Finally, state sees a healthy gain in number of doctors

Friday, June 3, 2005 | 4:32 a.m.

WEEKEND EDITION

June 4-5, 2005

Only three years ago new doctors in Nevada qualified as an endangered species.

The state was in the throes of what physicians called a full-blown medical malpractice insurance crisis in 2002.

High-risk medical specialists such as surgeons and obstetricians/gynecologists were being hit with up to triple-digit increases in insurance rates, driving many annual premiums over the $100,000 mark.

Nevadans were told that the rate hikes forced doctors to close their practices and leave the state in droves. Physicians launched an organization, Keep Our Doctors in Nevada, to push for reform in malpractice litigation. They aired television commercials showing long lines of doctors literally walking out of the state.

But the latest numbers from the Nevada State Board of Medical Examiners tell a different story.

2004 saw the highest gain of licensed Nevada physicians since the board began keeping that statistic in 1987. There were 3,879 licensed Nevada physicians last year, a record gain of 263 from 2003, not counting doctors who died, retired or moved to another state.

By contrast, there were only 70 more doctors in 2003 than in 2002, and only 23 more doctors in 2002 than in 2001.

Clark County accounted for most of the increase last year with a change from 2,366 doctors in 2003 to 2,578 last year.

2004 also had the greatest year-to-year percentage increase in licensed Nevada doctors -- 7.3 percent-- since 1998.

Another positive sign is that the number of newly licensed Nevada doctors has gone up over the past three years, from 209 in 2002 to 302 last year.

Lynnette Krotke, chief of licensing for the state board, cautioned, though, that a licensed doctor does not necessarily mean that he is seeing patients. The state only keeps track of licenses.

Among the Nevada physicians who were newly licensed last year, the most popular specialty was internal medicine at 96. That was followed by pediatrics, 36, and family practice, 29. General surgery with 10 and obstetrics/gynecology with eight barely made the Top 10, although 26 specialty surgeons not listed under general surgery also obtained licenses during that time.

Two newly licensed physicians, Drs. Sanjay Nayyar, a gastroenterologist, and Mitali Goyal, an internist, are a married couple who moved to Las Vegas from Chicago in September with their two children.

Nayyar has already gone into private practice locally but Goyal, who worked in a Chicago hospital for two years, has taken a break from medicine. She intends to resume her practice, possibly with a Las Vegas hospital, within three months.

"We just came here and liked the weather," Goyal said. "Geographically, this reminds us of India, where we came from. There are a lot of openings for doctors here."

While medical experts say the record increase in licensed doctors is certainly good for Nevadans, they also say that the state continues to be underserved by most medical specialties because the health care industry still has not caught up to Nevada's rapid population growth.

"We've increased the number of doctors at a decent rate," said Tony Clark, executive director of the state medical board. "It's good news for Nevadans. But do we have enough doctors to serve the population growth? Probably not."

That sentiment was shared by board President Dr. Stephen Montoya, a Las Vegas OB/GYN.

"We're still pretty short in all areas, even with the increase," Montoya said. "We're short in emergency room doctors, OB/GYNs, orthopedic surgeons and anesthesiologists."

Using national standards there should be at least one OB/GYN for every 10,000 residents, Montoya said. The state has 202 OB/GYNs with active licenses. But with a population of roughly 2.41 million people, Nevada should have at least 241 OB/GYNs, using Montoya's estimate.

Still, Nevada has suddenly gone through a growth spurt in the number of licensed doctors overall, the causes of which are subject to conjecture. These are the leading theories:

Nevada has become a more attractive place for physicians to work because of new limits on the amount of money an injured person can collect from a doctor for pain and suffering through medical malpractice lawsuits.

Nevada medical practices have stepped up recruitment of doctors to keep up with the state's population growth.

There has been a substantial increase in spending on medical facilities in Southern Nevada in recent years.

The state has relaxed laws to make it easier for individuals to obtain medical licenses in Nevada.

Medical malpractice

Dr. John Nowins, an OB/GYN and immediate past president of the Clark County OB/ GYN Society, would like to think that the increase in licensed doctors has been caused largely by Nevada's medical malpractice reforms.

The Nevada Legislature sought to solve complaints from physicians about rising malpractice insurance rates by passing a law in 2002 that capped pain and suffering damages for each case at $350,000 per plaintiff and per defendant. That law granted exceptions to the cap for gross negligence or a court finding of "exceptional circumstances."

But Nowins and other doctors complained that the law did nothing to stem the increase in insurance rates. That's what led to the successful Keep Our Doctors in Nevada ballot initiative that was passed by voters in November. The new law restricts pain and suffering damages for each case to $350,000 with no exceptions and regardless of the number of plaintiffs and defendants involved.

"Overwhelmingly, it has to do with what happened in November," Nowins said of the increase in licensed Nevada doctors. "There was a time when physicians were leaving. Now they're coming back. Physicians want to live in a state with a stable tort reform system. They don't like to be in a state where they fear the practice of medicine."

