Medical Education in Nevada: Progress Made, Long Way to Go

 
Great strides in expanding medical education in Nevada have been made in the past few years. Yet the effects have been minimal so far and won’t kick in until years in the future. In addition, much more work needs to be done, experts said.

“[Medical education] is improved and has a long way to go,” said Shelley Berkley, CEO and senior provost of Touro University’s Western Division.

Where it Stands

The state now has three medical schools with a fourth in the accreditation phase. More graduate medical education, residencies and fellowships, have been added. A new medical school clinic came online, and the existing ones have grown. New education and training programs have been launched or expanded for nurse practitioners, nurse educators, nurses and physician assistants.

In 2015, the most recent year for which data are available, Nevada had 7,429 doctors of medicine and doctors of osteopathic medicine, which is a 31.7 percent increase over that in 2005, University of Nevada, Reno’s June 2018 “Physician Workforce in Nevada” report showed.

“We’re starting to get a little traction, starting to get a little momentum,” said Dr. Thomas Schwenk, dean of the UNR School of Medicine, referring to Nevada. “Now, we have to actually start to grow to get into better supply, better capacity. We’re so far behind in many areas.”

Remaining Unmet Needs

The Silver State needs more physicians in all areas and other healthcare professionals across the board. It ranked in the bottom five states as far as number of physicians per 100,000 people, regardless of specialty. The state needs 2,561 more to reach the national average.

“We just plain don’t have enough doctors that are needed to take care of all the people,” said Dr. Barbara Atkinson, dean of the University of Nevada, Las Vegas School of Medicine.

Graduate medical education (GME) availability, in the form of additional residency and fellowship programs and slots in numerous areas of medicine, is critical to keeping medical students in Nevada after they graduate, Berkley said. Nevada also ranks near the bottom in terms of number of residencies. Statistics show about 70 percent of physicians end up practicing where they do their residency.

“That means that we are graduating a whole lot of future doctors to practice someplace else,” she added. “We have just scratched the surface of what we need in the state.”

Berkley noted that launching such GME programs is costly and takes time, but they’re self-sustaining once up and running.

As for the nurse count in Nevada, the addition of education and training programs and the increases in class size of existing ones have helped but not enough.

“We need more nurses. We need the nurses to be well prepared,” said Doug Turner, dean of the Nevada State College School of Nursing.

Well-prepared nurses today need a bachelor’s degree because Americans’ healthcare demands are more complex than ever and evolving, according to the National Academy of Medicine, a nonprofit organization that offers advice on health and medicine related issues. It has urged nursing schools nationwide to increase their number of bachelor’s degree-trained nurses to 80 percent from 50 percent by 2020.

The State Vision

Nevada’s goals are to provide all of the medical care needed by its citizens and improve their health, said Dr. Mark Penn, founding dean of the Roseman University of Health Sciences College of Medicine.

That will require greater collaboration as well as bolstering patient access and reimbursement rates. In addition, the state will need a better coordinated system, increasing the number of practicing physicians and nurses by expanding graduate medical education and getting better at recruitment and retention of those professionals. Stakeholders will need to do more applicable clinical research and develop infrastructure to add complex services, such as gene therapy and organ transplants.

Here’s a look at some of the schools involved in training medical professionals and their efforts to help meet the state’s healthcare objectives:

University of Nevada, Las Vegas School of Medicine

The University of Nevada, Las Vegas School of Medicine (UNLV SOM), whose second class of 60 students began in late summer, has grown since its launch. The school’s faculty encompasses 143 physicians; the intent is to hire another 25 this year.

Already the school needs more space and is planning a building for clinical education and another for basic science education. Once these new facilities are built, the medical school will pursue doubling the size of its incoming classes.

Today, the school has 11 GME programs in place in partnership with University Medical Center (UMC), Sunrise Hospital and Medical Center and the Veterans Administration, in which 278 residents and 35 fellows are enrolled. Two fellowships, in critical care medicine and pediatric emergency medicine, are slated to begin in July of next year.

