Editorial: Heller sponsoring bills to address doctor shortage

Nevada Sen. Dean Heller has joined with several other U.S. senators to introduce bills to address the looming shortage of doctors in the coming decade, particularly in rural areas.

According to a study released in March by the Association of American Medical Colleges (AAMC), the United States is facing a shortage of between 40,800 and 104,900 physicians by 2030, because the number of new physicians is not keeping pace with the demands of a growing and aging population. Though the population is expected to grow by 12 percent by 2030, the number of Americans aged 65 and older is expected to increase by 55 percent and the number of people aged 75 and older should grow by 73 percent.

One of the bills being co-sponsored by Heller is the Resident Physician Shortage Reduction Act. There is a similarly named bill pending in the House.

In a press release Heller said this bill would increase the number of Medicare-supported hospital residency positions by 15,000 to address the coming shortage of doctors and to try to keep new graduates from Nevada’s medical schools in Nevada and rural Nevada in particular.

“While the number of medical school graduates from Nevada’s universities continues to rise, the state does not currently have enough residency positions to keep pace with those graduates in Nevada,” said Heller. “The Resident Physician Shortage Reduction Act increases the number of hospital residency positions available to address the doctor shortage, particularly in our rural communities, and improve the quality of care patients receive.”

According to AAMC data from 2014, Nevada ranked 47th among the states in the ratio of doctors to population. Nevada had 197.4 doctors per 100,000 population compared to 265.5 nationally.

According to a news account in the Las Vegas newspaper this past November, the number of doctors per capita in rural Nevada actually declined by nearly 10 percent between 2004 and 2014.

“Those problems are aggravated in rural areas that have always struggled to recruit and retain or keep those types of professionals in their facilities and their communities,” John Packham, director of health policy research in the state’s rural health office, was quoted as saying.

The other bill being pushed by Heller is dubbed the Advancing Medical Resident Training in Community Hospitals Act. The is intended to make it easier for hospitals to start full-time residency programs by fixing a flaw in current law that prevents hospitals that have previously accepted part-time medical residents from establishing their own full-time, Medicare-supported residency programs.

“The Advancing Medical Resident Training in Community Hospitals Act aims to address the physician shortage in Nevada’s rural communities by giving community hospitals more flexibility to rotate residents,” Heller sad. “By making it easier for Nevada’s hospitals to train the next generation of physicians, our bill will increase access to care for Nevadans living in these communities.”

Though there will be a price tag on these bills, the added health care availability is well worth it.

A version of this editorial appeared this week in some of the Battle Born Media newspapers — The Ely Times, the Mesquite Local News, the Mineral County Independent-News, the Eureka Sentinel,  Sparks Tribune and the Lincoln County Record.

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.