Monday, Jan. 23, 2006 | 8:28 a.m.
With an ever-increasing older population and a large portion of its medical professionals nearing retirement age, the Las Vegas area could be on the verge of a health care crisis.
Between 1990 and 2000 the number of people in Clark County over the age of 55 rose more than 120,000 to 269,927, according to the U.S. Census Bureau.
By 2004, Las Vegas' 65-and-over population -- senior citizens who, collectively, require more medical attention than younger people -- totaled 182,948, census figures show.
The problems attendant to an aging population are magnified by the fact that the average age of Nevada's doctors is among the highest in the nation.
With Nevada's nurses also being two years older than the national average, health professionals fear that a retirement crunch in Las Vegas' medical community could create a shortage of doctors and nurses just as the region's citizens most need quality medical care.
"We are already awfully thin," said Larry Matheis, executive director of the Nevada Medical Association. "If we were to have any additional strain on the system, we could have a major crisis."
Demographics suggest that could come in about the next decade.
An American Medical Association report shows that more than half of the doctors in the state are 50 or older and almost one in three are at least 60. That makes the state exceptionally vulnerable to retirement by physicians, according to the report.
"We are already at or near the bottom nationally in the number of doctors, particularly specialists, statewide," Matheis said. "Just the rate of growth and size of the (Las Vegas) community have made this a critical situation to the point where hospitals are routinely understaffed throughout the valley."
Dr. Suresh Tawney of the Lied Ambulatory Care Center in Las Vegas, noting that many of his local colleagues are nearing retirement age, says something must be done soon to ensure that Las Vegans continue to receive adequate medical care.
"We need more doctors, definitely," the 55-year-old Tawney said. "A lot of the older doctors continue to practice, but the town is growing very fast."
A shortage of doctors would be cause for concern in any community, but Clark County's large concentration of senior citizens makes the figures especially disconcerting.
"Seniors use health services at a significantly greater rate than the rest of the population, so they will be disproportionately affected by a shortage," Matheis said.
One factor that could worsen the impact of that potential shortage is that many seniors currently are not taking full advantage of the health care system.
Julia Romanov, director of social services at the Henderson Senior Center, said many seniors do not realize what services are available to them.
"What frightens me is there are many people in large communities who are behind a closed door and don't have anyone to help them," Romanov said. "They may be sick or diseased and don't know what's available to them."
Tawney said a significant number of his older patients have conditions that have worsened because of a lack of sufficient care.
"Sometimes people won't have transportation to a doctor's appointment, so they can't go," Tawney said. "Or maybe they can't get their prescriptions, so a minor condition becomes a serious problem."
Tawney and Romanov see a need for enhanced outreach and education programs so that more seniors have access to the help they need.
In a bit of cruel irony, however, if a significant number of additional seniors benefit from such programs and begin receiving medical care more routinely, they could be thrown into a system ill-prepared to accommodate them.
The shortage of qualified health care professionals is not limited to physicians.
In a field that is chronically understaffed, the ratio of nurses to patients in Nevada is also well below the national average. Compared to the national average of 825 nurses per every 100,000 population, Nevada has only 604 nurses in that ratio.
With an average age of 49, Nevada's nurses -- one of three of whom is over 56 -- are more than two years older than the national average, according to Lisa Black of the Nevada Nurses Association. Those figures suggest that Las Vegas' nursing profession faces a retirement crisis similar to doctors.
"Only 12 percent of the nurses in Nevada are less than 35 years of age," Black said. "If this trend continues into the next decade, the nurses who are now practicing will be leaving the workforce ... and the drastic shortage of registered nurses in Nevada will continue to impact the health of Nevada citizens at more and more alarming rates."
Area nursing schools recognize the problem, but they are limited by, among other factors, a shortage of qualified instructors. Dr. Caroline Youcha, dean of the UNLV School of Nursing, said she has eight faculty openings.
"It's not like another program, where you can just add 10 more chairs to a room," she explained. "Each eight students need one faculty member."
In time, that could exacerbate the problems posed by the "graying" of the medical field by holding down the number of new nurses available to take the place of retirees.
As to doctors, some suggest an increase in residency programs as a way to replace doctors who are leaving the field. But that idea also has its pitfalls.
A resident is a physician who has finished medical school and an internship and is receiving training in a specialized field, such as surgery.
"A large number of doctors settle in the area where they do residency," Tawney said. "Their families are here and they become established and begin to build a practice, so they stay."
Dr. Mike Hutchins of Craig Primary Care in Las Vegas agrees that residency programs help attract doctors, but said it may not be easy to establish the programs here.
"There are limits to the number of residency programs you can have in a particular field," Hutchins said. "Doctors in residency are cheap labor and a lot of those programs are already established back East."
Tawney believes Las Vegas can justify the need for new residency programs or at least the expansion of existing programs.
"At the rate the town is growing, we can prove that we need them," Tawney said. "The challenge then will be attracting faculty and resident doctors."
The lure of the medical profession, Tawney said, is not what it once was.
"Now a lot of young doctors get into it for the money, but they get burnt out before they even start practicing," Tawney said.
He cited the time commitment and the cost of education as reasons why fewer students are interested in becoming doctors. He estimates a medical student today will owe about $500,000 in student loans by the time he graduates.
Hutchins, 46, acknowledged that the demands of the profession and the availability of other lucrative jobs will make it even more difficult to replace retiring doctors.
"It takes a minimum of 11 years before you can start to make a living," Hutchins said. "This is also probably one of the few jobs where you make less every year because Medicare continues to pay less."
In a worst-case scenario, Hutchins said the combination of more patients and fewer doctors could result in some patients, especially seniors, being deprived of nonessential services.
"People are living longer because of pharmacology, not because they are healthier," Hutchins said. "There could come a time when people who need certain procedures or medicines and can't afford them are just not going to get them."
Matheis hopes it will not come to that, but he knows that as more doctors retire and fewer physicians replace them, the problem will only grow worse. He said it will take a comprehensive plan and a lot of cooperation to solve it.
"We need a permanent fix and that will take some time," Matheis said. "It's going to take a commitment at the community, professional and state level to come up with a solution."
The state has hired a consulting firm to develop a long-term health care plan for Nevada, with an initial report perhaps available by midyear.
The comprehensive plan for which the report could serve as a road map, officials say, will be critical for the health not just of the citizens of Las Vegas, but the region's economy as well.
"It's important to have a health care system that people have confidence in," Matheis said. "If we fail to adequately address these needs, it will also have an adverse effect on our growth and vibrancy."
Sun reporter Cy Ryan contributed to this story.
Mark Hansel can be reached at 259-4085 or at hansel@ lasvegassun.com.
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