Monday, July 18, 2005
Copyright © Las Vegas Review-Journal

Shortage of health care personnel plagues state

Ratios of nurses and doctors to residents among worst in U.S.

Mitchell Forman, left, and Michael Harter sit in an examination room at Touro University-Nevada, which opened in Las Vegas in August with an inaugural class of 78 medical students. Forman is the college's dean, and Harter is its vice president of administration and dean of students. Photo by John Locher.

Many health care professionals say the biggest concern confronting Southern Nevada's medical industry is not a shortage of hospital beds or a lack of specialty care, but rather a scarcity of personnel.

"We're competing for what is generally considered a pool of health professionals that's already too small nationally," said Larry Matheis, executive director of the Nevada State Medical Association in Reno.

"We have to compete with all the major metropolitan areas that are growing and have highly developed care systems. Physicians, nurses and all the other medical professionals who move to Southern Nevada realize they're going to be stretched pretty thin, and they will not have the kind of backup support they would if they went to areas with more mature medical systems."

The University of Nevada School of Medicine now trains about 120 residents per year, and it will add 17 residents to the program in 2005-06 and 34 residents in 2006-07, said Dean John McDonald.

McDonald said the medical school also is looking to add training programs in emergency medicine and psychiatry, among other specialties.

But public colleges in Nevada find it impossible to keep up with the medical needs of a surging population, as the ratios of nurses and doctors to residents remain among the nation's lowest.

"Clark County alone is growing by more than 6,000 people a month," said Tony Clark, executive director of the state Board of Medical Examiners. "You're not going to keep up no matter what you do. The system falls more behind every single day because of the huge influx of residents."

As a result, private colleges are stepping in to help meet the demand for labor, and hospitals are escalating recruiting efforts outside the state.

"When people talk about population growth, they talk about roads and water," said Renee Coffman, dean of the college of pharmacy at the private University of Southern Nevada in Henderson. "Those are important, but you can't neglect the fact that health care needs increase as well.

"(The University of Nevada, Las Vegas) and (the University of Nevada, Reno) both do a great job, but they can't meet every need. Because they're tax-based, there will always be fights over what priorities they can fund. Most other cities have public universities and complementary private schools. The time is right for Nevada to have a complementary private education system -- one that doesn't take away from public schools but offers alternatives."

An ongoing parade of private medical colleges shows the development of that system is under way.

Touro University-Nevada opened in August with an inaugural class of 78 medical students, most of whom will enter practice as primary-care doctors rather than specialists, said Mitchell Forman, the college's dean. By its third year of operation, Touro will admit 135 students per class. Its ultimate capacity, Forman said, would be around 170 students per year. The four-year program trains students in both traditional medicine and osteopathic principles, which revolve around a "whole-person" approach that considers both the mental and physical needs of patients, Forman said.

Forman said Touro's emphasis on producing primary-care physicians rather than specialists is important because "what communities need is (doctors) who can provide the most immediate resources for their needs -- in other words, treating the whole patient rather than just the eyes, heart or lungs."

In October, Touro also established a program to train physicians assistants. The 30-month course of study has 36 students in its first class. And in August, Touro will begin training nurses and occupational therapists.

Touro's nursing program will begin with 32 students and grow to 50 students in its second year. Its occupational therapy school, Nevada's first at any public or private college, will start with 25 students and grow to 30 in its second year, said Michael Harter, vice president of administration and dean of students at Touro.

Forman said the school has recruiters who look for students at universities locally and in California, Utah and Arizona.

The University of Southern Nevada is accepting applications for 40 spots in its nursing program, which will offer a bachelor of science beginning this fall at its campus near Sunset Way and Sunset Road. Next year, the program will increase to 80 students per class. The following year, it will max out at 125 students per class, said Mable Smith, dean and professor of the university's college of nursing.

In addition, the university will have a 140-student class in its 4-year-old college of pharmacy this year -- up significantly since it launched its first class with 38 students in January 2001. Coffman said the Nevada Department of Employment, Training and Rehabilitation projects a statewide need for 120 new pharmacists per year through 2010.

Coffman said that before the college of pharmacy -- the state's first -- opened, Nevada "had a decent shortage of pharmacists. But in talking to many of the major employers in the area, they're saying the shortage has come down considerably."

After its nursing program is well-established, Coffman said university officials might consider adding a physicians assistant curriculum.

Also looking to initiate a nursing program this year is California-based National University of Nevada. The school, located at 2850 W. Horizon Ridge Parkway in Henderson, is looking for a director of nursing and is accepting applications from prospective students, said Charlotte Bentley, the university's vice president.

