Nevada ranks close to last in the nation when it comes to its ratio of physicians to residents. According to data published by the American Association of Medical Colleges in 2021, Nevada had only 218.5 physicians per 100,000 people, ranking it 45th for active physicians per capita. Additionally, Nevada ranked 48th for primary care physicians and 49th for general surgeons.
Dr. Marc Kahn, dean of the Kirk Kerkorian School of Medicine at UNLV, says the issue is critical as Nevada’s physician workforce and growing population ages.
“We have a primary care shortage, we have a mental health provider shortage. … We’re short in everything here,” Kahn says. “There’s some urgency, because if we’re going to provide the level of health care that we should provide, we’re going to need more health care practitioners. And the only way is to grow your own or import.”
Federally funded residencies
Nevada’s shortage of doctors stems from a lack of residencies, three to five-year training programs that are required for medical students to become practicing physicians. Kahn says students who complete their residency in Nevada have an increased chance of staying and practicing in the state.
Administered by the Centers for Medicare & Medicaid Services and funded by the federal government, residencies are “undersubscribed” in Nevada, Kahn says.
“The federal government froze those positions in 1997 when we were a very different state. To put things into perspective, the state of Nevada has about 403 federally funded residency positions, compared to states like California that have 9,000, or states like New York that have over 17,000,” he says.
U.S. Sen. Jacky Rosen, D-Nev., has urged the Department of Health and Human Services to take action to award more residency slots to the state. In a letter she sent to Secretary Xavier Becerra in November 2024, Rosen referenced 600 available graduate medical education residency slots, saying that Nevada should receive an “equitable distribution” of those.
“To date, of the 1,000 new medical residency slots Congress made available nearly four years ago, the Centers for Medicare & Medicaid Services has only allocated a small number to Nevada, which have not sufficiently kept up with the pace of our state’s surging population growth,” Rosen wrote, adding that Nevada has been the fastest growing state in the nation from 2000 to 2023.
Although Nevada’s federal delegation is continually trying to move the needle and get more federally funded residency programs in the state, Kahn says he’s “not optimistic” that that will happen any time soon.
State-funded residencies
In the meantime, state officials have a few options to shore up Nevada’s health care workforce. For one thing, they can follow the example of other states like Texas by using state money to create residency programs for graduate medical students at Nevada’s public medical schools—UNLV and the University of Nevada, Reno’s (UNR) medical school.
Gov. Joe Lombardo in his January 15 State of the State address pledged to “double” the state’s investment in graduate medical education.
Currently, UNLV’s medical school has 12 graduate medical education residency programs and 15 fellowship programs, which typically take two years and are done after students have completed a residency. UNR’s medical school has four residency programs and five fellowship programs.
“We say provide $20 million to fund residency programs. What we’ve asked is to give each of the two state public medical schools $5 million a year each year for the biennium, for which we will create five new residency programs in five years,” Kahn says.
Student loan repayment programs
Another means of addressing the doctor shortage is focusing on student loans. Kahn says the average medical student graduates with over $200,000 per year in debt, “so loan repayment is a way of attracting physicians to our state.”
Earlier this month, Nevada Treasurer Zach Conine announced the launch of the Nevada Health Equity & Loan Assistance program, aimed at bringing additional healthcare providers to underserved communities across the state. The result of a law passed in the 2023 legislative session, the program will give health care providers up to $120,000 in student loan repayment in exchange for a commitment to serve in rural and underserved urban communities in Nevada for at least five years, according to a news release.
To be eligible, providers must be residents of Nevada and be licensed, certified or registered to practice in Nevada. Applications for the loan repayment program will close on February 13. More information and the application is available at nevadatreasurer.gov/HEAL/.
Streamline Nevada’s licensure process
While state-funded residencies and loan repayment programs can help Nevada grow its health care workforce from within, more can be done to bring doctors in from out of state, experts say. Dr. Pedro “Joe” Greer, founding dean of Roseman University College of Medicine, said his process of becoming licensed in Nevada was “onerous” and would accept only hard copies of documents, rather than electronic documents.
“The problem to me is more a systemic problem in Carson City, because what you need to do is facilitate a program that can get people licensed, especially people who are already licensed in other states,” he says.
Kahn says when he applied for licensure during the pandemic, it took seven months to complete the process. He calls Nevada’s medical licensure process “cumbersome” and “laborious,” and suggests streamlining it.
“If someone is board-certified in a specialty, the only way to get there is they need to have graduated medical school, passed all their tests, completed a residency program and completed a test to get board-certified in that residency program. [It] seems to me, if somebody is board-certified and has an acceptable malpractice review, they ought to at least be able to get a temporary license,” Kahn says. “Rather, what the state does is, it requires every applicant to provide all that information up front, even though there’s no way they could be board-certified without any of that. And things get lost in the mail, and there are delays, and things are asked for that weren’t being asked for upfront.”
Strengthen higher education pipelines
Perhaps the best way to solve Nevada’s longstanding doctor shortage is to strengthen the state’s higher education pipelines and create pathways for all students to be able to become doctors. Greer, who previously served as associate dean for community engagement at Florida International University Herbert Wertheim College of Medicine in Miami, says Roseman is under review to receive preliminary accreditation as a medical school.
“If we get accredited in February, that means you’ll have four medical schools,” Greer says, naming UNLV, UNR and Touro University as the state’s existing medical schools.
He adds that, on average, less than 400 students apply to medical school every year in Nevada. “We have to increase that,” he says, pointing to Roseman’s pathway programs that have partnered with schools from elementary to college level to encourage students who might not see medical education as a viable pathway for them.
“One of the strategies we’re looking at at Roseman is going after first-generation students. And the reason is very simple. First-generation students, from our experience with the last medical school we started in Miami, tend to come home,” Greer says. “They’re the first ones in their family that have the opportunity for generational wealth. And they feel much more comfortable in their home environment, and can help out their own family. So we need to start recruiting from that perspective, too.”
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