To get doctors, improve residencies

What’s the first order of business in improving Nevada’s health care system?

Is it opening an allopathic medical school at UNLV? The project has the potential, over the long term, to significantly boost the economy and create thousands of new jobs in medicine and medical research. But it’s not the starting point.

Is it creating new medical residencies? Without question, this has to happen before the planned UNLV medical school graduates its first class. Residencies place medical school graduates in hospitals to practice medicine under the watch of faculty and experienced physicians. And Nevada, despite having one of the worst physician shortages in the country, doesn’t have enough residencies and fellowships to place all the graduates of the University of Nevada School of Medicine and the valley’s private Touro University, making the state a net exporter of medical school graduates.

But adding new medical residencies isn’t the place to begin, either.

Why? Regent Mark Doubrava says the state’s medical school graduates aren’t exactly tripping over each other to land any of Nevada’s existing residencies — he says about 80 percent of Nevada’s graduates go elsewhere for their training. Doctors typically end up practicing in the area where they complete their residency, meaning once Nevada medical school graduates leave, they aren’t likely to come back.

Doubrava himself is an exception. The regent is a Clark High School product who graduated from the University of Nevada School of Medicine, left the state for residency and fellowship training, then returned to Southern Nevada to practice medicine as an ophthalmologist.

So why are Nevada’s medical school graduates leaving the state for their training? Not because of a lack of opportunity. One need only find out how long it takes to get an appointment with a local doctor — assuming the physician is taking new patients — to see there are incredible opportunities here for health care professionals, especially in Southern Nevada. Might some medical school graduates be down on the state in general, given its immature health care infrastructure and social and economic challenges, and simply want to live and practice somewhere else? Perhaps.

The most obvious answer, unfortunately, is that a lot of Nevada’s existing residencies simply aren’t that good. Doubrava points to some troubling numbers from this year’s “match lists” to back that up.

First, the vast majority of this year’s University of Nevada medical graduates are, once again, leaving the state. Many of them earned highly sought-after residiencies at places such as Stanford, UCLA and the Mayo Clinic.

So who’s filling the University of Nevada’s residency slots? In Reno, all 15 of the state’s categorical internal medicine positions went to graduates of international medical schools. Five of those 15 were Americans studying abroad, while the other 10 were foreigners. And in Las Vegas, 21 of the 24 categorical internal medicine slots went to international medical school graduates. Seven are American citizens and 14 are foreigners.

In total, 60 graduates of American medical schools accepted residencies through the University of Nevada this year, while 51 positions went to graduates of international medical schools. In Reno, the international medical school graduates actually outnumber graduates of American schools, 22 to 15.

This isn’t about nationalism. It’s widely known that international medical schools are much easier to get into than American schools.

These numbers show that Nevada medical school graduates aren’t alone in avoiding Nevada residencies. The numbers say no American medical school graduates want certain Nevada residencies. Regents have discussed the high number of foreign medical school graduates entering Nevada graduate medical education residencies.

“The argument that we should only concentrate on expanding Nevada GME [graduate medical education] is wrong, in my opinion,” Doubrava wrote in an email. “We should first improve the quality of our current GME. Improved quality will attract more of our Nevada grads to stay in Nevada to finish their training. A UNLV medical school would help attract the necessary faculty and doctors to participate in better GME.

“Expanding low-quality GME does nothing for the diversification of our economy.”

The state must add more medical residencies, and the 2015 Legislature is going to have to come up with millions of dollars in funding to make that happen. The Legislature will have to dedicate millions more dollars to get UNLV’s medical school off the ground.

But we won’t improve our health care system if we can’t attract the best medical school graduates to train here.

Glenn Cook (gcook@reviewjournal.com) is the Las Vegas Review-Journal’s senior editorial writer. Follow him on Twitter: @Glenn_CookNV. Listen to him Mondays at 4 p.m. on “Live and Local with Kevin Wall” on KXNT News Radio, 100.5 FM, 840 AM.