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July 24, 2014

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Shiny, new VA hospital suffers from longtime Nevada malady: doctor shortages

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Steve Marcus

Dr. Aimee Fleury confers with Dr. Nick Spirtos, medical director of the Women’s Cancer Center of Nevada, at the center Thursday, Sept. 6, 2012. Fleury, a gynecologic oncologist, joined the center this August.

VA Medical Center North Las Vegas

The new VA Medical Center in North Las Vegas seen on Friday, August 3, 2012. Launch slideshow »

Dr. Aimee Fleury

Dr. Aimee Fleury poses in an exam room at the Women's Cancer Center of Nevada, 3131 La Canada Street, Thursday, Sept. 6, 2012. Fleury, a gynecologic oncologist, joined the center this August. Launch slideshow »

When the Veterans Affairs Medical Center opened last month in North Las Vegas, it was hailed by local and national leaders as a major step forward for delivering healthcare in the valley.

The $600 million, 1-million-square-foot building, which is stocked with state-of-the-art technology and provides a centralized location for a variety of specialized clinics, is expected to improve the quality of care for veterans and will allow the VA to increase the number of Southern Nevada patients it serves by a third to 60,000.

The only problem: There aren’t enough doctors on staff to handle the influx of new patients.

A doctor shortage has long been plagued Nevada, which consistently ranks near the bottom nationally in doctor-to-patient ratios. In 2011, the most recent figures available, Nevada had 171 physicians for every 100,000 of its residents.

With affordable housing, good weather and a medical industry that’s easier to break into than in older, more-established cities, Las Vegas is an attractive option for many doctors.

But a lack of residency and fellowship programs – especially in specialty areas like gastroenterology and head and neck surgery – makes it difficult to train enough doctors in state to meet the demand, forcing hospitals to look out-of-state when recruiting physicians.

At the VA Medical Center, administrators have been on a furious hiring spree, adding 45 physicians to its current staff of 100, drawing from its internal network of medical centers across the country while also recruiting doctors from out of state and from other local clinics. The center still needs to add about 15 physicians to reach full capacity, and administrators are confident they will reach their mark.

“The first selling point is the hospital itself. This idea of a magnificent, brand-new medical center attracts people,” said Dr. Ramu Komanduri, the VA Medical Center of Southern Nevada’s chief of staff. “Often (doctors) have a perception that Vegas is one type of town where you go for entertainment, that’s it’s not the kind of place you settle down. But we have good parks, the school system. We try to highlight some of those aspects and paint a realistic picture. Once they hear about the things they don’t see in the media, they’re more willing to consider relocation to this area.”

The Nevada State Board of Medical Examiners reports there were 3,027 licensed physicians in Clark County in 2011, an increase of 21 physicians from the previous year.

With the Affordable Care Act expected to bring insurance to millions of people and large-scale healthcare projects like Union Village looming on the horizon, the need for more doctors in Nevada will only increase.

“Nevada has the lowest ratio of providers to patients in the country. There’s plenty of room for growth. The key thing is to ensure that where we grow fills a need,” said Brian Brannman, CEO of University Medical Center. “We have a huge need in the community for primary care, for hepatologists. We need to fill in some of those gaps.”

Addressing that shortage will mean expanding residency and fellowship opportunities within the state, and finding better ways to organize doctors that are already here to deliver the most efficient care, medical leaders say.

“We are a microcosm for a much larger issue. The single limiting factor for growing the physician pipeline everywhere in response to healthcare reform and state needs is residency and fellowship positions,” said Thomas Schwenk, dean of the University of Nevada Medical School. “Those are funded and capped by Medicare, with limitations to how many a hospital can have. … The biggest issue is how do we restructure the funding. Who would put more in? Should it be the states? Should it be private insurance?”

