Column: ObamaCare doctor shortage coming, especially to rural Nevada

While America, as a result of a number of factors, is about to get slapped with a serious shortage of doctors, rural Nevada may be in for a train wreck. By 2020 the nation will have 90,000 too few physicians, according to the Association of American Medical Colleges. AAMC predicts the doctor shortfall will affect everyone, but will especially impact those who live in areas designated as health professional shortage areas, as reported in this week’s newspaper column, available online at the Elko Daily Free Press and eventually at The Ely Times, when they get their Internet server back up.

Gary Varvel cartoon, July8

According to the University of Nevada School of Medicine, 66.9 percent of Nevada’s rural population already live in a designated Primary Care Health Professional Shortage Area. While there are 182.2 physicians per 100,000 residents in urban areas of Nevada, there are only 76.5 physicians per 100,000 in rural areas — for a statewide ratio that is 48th worst in the nation. Just in time to twist the scalpel in the wound, along comes the Patient Protection and Affordable Care Act, which seeks to provide health insurance to an estimated 30 million Americans. More insured patients. No more doctors. At a recent meeting of the Nevada Republican Men’s Club, I asked Nevada Rep. Joe Heck, himself a former emergency room physician, about the impending doctor shortage. “This bill (ObamaCare) has done nothing to increase access to health care. All it has tried to do is increase access to health insurance. Having insurance does not equate to having health care …” he said. “So what is going to happen is you’re going to get a big influx of people who now have insurance. They’re going to call a doctor and ask for an appointment. And they’re going to be told, ‘We can see you in three to six months.’ And they’re going to say, ‘Wait a minute, I don’t want to wait three to six months. I’ve got insurance now. Hmm, let me go to the emergency department.’” Emergency rooms are already overcrowded, Heck noted. One small glimmer of hope for Nevadans is that the state Legislature passed and Gov. Sandoval signed a bill that as of July 1 allows certain qualified nurse practitioners to practice independently of a doctor. The journal Health Affairs noted “nurse practitioners could fill the growing primary care shortage more quickly than could physicians, since it takes nurses on average 6 years to complete their education and training, including undergraduate and graduate degrees, compared to an average of 11 to 12 years for physicians, including schooling and residency training.”

Dr. Scott W. Lamprecht, president of the Nevada Nurses Association, says the difference is not all that great and will be less so in a couple of years when requirements entry level nurse practitioners are made even more stringent.

Lamprecht explains that currently a nurse practitioner must complete a bachelor’s degree in nursing, which takes four to five years including prerequisites, then a master’s degree in nursing is approximately two years, with an additional one to two years to complete the post-master’s Nurse Practitioner Certificate. This is approximately seven to eight years by the current standards. In 2015, Lamprecht says the entry level nurse practitioner will have to complete a Doctorate in Nursing Practice (DNP) which is approximately an additional two to three years, which raises the overall requirement to eleven to twelve years. Additionally, Board exams are required for both registered nurses and nurse practitioners. “The education content for nurse practitioners is different from that of physicians, but the professional expectations for taking care of patients are the same,” he said. “Nurse practitioners care for patients, manage diseases, perform screenings, order diagnostic tests, write prescriptions, and promote wellness using a holistic philosophy. The goal for all providers should be to provide access to high quality patient care for everyone including rural and urban areas.”

See you in the doctor’s waiting room. Read the entire column at the Elko site and eventually at Ely‘s.

20 comments on “Column: ObamaCare doctor shortage coming, especially to rural Nevada

  1. Rincon says:

    I’ve always wondered why there aren’t more medical schools in this country. The law of supply and demand suggests that we should have more. We’ve had a doctor shortage since I’ve been a teenager and we’ve been importing doctors for just as long, but our medical schools turn away large numbers of applicants. Instead of training enough of our own citizens, we turn them away in favor of immigrant MD’s

  2. Many of the immigrant docs are trained here.

  3. nyp says:

    Let’s see now. A study of doctor supply ranks Nevada as currently next to last in the nation — and you blame that on ObamaCare.

  4. Steve says:

    So,Nyp, ACA will fix it?