“We are starting to really look at what residencies we want to expand,” Dean Atkinson said.

In a year’s time, the medical school’s clinical practice has burgeoned. With 396 practice plan employees, residents and medical students working in them, all of the 17 departments’ clinics are seeing about 500 patients a day, or 10,000 a month. The practice plan is expected to generate $78 million during the next fiscal year.

The medical school is working to obtain its next provisional accreditation from the Liaison Committee on Medical Education in May (full accreditation won’t happen until first-year students are in their final year).

Also in progress is the master affiliation agreement between the medical school and UMC to develop new GME programs together, which now needs approval by the Nevada Board of Regents and the Clark County Commission.

In five years’ time, UNLV SOM should be completely up and running, with class size, GME program and clinic patient totals growing, Atkinson said.

University of Nevada, Reno School of Medicine

Since splitting from Las Vegas, the University of Nevada, Reno School of Medicine (UNR SOM) has been recreating in Northern Nevada the clinical campus it left behind in Southern Nevada. In doing so, it added clinical departments, including surgery and obstetrics/gynecology, and about 300 physicians to its faculty.

It expanded its training opportunities for residents and medical students, in collaboration with Renown Health and the VA. It developed primary care and rural family medicine residency programs, the latter requiring residents to train in Elko for two years. UNR SOM expanded its psychiatry residency and its geriatrics fellowship. It now is in discussions with Renown about launching a residency program in pediatrics and then in three to four years, possibly one in neurology.

“We want to really grow all of those departments so that we can begin to train more students and residents,” Dean Schwenk said.

One goal of the school is to become the second largest primary care medicine practice in town, behind Renown Medical Group. Another is to conduct more clinical, or patient-oriented, research that will help advance medicine.

This summer, the medical school launched its Physician Assistant Studies Program. The first class, of 24 students, is slated to graduate in 2020. Another recent accomplishment was getting full Liaison Committee on Medical Education (LCME) accreditation through 2026.

UNR SOM, which is admitting 70 applicants a year now, is celebrating its 50th anniversary (the official date is March 25, 2019) and having graduated about 2,300 medical students and residents during its half-century in existence.

By the 55th anniversary, Nevadans can expect UNR SOM will have matured its departments along with its clinical programs, residency training, faculty and clinical research, at the least.

Roseman University of Health Sciences College of Medicine

Roseman University of Health Sciences College of Medicine, currently working through the accreditation process, could accept its first class of 64 students in 2020 if it can obtain sufficient financing in time, said Dean Penn. The Henderson university already has longstanding Colleges of Nursing, Pharmacy and Dental Medicine.

This is the administration’s second attempt to get the medical school accredited by the LCME. The outcome of the first was the school’s lack of sufficient funding. It needs roughly $50 to $60 million and today has $12 million. As a private institution, the College of Medicine doesn’t qualify for state funding and, as such, donations continue to be sought.

However, what will help significantly is the revenue generated from the Roseman Medical Group, the medical school’s multi-specialty clinic launched in January. Located near Spring Valley Hospital Medical Center, the office should accommodate seven or eight faculty practitioners. Four already have been hired—two family practice physicians, a pediatric nephrologist and a neurologist—and recruitment continues. These faculty will see patients and teach residents and medical, nursing, pharmacy and dental students.

While fundraising, faculty hiring and curriculum development are taking place, so are other efforts. One is engaging with the local hospital systems to develop residency training programs. For instance, Roseman and the Valley Health System (VHS), are “sharing the hire” of a person who’ll double as VHS’ residency program director and the medical school’s chair of family medicine.

The college continues its pipeline programs that aim to get more students ultimately in healthcare professions and medicine. For instance, its Camp Med summer program gives ninth graders the chance to visit the medical school over a couple of days, listen to various health professionals’ stories and even tackle a patient case.

