. “Our population has increased 15 percent over the past decade. As a result, Nevada ranks at the bottom of funded residency and fellowship positions as compared to New York, which has 25 times the number of funded slots per 100,000 population.”
Too often, Kahn said, students from Nevada have no choice but to leave the state for GME. In the class of 2021, the medical school’s charter class, 36 percent were able to stay in Nevada for training. In the class of 2022, the percentage was 41 percent.
Kahn says CMS has provided funding for 1,000 additional positions across the country and the medical school has applied for new positions. “Our state has announced pilot funding for new residency positions funded outside of CMS, and we are in the process of applying for those.”
There is no question, the dean says, that political and community leaders must continue to advocate for increased federal and state support to serve the medical needs of Nevada. He noted that, despite being in the Sunbelt, Nevada has no residencies in dermatology, and despite the state’s aging population, there are no fellowships in medical areas that include hematology/medical oncology, ophthalmology, or urology.
“In a physician shortage state like Nevada,“ Kahn said, “keeping doctors in state is imperative.”