  5. No, ObamaCare will make it worse.

  6. Milty says:

    Just a small part of the price to be paid for the gift of a healthcare plan we are forced to purchase, and fined if we don’t, which purportedly covers at least ten million more people, without adding a single new doctor, but provides for 16,000 new IRS agents, written by a committee whose chairman says he doesn’t understand it, passed by a congress that didn’t read it, but exempted themselves from it, and signed by a president who smokes, with funding administered by a treasury chief who didn’t pay his taxes, for which we will be taxed for four years before any benefits take effect, by a government which has already bankrupted Social Security and Medicare, all to be overseen by a surgeon general who is obese, and financed by a country that’s broke.

  7. nyp says:

    Milty – been there, done that.

    Mr. Mitchell: You really seem upset at the fact that more American families will be able to afford to see a doctor when they get sick. So upset that you are willing to forget the laws of supply and demand. Not to mention the considerable resources expended pursuant to the ACA to training new healthcare providers, allocating them to underserved areas such as rural Nevada, encouraging use of primary care physicians, encouraging greater provider productivity, etc.

    I understand that you believe that not a single one of those programs will have any positive affect on the supply of healthcare providers in underserved areas. But why do you think they are so irrelevant that you would not even mention them to your readers?

    By the way, there is considerable evidence that the overall projections of a physician shortage (projections generated by self-interested medical colleges) are specious. But I’m not qualified to make a definitive judgment on that one.

  8. Milty says:

    “But I’m not qualified to make a definitive judgment on that one.”

    Since when has a lack of qualification caused Nyp to refrain from making a judgment on something?

  9. nyp says:

    Now, I suppose.

  10. Milty says:

    “Now, I suppose.”

    It’s good to see you’re maturing, Nyp. Lack of qualification never stopped you so many countless times before “now.”

  11. ObamaCare distorts the supply and demand of the free market. The central planners always screw things up.

  12. Steve says:

    “Not to mention the considerable resources expended pursuant to the ACA to training new healthcare providers, allocating them to underserved areas such as rural Nevada, encouraging use of primary care physicians, encouraging greater provider productivity, etc.”

    Appears to me Nyp answered my question. He seems to be saying an “unqualified” yes.

  13. Milty says:

    “I’ve always wondered why there aren’t more medical schools in this country. The law of supply and demand suggests that we should have more.”

    Part of the reason may be start up costs. On a June 24 post on his blog, Jim Rogers (former chancellor of higher education in Nevada) discussed the costs associated with establishing a separate medical school in Nevada at UNLV. In this post, Mr. Rogers said that the start up cost to establish the Dell Medical School at the University of Texas at Austin will be $360 million for a class of 50 students who won’t even begin their studies until 2016. Given UNLV’s current total annual budget of $500 million, it’s a pretty huge amount of money to get a new medical school up and running.

  14. Rincon says:

    To earn 10%/year on a $360 million school, not counting operating expenses, comes to $72,000/year per student. Sounds like medical education is just too expensive and inefficient in this country, just like the whole medical system.

  15. Rincon says:

    I’m forgetting. There would be 4 classes of 50 students apiece, which comes to $18,000/student. That’s more realistic as total tuition, but operating expenses are likely to be far more than just the cost of the facility. I still think it’s unrealistically expensive.

  16. Milty says:

    “Sounds like medical education is just too expensive and inefficient in this country, just like the whole medical system.”

    Or maybe just like the whole college tuition system?

  17. Rincon says:

    Good point Milty! The inefficiency of the entire educational system is apalling.

  18. Steve says:

    One person’s “inefficiency” is another’s windfall. Welcome to the world of ACA.

  19. bc says:

    Rather than build a new school in LV, add to the school in Reno, if the demand is there. The clinical rotations (the second two years of Med school) is done largely in Vegas anyway. For those who wonder/worry about “foreign doctors”, as Thomas says many are schooled here and many of those are Americans who go to school overseas

  20. […] shortage is being totally ignored. Back in 2013, then Republican Rep. and former emergency doctor Joe Heck said, “This bill (ObamaCare) has done nothing to increase access to health care. All it has tried to […]

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