Northern Nevada low on specialty doctors

Northern Nevada’s metro areas have enough physicians to serve a growing population, but there are shortages in a few specialties.

The best way to remedy that, say experts, is by adding local residency programs.

“Comparatively speaking, northern Nevada is doing better than southern Nevada, but the stand outs are pediatrics and psychiatry,’ says John Packham, director of Health Policy Research, Office of Statewide Initiatives, the University of Nevada School of Medicine.

The good news, says Packham, is the state ranks extremely high in terms of retaining residents. In other words, persuading physicians to practice medicine here once they finish their training program.

“We rank 9th in terms of retention, which is a really good story,” says Packham, who last year wrote a study for the Governor’s Workforce Investment Board, Health Care and Medical Services Sector Council. “In most workforce metrics we don’t rank very well, but we’ve done a pretty good job of keeping physicians.”

To capitalize on that, and to fill in the specialties gap, the School of Medicine plans to add $5 million to its 2016-2017 budget request to fund new faculty and residencies.

“A lot is riding on the next legislative session,” says Thomas Schwenk, M.D., dean of the University of Nevada School of Medicine, where the budget submitted by the governor’s office is subject to debate and changes before being passed.

The school of medicine and Renown Health are entering into an affiliation agreement, which goes to the Board of Regents next month for approval, to integrate the school’s and the hospital’s pediatric departments. A single pediatric physician will be hired to chair the school’s department and to be chief of pediatrics at Renown.

“A pediatric residency is a tricky issue. We have to recruit some of the sub-specialties before we can apply for a residency program,” says Schwenck. “It may be 2017 before we can start a residency.”

The school and Renown plan to do something similar in neurology, says Schwenk. The hospital already had a department run by John Rothrock, M.D., who will now also become the chair of the school’s recently approved neurology department.

“That may lead to a residency as well,” says Schwenk.

The new departments will also help expand the campus here, says Schwenk, so that fewer students need to finish the second half of their studies in Las Vegas.

The school is also working to create a family residency program with Saint Mary’s Regional Medical Center that will launch in 2016 and be fully funded by the hospital, and is in talks with Carson Tahoe Health about an adding another family medicine residency at the Carson City hospital.

There are currently three residency programs in northern Nevada — in psychiatry, internal medicine and family medicine.

Part of the answer for the mental health piece is a new program at UNR’s Orvis School of Nursing. Starting in the fall of 2015, the school of nursing will admit students for a master’s degree in advanced practice in mental health. The school is now looking to recruit one full-time nurse practitioner certified as a mental health specialist to run the program, says Sandra Talley, visiting professor, who was brought on to create the degree.

“We have six or seven students now who are interested in the program,” says Talley.

Talley says nurses and nurse practitioners are often on the mental health system frontlines and should not be considered a substitute for physicians.

“Initially, 40 years ago when the nurse practitioner movement began, the idea was they’d see less ill people. In mental health, the reverse ends up being true. We see the chronically ill who require more time,” says Talley. “Nursing has that philosophy. We care for people and will take that long journey. We bring something different than doctors and we’re not a replacement.”

For at least one smaller medical group, recruiting physicians to the area has not posed a problem. Sierra Neurosurgery Group in Reno began recruiting for a neurosurgeon in March 2014 and six months later hired Dawn Waters, after receiving plenty of applicants, according to Dyana Selby-Davis, human resources supervisor.

Northern Nevada Medical Center, the 108-bed, 400-physician hospital in Sparks, is part of a national hospital chain, Universal Health Systems and can rely on its parent company’s tools and other resources. Alan Olive, CEO of the Sparks hospital, says they can cast a wide net, recruiting for physicians as well as what he calls important mid-level staff such as nurse practitioners and physician assistants.

Still, Olive is concerned that with expected population growth in the area – the state demographers projects northern Nevada to add about 200,000 people in the next 20 years – will tax the system.

“We need the right primary care specialists so people don’t access the emergency room as their main source of care,” says Olive. “That model is inadequate. And now with Tesla and other companies coming here, it exacerbates the issue.”