To the editor:
In response to Glenn Cook’s Aug. 10 column about the inadequacies of Nevada’s programs to train new primary care and specialty physicians, we agree with his overall conclusion, but would suggest that the reasons behind this problem were poorly described (“To get doctors, improve residencies,” Aug. 10 Review-Journal). Nevada is inadequate in the three basic factors that drive quality in graduate medical education (GME) programs: hospital support, the breadth of specialty and sub-specialty training opportunities, and funding.
The University of Nevada School of Medicine does not own or administer any hospitals in our state on whom it is dependent for training opportunities. Thus we have little control over the size and breadth of the GME programs available, and we are particularly dependent on hospital support for competitive resident salaries and benefits, faculty salary support for teaching, administrative support, educational infrastructure such as conferences, medical education conference attendance and research funds.
The nature of this support varies widely across our hospital partners, because the financial performance of the hospitals varies widely. Overall, hospitals are stressed financially and facing uncertainty with health care reform, so their ability to support GME is challenging. It is true that many of our medical school graduates leave Nevada to train in specialty programs that we actually have in the state. The reasons they do so are many, including personal and geographic factors. But one major factor is the availability (or lack thereof) of advanced training in a wide range of sub-specialty disciplines following their basic residency training.
A majority of our graduates indicate they intend to sub-specialize, to pursue fellowship training in highly advanced disciplines. These programs are mostly unavailable in Nevada. We have worked hard, with very scant funding, to open three new fellowships in Las Vegas: cardiology, gastroenterology, and child and adolescent psychiatry. We need much more support to develop many more fellowships in internal medicine, pediatric, surgical and women’s health disciplines. These programs will not only attract top students (including our own), but also help address the state’s severe physician shortage in essentially all disciplines.
Our success in achieving these objectives depends entirely on funding. Resident and faculty salaries are, in general, not competitive nationally. Federal support for GME is flat or declining. Hospitals’ support will depend on their long-term financial success. State support for higher education declined dramatically during the recession, including to the School of Medicine. Reimbursement for the medical care provided by physician faculty members (a critical component for clinical teaching) is low for government-funded insurance programs. Federal support for research (a major platform for sub-specialty training) is declining. The result of these funding inadequacies is that we need to expand our physician workforce just at the moment when all of the potential funding sources to do so are weak.
The training of an adequate number of high-quality physicians for Nevada is a team sport that requires the commitment of government, higher education and medical, hospital, business and community leaders working together in a focused, collaborative, ambitious way for the benefit of the state. If these elements come together, high-quality training programs will develop or expand and attract the top students — including Nevada students — needed to improve health and health care in Nevada.
THOMAS L. SCHWENK, M.D.
MIRIAM BAR-ON, M.D.
The writers are, respectively, dean of the University of Nevada School of Medicine and associate dean for graduate medical education at the University of Nevada School of Medicine.
VA care top-notch
To the editor:
After reading the letter to the editor by Fred E. Washington Jr. (“Kudos to the VA,” Aug. 16 Review-Journal), I decided to further substantiate his support of Veterans Affairs care in the Las Vegas Valley. Like Mr. Washington, I am also a disabled veteran, and I have had nothing but excellent care from my primary care physician, Dr. Roosevelt Watson, and his nurse at the VA Southwest Primary Care Clinic.
This also goes for the care I received as a result of Dr. Watson’s referrals to specialists at the VA Medical Center. Wait times for my scheduled appointments have never been more than 15 minutes, far less than I had previously experienced in non-VA clinics and hospitals. Also, Dr. Watson’s communication with me has been impressive, utilizing the secure messaging provided by the My HealtheVet website.
I send my gratitude to my doctor, his staff and the VA for providing a pleasant experience.
GARY E. KLANN
To the editor:
With some trepidation, I turned to the editorial on the situation in Ferguson, Mo. (“Missouri madness,” Aug. 18 Review-Journal). I expected to read the same Rush Limbaugh-Sean Hannity line so prevalent in most R-J opinion pieces.
Instead, I read a thoughtful and well-reasoned piece about the failure of Ferguson officials to do anything effective, while throwing needless fuel on the fire. It seems that at least someone on the Review-Journal editorial board lives in the real world. Thank you.