The lack of numbers of residencies and fellowships is an issue," says John Packham of the University of Nevada School of Medicine. "But we also lack breadth. We have a pediatric residency you can get here, but we don't have pediatric oncology or pediatric endocrinology.
Above: Valley Hospital resident Dr. Karleen Adams examines a patient, overseen by Dr. David Park. Left: Dr. Jennifer Baynosa, far left, talks to residents at University Medical Center.
brand-new doctors in town for years to come. In any given year, there are anywhere from 100 to 130 residency slots available in Nevada, which are open to medical grads around the world. The University of Nevada School of Medicine has 12 residency programs, including internal medicine, family medicine, general surgery, plastic surgery, pediatrics and OB/GYN. Those programs have more than 100 slots open for a multi-year residency in any given year, most of which take place at University Medical Center. Meanwhile, Valley Hospital, which partners with Touro University to train its graduates, has seven residency programs. In any given year, about 30 slots are open in those. There’s the bottleneck: About 200 med grads a year statewide, with 130 or so residency slots open to applicants from around the world. Plenty of med grads, not enough residencies. That disparity feeds into an annual glut of medical graduates who don’t match into a residency program at all. According to the Association of American Medical Colleges, this year, more than 34,000 medical students applied to more than 29,000 residency slots — leaving many eager young doctors without a program to complete their final training required to practice as doctors in the U.S. 100 | Desert
Companion | AUGUST 2013
Money infusion, stat! why don’t we just make more residency slots? We don’t control the purse strings. Largely through Medicare, the federal government is in charge of paying for graduate medical education, kicking in about $9 billion a year to fund more than 100,000 residencies nationwide. State governments, grants and other money fill the gaps. The problem? The Balanced Budget Act of 1997 essentially froze the number of federally funded residencies, leaving states to scramble and scrape for ways to create new post-grad medical training programs to meet rising demand. “Whether there are 10 or 100 spots, once they’re filled, that’s it. I blame Bill Clinton,” jokes Dr. Jerome Hruska. He just completed his residency in internal medicine at Valley Hospital, and is about to start a fellowship there in pulmonary critical care. He witnesses firsthand the physician shortage, noting he often sees patients in the emergency room for routine issues. “At certain times, you’re taking ER calls, and you’re kind of like, ‘Where’s the help?’ It can get a little frustrating.” Hruska originally wanted to pursue a residency in orthopedics after medical school,
but such a residency didn’t exist in the state at the time. It brings up another issue. The residency shortage is not just a question of depth. With its relatively slim portfolio of slots, Nevada lacks residencies in specialties and subspecialties that Nevadans need. “The lack of numbers of residencies and fellowships is an issue,” says Packham. “But we also lack breadth. We have a pediatric residency you can get here, but we don’t have pediatric oncology or pediatric endocrinology. We lose that person we might have had as an undergraduate. We need more specialized training.” He adds: “But I caution people that if I were the czar, I’d say we need to expand our primary care offerings as well. Yes, we’ll need specialists, but those 300,000 or 400,000 (Nevadans) who will be newly insured through the Affordable Care Act will need primary care doctors.” “Last year, we graduated the first class of oncology fellows, and 75 percent of them stayed on to practice in Nevada,” says Dr. Miriam Bar-on, associate dean for graduate medical education at the University of Nevada School of Medicine. “That’s very good, but if we have students who want to go into anesthesiology, radiology, orthopedics or pathology, they absolutely have to leave the state. We can’t address these because we don’t have the programs.”