by April Corbin Girnus, Nevada Current
February 3, 2023
Back in October, the Kirk Kerkorian School of Medicine at UNLV officially opened its first dedicated building, on its 9-acre campus on Shadow Lane in central Las Vegas. It was heralded as the beginning of a new era, the opening of a state-of-the art facility that will allow the medical school to eventually double the size of its graduating classes, anchor future development in the medical field and help address the widespread shortage of healthcare professionals across the state.
All that is probably true. But it’s not as simple as some might think.
“Everyday people assume that since we have medical schools now we have lots more doctors,” said Caitlin Saladino, the director of strategy at Brookings Mountain West and The Lincy Institute, “but residencies are the missing piece.”
After someone graduates from medical school, they submit themselves to be “matched” through a national system with a residency program that will provide them with the additional training and hands-on experience they need to become licensed to practice independently.
Data shows that where people receive their graduate medical education (GME) is important. National research has found that, depending on speciality, upwards of 50% of physicians stay within 100 miles of their residency program.
A 2021 analysis conducted by UNR’s Nevada Health Workforce Research Center put Nevada’s percentage lower, finding that 41% of GME graduatesover the past decade said they planned to remain in Nevada while 59% planned to leave.
The Lincy Institute & Brookings Mountain West recently compiled residency data for the 2021 and 2022 graduating classes at the UNLV and UNR schools of medicine. They found that 36.2% of the GME programs matched to UNLV students — and 14.6% of the GME programs matched to UNR students — were located in Nevada. The rest were out-of-state programs.
But it’s not just about the raw number of GME programs available.
Equally important is diversifying the types of residencies available. UNLV Kirk Kerkorian School of Medicine Dean Dr. Marc J. Khan notes that Nevada has zero residencies in some specialities and subspecialities.
For example, according to Kahn, two current UNLV students would like to specialize in dermatology but there is no dermatology training program anywhere in the state. Those students will have no choice but to seek opportunities elsewhere upon graduation.
“And we know, when they leave, the likelihood of them coming back is low,” he adds.
That issue is more pronounced in Northern Nevada, where accredited GME programs exist in only four specialties: family medicine, internal medicine, psychiatry, and sports medicine. (A fifth GME program, in pediatrics, is scheduled to launch later this year.)
That may contribute to why only 15% of the graduates of UNR’s medical school last year matched to an in-state residency, according to the university.
UNLV fared better with its most recent graduating class: 41% of its studentsmatched with an in-state residency program, mostly in Southern Nevada, on Match Day, according to UNLV.
Saladino notes that UNLV embedded into its medical school a preference for applicants with strong ties to Nevada. The medical school boasts on its website that 74% of its Class of 2022 attended high school in the state, and 53% went to college in the state.
‘at least five times that’
Much of the frustration over graduate medical education is directed at the federal level. As part of the Balanced Budget Act of 1997, Congress froze the number of residency positions funded through The Center for Medicare and Medicaid Services (CMS).
Robert Orr, a policy analyst at The Niskanen Center, a think tank, wrote recently that the cap was implemented amid a fear that the U.S. was going to wind up with a surplus of physicians.
The opposite has proven true.
Yet no major overhaul of GME funding has occurred. And Nevada’s population has more than doubled since 1996, bringing with it increased medical needs.
Nevada currently has 404 residents funded through CMS.
Khan says Nevada could use “at least five times that.”
According to a 2021 report by the U.S. Government Accountability Office, 70% of hospitals nationwide are “overcapped” — meaning they train more residents than CMS funds. That includes University Medical Center, which is owned by Clark County and is Nevada’s only public hospital.
UMC CEO Mason Van Houweling says the hospital is capped by CMS at 156 residents but currently has around 200. While some of those overcap residencies are subsidized with grant money, it still comes at an expense to UMC.
“It’s a significant one but it is a major part of our mission,” he said.
Van Houweling says he would like to see UMC’s residency slots in the “300 to 400 range.” They could strengthen what he calls the “bread and butter” fields, like primary care and family medicine, but also expand into other medical areas.
“We have the capacity,” he adds. “We do want to do more specialities — rheumatology, radiology, anesthesiology — all are critical shortages in the state.”
Nevada Democratic Sen. Jacky Rosen and Arkansas Republican John Boozman have teamed up numerous times in recent years to introduce legislation aimed at addressing the federal issues of overall funding levels and distribution across states, but the bipartisan pair have yet to get anything over the finish line.
Some additional funding was provided in pandemic relief packages to increase residency spots nationwide by 1,000 spots over five years. Likewise, when the Affordable Care Act passed it came with a reallocation of CMS-funded residency spots that favored Nevada. But both fall far short of addressing overall needs.
Other states, including Texas and Florida, have already taken matters into their own hands and fund GME directly. Texas once set a lofty goal of having 1 residency spot for every medical student it had.
Nevada has toyed with pilot programs but has nothing comprehensive or permanent in place.
At the grand opening of the Kirk Kerkorian Medical Education Building in October, then-Gov. Steve Sisolak announced his intention to introduce legislation to create a special “Las Vegas Academic Medical District.” Specifics were scant at the time, but the idea was well received as another possible step in improving the medical community in Southern Nevada.
Such a district could potentially be a source of permanent funding for GME.
Sisolak, however, lost reelection less than a month later, and there’s no indication where his successor, Gov. Joe Lombardo, stands on the prospect of an academic medical district.
Sisolak last fall also announced an $8.5 million pilot program to fund GME spots across Nevada. Lombardo’s executive budget does not appear to include continued funding for that program.
Lombardo’s office did not respond to the Current’s request for comment.
Khan and Van Houweling, who both collaborated with Lombardo’s transition team to identify the state’s health care needs, said they believe the new administration understands there are dire shortages in healthcare professions and listened to theirs and others’ recommendations.
Van Houweling says improving graduate medical education opportunities will take a huge investment of hundreds of millions over years, but he says he’s encouraged by steps in recent years — like opening the Kerkorian school.
Nevada’s healthcare shortages are pervasive and well documented. For example, the entirety of the state is considered to have a shortage of primary care physicians, according to the Rural Health Information Hub, a site supported by U.S. Department of Health and Human Services grants.
Residencies aren’t the only contributor to the shortage, experts say, but they are a key component. Khan said he’s working with lawmakers on ways to address other contributing factors, including ones related to insurance. Lombardo has also promised a review of regulations and licensing which could potentially impact medical fields.
Also, in December, Nevada’s Interim Finance Committee approved $10 million in funding to Roseman University to help seed its planned medical school.
“These are all positive things,” Saladino from Brookings says. “Realizing we need new residency programs is not a policy problem. It’s a good thing. Needing more means we have the infrastructure in place to support them.”
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