Schwenk said enrollment was up at the University of Nevada Medical School and at medical schools around the country. He estimated that 300 physicians in Las Vegas were graduates of the state’s medical school – about 10 percent of its total alumni – but with limited fellowship and residency options in state, many doctors have to look elsewhere to get the training they need.

“We’re not really changing the number of physicians and the types of physician positions available,” Schwenk said.

The medical school recently received approval for 71 new residency slots in primary care and general surgery – 50 of them at University Medical Center – two areas with the most pressing needs, Schwenk said. But more positions in a range of specialties are needed.

Statistics show doctors are more likely to stay in the area where they completed their residencies and fellowships, Brannman said, and doctors leaving Nevada for further training might not return to practice medicine here.

Dr. Aimee Fleury was one of those who left the state. A Montana native, Fleury graduated from University of Nevada Medical School in 2005, before moving to the East Coast for a fellowship at Johns Hopkins University.

But Fleury returned earlier this summer to Las Vegas to complete her residency. She took a job at the Women’s Cancer Center of Nevada, where she specializes in gynecological oncology.

“Having worked here before with the Women’s Cancer Center, it was pretty much always in the plan to come back. It’s really a world-class practice,” she said. “It was an attractive place to come work, but also a city I find very easy to live in.”

Doctors choose where to open their practices for a variety of personal and professional reasons, Fleury said.

Las Vegas offers many “a climate of opportunity to build your practice,” she said, because of the lower number of doctors.

The valley’s ability to recruit doctors relies foremost on the area’s ability to offer a quality work environment and modern facilities, Brannman said.

“You want to establish a competitive salary range … you want to provide an attractive environment with a broad mix of physicians,” he said. “Doctors want top-notch peers, clinically challenging patients.”

Solving the state’s doctor shortage will require building an attractive medical industry for out-of -state doctors while improving education opportunities inside the state, he said.

“The next step is to develop an advanced level of training where we’re getting the cardiologists, the gastroenterologists that we need in the community, that will grow here and stay here.”

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  1. Few doctors of any quality are currently in the LV VA system. Good, conscientious doctors will be drawn to a location where their children cannot be educated. NV is #50 in education and LV is at the bottom of that barrel. I have no ties to the education system. No relatives as administration, teaching or as students. As a disable veteran I just want some decent health care. A fancy new building doesn't treat patients.

  2. Coupe_deville: Anyone can use the VA healthcare system if they have served in the US Armed Forces (it helps to have been injured while in serving). You will then be provided a priority (from 1 to 8) to determine if you will be seen by the system.

    Then you can wait 90 days for an appointment to see your ASSIGNED (they pick your doctor, not you) primary care provider. If you wish to see a speciality care clinic (dermatology, cardiology, etc.), then you have to get a referral to see them from your provider. Then wait 30-60 days to get the appointment to see them.

    When I was waiting to be moved from the Henderson Clinic to the Northwest Clinic, it took 8 months due to the shortage of doctors. I was told that each doctor had about 1,500 vets while the standard is about 850 to 1. This is a primary cause of the long lead times to be seen for care.

  3. Seems Retired Army Pettyjohn isn't happy with his Doctor...then change it...you have that right,you obviously know how the system works right down to the priority groups.There's a thing called standard of patient care which will limit the number of patients any one doctor will see before they close off his "new" patient load. Doubling a doctor patient load isn't exactly good for you or the doctor and doesn't give you the care or time that should be devoted to you. Then on the other hand I'm sure Pettyjohn is aware of the patient advocate and how that works.Opening a new and I might say....first of its kind VA Hospital here in Nevada is no easy matter. Background checks on doctors from the VA are thorough if nothing else.Someone here mentioned the Nevada school system.Recruiting a family who has to use it would be a issue for many. Straight salary,no malpractice insurance to pay would be a plus.Thought the locality pay I would assume would be low for here since it's based on cost of living index here in Nevada. They just opened their doors...give them some time to settle in and work out the kinks.

  4. Babyboomer - Actually I like my doctor.