There are not enough doctors in Nevada, and the shortage is likely to get worse as tens of thousands of people become newly insured under the federal health care overhaul.
A study released this year by John Packham, health policy researcher at the University of Nevada School of Medicine, ranked Nevada 46th in the nation for its share of primary care doctors, family care specialists and pediatricians. The state ranked last in general and orthopedic surgeons, next to last for psychiatrists and 42nd for obstetricians and gynecologists.
“Any growth during the last decade in the number of licensees in medicine ... have been insufficient to meet population growth and demand,” said Larry Matheis, executive director of the Nevada State Medical Association. “The shortages are affecting availability of specialty care in Medicaid and Medicare and primary care all around. The expanded coverage coming in 2014-2015 will surely exacerbate this.”
Under the federal health care law, Nevada’s Medicaid enrollments are projected to swell from 313,000 to about 490,000 by 2015. The increasing caseloads include people who currently are eligible but not enrolled, and those who are expected to sign up as eligibility thresholds are expanded to meet a mandate to have health insurance.
“With national work shortages, it’s not likely that Nevada can recruit to fill our needs,” Matheis said.
Recruiting has always been an ongoing challenge in Nevada’s rural areas, said Kerry Ann Aguirre, director of business development at Northeastern Nevada Regional Hospital, a 45-bed facility in Elko.
“We’re always trying to recruit, she said. “It’s just very, very difficult to keep physicians in the rural communities. It’s a nice community but they’re not really wanting to settle into the rurals.”
Aguirre agreed that implementing the Affordable Care Act will bring new challenges.
“It’s interesting because the ACA was passed to increase access to health care while reducing costs. But in the rurals, that means there’s a decrease in payments to physicians and hospitals” because of reduced rates.
“That means they’re going to be pressed to keep their practices open,” Aguirre said.
Another downside is that without enough primary care doctors, more patients will turn to hospital emergency rooms, where care is more expensive.
“It does no good for a patient to come through an emergency room and then have no primary care physicians to follow up with,” she said.
Nevada, like other states, is taking small steps to try to address the need.
Lawmakers approved and Gov. Brian Sandoval signed AB228, permitting a doctor licensed in another state to provide voluntary health care in Nevada.
Another measure, AB170, expands the role of advanced practice registered nurses. Under the bill, nurses with advanced degrees can practice medicine and prescribe drugs without a collaborating physician.
“I do anticipate we will see increased access developing in Nevada over the next two years,” said Taynin Kopanos, vice president of state government affairs with the American Association of Nurse Practitioners.
There are roughly 800 nurse practitioners in Nevada, which, when the law takes effect July 1, becomes the 17th state to provide full and direct access to such advance nurse practices.
Matheis said he doesn’t expect the new law will have an immediate effect on easing Nevada’s health provider shortage.
“This doesn’t actually fill the shortage,” he said. “In an immediate sense, it doesn’t add a single nurse into the system.”
But Kopanos said Arizona, which expanded the practice of nurse practitioners in 2001, saw a 73 percent increase in the number of nurses practicing in rural areas within five years.
Nevada joins 16 other states and the District of Columbia to allow advanced registered nurses to practice on their own.