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.
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.”