The school also is seeking state approval to offer an undergraduate degree in allied health, which Bentley said is a precursor to a nursing degree. Bentley said she expects classes to begin as early as August; the university's first graduating class of 100 nurses should complete school in about two years.

"Local hospitals are telling us they'll take as many (graduates) as we can provide them," Bentley said of the demand for nurses.

Dennis Barker, a consultant for the American Scientific Institute, said hospital recruiters are bombarding him with similar requests.

"When I talk to them and say, `Nurse,' they say, `Give me 12,' " Barker said. "Our market research found that Nevada ranked 50th in having enough qualified health care professionals. From a business standpoint, that would dictate to us that there's a huge need (for nurses). Our job as vocational educators is to put people to work, so we're going to where the jobs are."

Officials of the American Scientific Institute, a private college based in Los Angeles, hope to open the school's first campus outside California in August, pending approval from the state Commission on Postsecondary Education and the state Board of Nursing. Barker said the college has leased about 5,000 square feet at 4300 Sunset Road, where it will train 80 nurses in its first year.

The institute also is seeking a location for a second Southern Nevada campus, which would open early next year and also train 80 nurses in its first year. Barker said each location could expand to graduate 120 nurses per year.

The institute also plans to open a campus in Northern Nevada in the next 12 to 18 months, Barker said.

In addition to offering a licensed professional nurse degree, the school will add technical certifications in high-demand areas such as kidney dialysis and respiratory therapy -- specialties that "make a nurse worth more money," Barker said.

But local hospitals aren't relying solely on medical-professional schools to fill their work force needs.

In May, labor recruiters from Southern Nevada's hospitals traveled to Chicago as a group to hold a job fair for more than 1,000 nurses there.

"We all recognize the fact that we need to be more creative," said Jim Clark, vice president of human resources for Sunrise Hospital and Medical Center and Sunrise Children's Hospital. "It really gets to the point where we don't care who lands the nurses. We're just interested in how we can increase the pool of health care professionals. Our objective is not to pull nurses from other hospitals (in Las Vegas). We want to bring new nurses to the state."

Clark said the job fair gave Sunrise leads on at least a dozen Midwestern nurses who might consider relocating to Las Vegas.

"We don't leave any stone unturned," Clark said, noting that Sunrise offers relocation assistance and signing bonuses and works with colleges around the country to identify promising nursing graduates. He said more than half the hospital's nurses come from out of state, mostly from California.

Rod Davis, president of the Nevada market for St. Rose Dominican Hospitals, said his company "is continually reviewing our benefit package to make sure it's competitive and conducive to retaining and recruiting staff."

Among the company's perks are a new pension program, free health care and tuition reimbursement. St. Rose also offers nurses help with down payments and closing costs for home purchases.

Valley Health System, which includes Summerlin, Valley, Spring Valley and Desert Springs hospitals, spends about $1 million a year on recruitment, said Marketing Director Mike Tymczyn, who is no longer with the company.

Tymczyn said the company focuses its hiring efforts on slow-growing areas of the country where hospitals are closing, such as the Northeast.

In 2001, Valley Health started its Adopt-A-Student program for nursing majors at UNLV, Nevada State College and the Community College of Southern Nevada. The company pays for students' final two years of school, picking up the tab for tuition, books, uniforms and most incidental expenses. In exchange, students in the program must agree to come work for a Valley Health hospital for two years after graduation. Tymczyn said several hundred students have participated in the program.

And on May 1, Valley Health launched a Web-based system for tracking job applications. The program allows an immediate connection between applications and the managers who hire.

"There's no lag time," Tymczyn said. "If someone comes to us and wants a job, and they're qualified and everything checks out, we are able to act on it almost instantaneously. We can't afford to lose one afternoon or one hour."

Matheis, of the Nevada State Medical Society, said health care companies might have to get even more aggressive in their personnel pursuit.

"So far, we haven't been able to get out of last place in sufficient manpower-to-(population) needs," he said. "As long as population growth continues -- especially among seniors and youngsters, the two populations that press the health care system the most -- we're going to see demand exceed supply for quite some time.

"(Operators) might need to establish permanent recruitment centers in and around the major health education areas of the country. And perhaps we have to develop programs to retain students, to make sure they don't train here and move somewhere else. We also have to find ways to demonstrate just how attractive a place (Nevada) is to live and to raise a family. That can mean everything from finding educational opportunities for their kids to helping them find housing."