If all goes as planned, the College of Medicine will be accredited and will have accepted a first, and possibly a second, class by 2023.

“Our mission and our goal are to serve our community,” Penn said.

Touro University Nevada

Touro University Nevada, the private, Henderson-based university is “in a period of extraordinary expansion and growing our programs,” said CEO Berkley. To accommodate the growth, it is building new facilities.

As for its medical school, the College of Osteopathic Medicine, Touro recently expanded class size to 181 from 135 (most recently, 5,100 individuals applied).

With respect to its nursing programs, Touro added a Master of Science in Nursing degree that prepares students to become either a nurse educator or family nurse practitioner. Also, it offers a program where the area hospitals’ nurses with two-year degrees may attend Touro to obtain a four-year degree over 18 months.

“The response to that has been extraordinary,” Berkley said, noting that many hospitals now require incoming nurses to have a bachelor’s degree.

Other expansions at Touro were in the class sizes of its Master of Science in Medical Health Sciences program, to 60 from 30 students, and of its Physician Assistant Studies program, to 80 from 60 students.

By year-end, the university will launch its third mobile healthcare clinic, from which students will provide basic care to residents of Nevada HAND communities. Nevada HAND is a non-profit organization that provides affordable housing solutions and supportive services to low-income individuals.

Touro’s challenges, now and in the future, are ensuring adequate amounts of preceptors to train its third- and fourth-year students and enough GME offerings in Nevada to keep its graduates from having to leave the state to complete a residency.

Over the next five years, Touro plans to grow its programs and start new ones as necessary, add more mobile clinics, investigate and potentially pursue telemedicine and, along with Roseman and the other medical schools, continue to encourage Nevada’s legislators to fund GME.

“Our goal is to ensure that we are graduating the best possible future healthcare providers for the people of the state of Nevada and that we do community outreach and service to help address their needs,” said Berkley.

Nevada State College School of Nursing

Today, Nevada State College School of Nursing is graduating about 270 bachelor degree-prepared nurses per year through its three programs: a full-time Bachelor of Science Degree in Nursing, a part-time B.S. in Nursing and an RN-to-BSN degree for registered nurses.

The online offering, added about a year ago, already has accepted more than 300 students. NSC will keep growing it to meet demand.

“We see that as filling a really critical state need for practicing nurses who are looking to expand their credentials and scope of practice,” School of Nursing Dean Turner said, particularly those in rural areas of Nevada with limited access to medical education.

The RN-to-BSN program differs from others, Turner said, because the curriculum and student experience are built around Dr. Jean Watson’s Caring Science Philosophy, which is a holistic approach to nursing and the mindful delivery of authentic, patient-focused care.

Prior to adding the online offering, the School of Nursing had tripled the class size of its full-time students and doubled the size of its part-time students.

It has maxed out its brick-and-mortar capacity and needs more space, so much so that it had to reject more than half of the qualified applicants for this year. Administrators hope funding for a medical education building will get approved in the governor’s next budget to allow for further nursing program expansion.

The school is considering adding a nursing master’s degree program, perhaps with a nursing education track, and certifications in holistic care and gerontology. It’s also exploring partnerships with Nevada’s community colleges to offer students dual enrollment, in a community college’s associate’s program and NSC’s RN-to-BSN program.

“Our first and foremost goal is to focus on providing the highest quality education we can,” Turner said. “We’re focused on the healthcare of Nevadans being met to the highest possibility we can contribute to that.”

Future Snapshot

In a handful of years, Nevada will have four medical schools and, on the whole, medical and graduate medical education in the state will have expanded further, experts said. Greater coordination will exist between the medical schools and hospitals with GME programs. Collaboration will be enhanced between the state, the Regents and all of the schools involved in medical and healthcare education.

“I just think that it’s going to continue to look brighter and brighter every five years that you look out into the future for all of the state and for healthcare in general,” Penn said.