University of Nevada, Reno School of Medicine Report Addresses Statewide Physician Shortages, Opportunities for Improvement
Nevada 3rd fastest growth in residents and fellows over past decade, still bracing for access challenges
A physician shortage continues to be a problem in Nevada and is hindering patient care access hardest in rural regions, according to a recent report focusing on health care workforce trends in the Silver State.
According to the latest data published in the report, “Physician Workforce in Nevada: A Chartbook – January 2020,” demand for physicians in Nevada continues to exceed the current supply. While the number of licensed physicians in the state has increased over a decade, Nevada ranks 45th for active physicians per 100,000 population, 48th for primary care physicians per 100,000 population and 50th for general surgeons per 100,000 population.
“Health care workforce is a critical component for a healthy Nevada. Updated data, such as this report, will help inform initiatives and policies to address those challenges,” said UNR Med Dean, Thomas L. Schwenk, M.D.
The report is produced by Nevada Health Workforce Research Center based at the University of Nevada, Reno School of Medicine (UNR Med) Office of Statewide Initiatives (OSI). UNR Med’s OSI collects data on Nevada’s statewide physician workforce on an annual basis for a variety of purposes, including predicting population health management and social determinants of health issues in the state.
From 2010 to 2017, the number of actively practicing physicians in Nevada increased by 1,142 or 22%. However, in 16 of 42 specialty areas, including anesthesiology, dermatology, gastroenterology and obstetrics/gynecology, the growth in the number of physicians did not keep pace with population growth.
In addition to gaps in care for certain specialties, the report data points to several obstacles to developing a stronger physician workforce in Nevada.
“A key obstacle is underdeveloped fellowship and subspecialty training opportunities for physicians completing residencies in Nevada. If physicians leave the state for additional training, they don’t necessarily come back,” said the report’s lead author Tabor Griswold, Ph.D., health services research analyst for UNR Med’s Office of Statewide Initiatives. “Another obstacle is that we are surrounded by other western states with equally severe shortages that create strong regional competition for physicians.”
Griswold added that the percent of population increase in Nevada is higher than the percent of physician increase, which contributes to the current access to care gap in the state. “Currently, about one-third of physicians in the state are over 60 years old. These providers are likely to retire in coming years, and there is limited opportunity to replenish the workforce with younger physicians when that time comes.”
According to U.S. Census Bureau population estimates from 2016 to 2017, Nevada is the fourth fastest growing state for people aged 65 and older. The other fastest growing states for 65+ are South Carolina, Hawaii and Delaware.
The report did reveal some marked areas of improvement.
“A key area of improvement is the steady increase in the number of residents and fellows graduating in Nevada, particularly in southern Nevada,” said co-author John Packham, Ph.D., associate dean for UNR Med’s Office of Statewide Initiatives. “Over the past decade, Nevada has had the third fastest growth in the number of residents and fellows. Combined, with our high retention of graduating residents at 54.6%, this will lead to improvements in the physician supply.”
Despite these improvements, OSI researchers say the state must continue to work to reduce the physician shortage issue to promote better patient access to care. Other recommendations for improving the physician shortage in the Silver State include:
- Expanding residency and fellowship programs that will ultimately keep doctors in Nevada. Approximately 27% of UNR Med’s Class of 2019 has remained in Nevada for some part of their residency training, and 43% matched in primary care, which includes family medicine, internal medicine, internal medicine/pediatrics, pediatrics and obstetrics/gynecology.
- Increasing support of pipeline programs and other programs that funnel physicians in-training to practice in rural regions. “The Elko Family Medicine Residency Program is helping increase the number of rural health professionals, but substantial recruiting challenges still exist in rural and underserved areas,” said Packham.
- Continuing telehealth programs like Project ECHO Nevada to expand health care access and treatment to underserved populations throughout Nevada. At 110,000 square miles, it’s not uncommon for Nevada’s 300,000 rural residents to have to drive 300+ miles for specialty care. Project ECHO Nevada is a program that addresses the lack of available specialty care by using teleconferencing technology to connect specialists at UNR Med with primary care clinicians in rural underserved communities in Nevada to provide specialty care to patients who otherwise would have to travel to a larger city or wouldn’t receive it at all.
“UNR Med is committed to increasing the number of physicians in Nevada by educating more medical students, retaining them as residents and ultimately as practicing physicians,” said Schwenk. “The fact that students want to train in Nevada supports our goal of training physicians who recognize health care needs in our community and are committed to staying, or coming back to Nevada.”
Since 1969, UNR Med has trained more than 3,500 physicians, with nearly 40% practicing in Nevada and working to address the access to care gap in the state.