Medical Education in Nevada: a Team Approach
It is no surprise that Nevada, and moreover Las Vegas, needs more physicians. We are near the bottom of physician to patient ratios and would need to add thousands of new physicians just to get to the 50th percentile. Recruitment of physicians can be problematic, as some see Las Vegas as the party destination it is portrayed as in the movies—they do not see the schools, community, and cultural offerings such as the Smith Center or Nevada Ballet Theatre that many of us have fallen in love with as residents of this great city. There are few places better to move one’s family and practice medicine—though reimbursement rates continue to be an issue, opportunity abounds.
One way to address this shortage of physicians is to grow our own, as typically 50% of medical students and 75% of residents will stay where they trained. This year we celebrate 50 years of this vision, commemorating the founding of the University of Nevada School of Medicine (UNSOM). Organized medicine and community leaders worked with governmental representatives to make this happen, and over the years this has given thousands of Nevadans the opportunity to study medicine, become physicians, and care for patients.
With the tremendous growth of Las Vegas, it became apparent that significant amounts of patients were to be found in the south. UNSOM partnered with University Medical Center (UMC) to garner a wide breadth of experience. For example, when I was attending UNSOM, our Ob/Gyn and surgical rotations were in Las Vegas. The surgical 12-week block consisted of 8 weeks in Las Vegas and 4 weeks in Reno, so one third of the students went 4 weeks in Las Vegas, then 4 weeks in Reno, then 4 weeks in Las Vegas. The surgical rotation is always challenging, and this challenge was exacerbated as the medical student housing near UMC went away. Often medical students would just trade sleeping in each other’s apartments through the rotation, depending what city they were in that week.
UNSOM served the entire state, including the rural counties. Most medical students remember fondly their rural rotation, and often the 4th year medical student was put in charge of the ER at night in such places as Ely, Winnemucca, Elko, etc. It really gave you the sense that you were the doctor, even though you had back-up—you also learned how helpful nurses can be.
Las Vegas continued to grow, and there was room for additional medical education institutions. Touro University came to Henderson and continues to grow exponentially. It was later decided that UNLV would have its own medical school, and that it would use UMC as its clinical base. UNLV’s inaugural class now has finished their second year and are studying for their board exams. Roseman University is awaiting its accreditation, so soon we will have three medical schools in Las Vegas. Local hospital systems such as the Sunrise System and Valley Health System are now expanding their Graduate Medical Education (GME) programs, and UNSOM has now rebranded itself UNRSOM.
These entities are working with community physicians, as the full-time academic physicians continue their excellent clinical, research, and instructional work. Community physicians help to augment and broaden that experience for the trainee.
There has never been a “town vs. gown” mentality that you may see in other cities. When speaking with many of the community physicians, they may have been a little hesitant to help at first, but often they will say that it is one of the best things that they do. They will say that they see the sense of wonder that we all had when entering medicine in the eyes of their young, enthusiastic trainees. It reminds them of why they became a doctor in the first place. I fondly remember traveling with a general surgeon in his Buick to do cases at the hospital in Yerington. It was surreal, as each patient seemed to have a baked good for the surgeon. More real was that he asked me surgical questions during the time in the car—3 hours in total. Although painful at the time, it helped tremendously for my oral exam at the end of the rotation.
Students and residents want to learn. Recently CCMS offered a “Stop the Bleed” course, and we received 70 RSVP’s from medical students within the first 48 hours. We are asked frequently to find a physician to give a lecture on a particular subject, and CCMS has been working the medical students and residents to meet and casually talk with physicians at social mixer events. At our Resident Job Fair each year, the residents hear lectures about the business of medicine, and are able to meet potential employers. In addition, CCMS and NSMA are working with our legislators to secure adequate funding for medical education and GME programs.
If you are not able to teach or interact with medical students and residents, please consider contributing to the CCMS Scholarship Fund. It is a separate 501(c)(3) charitable organization that is tax deductible—to put the importance of this fund into perspective, thirty years ago I received this scholarship, and it made it possible for me to attend in-state medical school and fulfil my dream of becoming a doctor. Tuition has increased five-fold since then, and the grants have not kept up with the times.
Opportunity for medical education abounds. Our medical institutions continue to grow, acquire more renowned instructors, do spectacular research, and serve our community. At CCMS, we intend to continue to facilitate strengthening our medical institutions and bridging the gap between medical student and practicing physician.
Please do what you can. You will feel better for it, and together, we will have a brighter future.
Jeffrey J. Roth, M.D.
Clark County Medical Society