Most of the doctors who obtained their medical licenses in Nevada in 2004 did so before the November election. That makes it difficult to measure the effect Nevada's latest medical malpractice reform had in attracting doctors to this state.

In addition, a Dartmouth College study released last week found that the increases in malpractice insurance have been more likely caused by insurers wanting to recoup failed investments, as plaintiffs' attorneys have argued, than by large jury awards and settlements from malpractice lawsuits, as doctors have claimed.

But Nowins' opinion is backed by two other studies published in separate medical journals last week that found that states with malpractice damage caps have had greater increases in physicians than states without caps.

One study by the federal Agency for Healthcare Research and Quality, covering 1970 through 2000, found that states, within three years after enacting caps, had five more doctors per 100,000 residents than states without caps. Stanford University researchers found separately that there was a nationwide increase in physicians from 1985 through 2001 but that the increase was 3 percent greater in states with caps.

Insurance rates have since stabilized for most of the high-risk specialties, though they remain much higher than they were three years ago. Nowins is paying $81,644 this year, far more than the $25,800 he paid in 2001 and the $36,200 he paid in 2002.

And there is still a chance that the new law could be challenged before the Nevada Supreme Court, which doctors fear could mean another round of insurance rate hikes.

Insurers have said they won't lower rates substantially until they are certain the new law will withstand constitutional muster. Goyal said she and her husband are willing to give Nevada a chance.

"It's not easy to relocate and then decide to move back," she said. "We are concerned about the high insurance rates but we were relieved by the election results in November."

Population growth

Dr. Anthony Shaya, an OB/GYN who received his state medical license last year, was lured to Nevada after a health care "head hunter" obtained his resume. It included about a year of substituting for other doctors in Louisiana hospitals.

"I was looking to set up shop somewhere," Shaya said. "I like Las Vegas because it is a growing area and because the economy is growing."

Shaya said he saw opportunities for relatively new physicians such as himself. He now works for Women's Wellness of Nevada in Henderson and Las Vegas.

"Because doctors have left Nevada it's a good place for other people who are staring out," Shaya said. "It seems that Las Vegas affords a lot of opportunities."

Given Southern Nevada's population growth, Clark said it should not be surprising that "more doctors are coming in and seeking licenses."

While the population growth has been fueled by a strong local economy, and doctors have been encouraged by medical malpractice reforms, one of the leaders of the reform movement, Dr. Rudy Manthei, said physicians still face stiff financial hurdles.

Manthei, a Henderson ophthalmologist, said those hurdles include medical reimbursement rates from managed care organizations that remain considerably below the rates of other states.

"Our cost of living has really gone up while reimbursement to Nevada physicians has been going down," Manthei said.

To recruit even more physicians to Nevada -- including advertising with medical schools that train specialists -- the pitch is not necessarily an economic one, Manthei said.

"It is luring doctors who have trained in northern states to come here because of our weather," he said. "The weather is the key."

Expanding facilities

Another possible explanation for the increase in physician licenses has to do with spending on medical facilities in Southern Nevada, according to Jeremy Aguero, the principal economic analyst of Applied Analysis in Las Vegas.

Aquero said that Southern Nevadans are beginning to see the operation of medical facilities that were planned in 2002. He expects the current pace of expansion of medical facilities to last at least through 2006.

"It has a lot to do with an improved economy," Aguero said. "There has been substantial medical investment in the area. There are a lot of new hospitals and post-acute care facilities coming in. One out of five people moving to Nevada are retirees, and people over 65 spend four times as much on health care as people under 65."

Aguero's company found that Southern Nevada had 3,148 licensed hospital beds last year, 299 more than in 2003. Spring Valley Hospital Medical Center opened in October 2003 at 5400 S. Rainbow Blvd.; Southern Hills Hospital and Medical Center opened in March 2004 at 9300 W. Sunset Road; and the St. Rose Dominican Hospitals-San Martin Campus in the southwest valley is scheduled to open next year.

The Nevada Cancer Institute also plans to open its 140,000-square-foot outpatient research clinic in Summerlin this summer.

"All of this has made Southern Nevada very attractive for doctors," Aguero said. "We have a supply-demand imbalance in terms of health care because we have fewer doctors and nurses (per capita) than just about anywhere in the country."

Relaxed licensing

Another factor that Larry Matheis, executive director of the Nevada State Medical Association, cited was a law passed by the Legislature in 2003 that makes it easier for doctors from other states to obtain Nevada medical licenses.

One aspect of the law allows licensing requirements to be relaxed by the governor in cases where there are "critically unmet needs" for certain specialties.

The law also allows the state medical board to issue licenses to physicians from other states who do not meet some of the standards required of Nevada doctors, such as three years of postgraduate work following medical school.

"We have had a lot of applicants from other states apply for licenses simply because they could," Matheis said. "They didn't have to face the previous requirements."

archive