New SNHD services help, can’t fix primary care crisis
SNHD’s Decatur location. (Google Earth photo)
More than two-thirds of Nevadans live in a federally designated Primary Care Health Professional Shortage Area.
“That’s about 67 percent of the state experiencing a primary care doctor shortage,” says Scott Jones the manager of the Primary Care Office at Nevada Department of Health and Human Services’ Division of Public and Behavioral Health. “That’s pretty dismal.”
While it won’t solve the lack of doctors, the Southern Nevada Health District recently expanded its primary care services. The Family Health Care Center opened Monday at SNHD’s main facility on Decatur, near several ZIP codes in Southern Nevada deemed medically underserved populations, which means they are high poverty areas that lack access to primary care providers.
Health district officials say this is needed for the community, but also acknowledge it’s a Band Aid solution.
“This is far from getting close to solving the actual problem of lack of access to care,” says Fermin Leguen the Chief Medical Officer and Director of Clinical Services for the health district. “But this is a contribution to trying to decrease the problem.”
According to the health district, more than 600,000 residents in Southern Nevada live in a Health Professional Shortage Area. A few zip codes — 89030, 89106, 89101, 89169 and 89119 — have particularly low access to health services and, accordingly, high rates of preventable emergency room visits and hospitalizations.
Leguen estimates there are about 179,000 low-income residents in those zip codes, which also have higher portions of minority residents. “Only 7,000 (about 4 percent) are enrolled at a primary care community health center,” he says.
There aren’t many options for them to seek out a primary care doctor. Nevada ranks 49th when it comes to primary care physicians per capita. There are an estimated 63 active primary care physicians per 100,000 people in the state, compared to 83 per 100,000 in the United States.
The shortage is even worse in Clark County, with only 1,066 primary care providers — about 50 per 100,000 people, according to the health district estimates.
With the new service provided by the health district, medically underserved populations — people who also usually struggle with being underinsured or uninsured — can get treated for ailments ranging from cold symptoms and allergies to rashes. The clinic will also will help manage chronic conditions such as asthma, high blood pressure, high cholesterol and diabetes.
For uninsured clients, fees are assessed based on an income-based sliding scale. “We provide to everyone who comes into the clinic and no one is denied,” Leguen adds.
‘Laws of supply and demand don’t operate’
The health care shortage is a national issue says Makayla Palmer, an assistant professor in UNLV’s Economics Department who studies health care. Fixing the problem isn’t easy.
“The laws of supply and demand don’t operate as freely in health markets as they do in most sectors,” she says. “Increasing the supply of physicians by producing new ones takes at least 7 years.”
There are several reasons why Nevada’s primary care physician shortage is so acute. “There needs to be more residency slots in Nevada so doctors are able to get their final training and enter the workforce,” Jones says.
The problems in Clark County differ from rural areas struggling to attract primary care physicians, Jones says. “One of the challenges to rural and frontier recruitment is that they might not have access to the same resources as other areas,” he adds.
Some are looking to UNLV’s new medical school as a solution.
However, Nevada has more medical students than it has residencies, Palmer notes. “Students who leave for their residencies are less likely to practice in Nevada after their residency,” she says.
All of Nevada’s U.S. House delegation sponsored the Resident Physician Shortage Reduction Act of 2017 to help increase the number of Medicaid-supported residencies — it was estimated to add 3,000 residency spots over five years. On the Senate side, a similar bill was cosponsored by Sen. Dean Heller and Sen. Catherine Cortez Masto. The legislation enjoys broad bipartisan support in Washington, but is still in the committee referral stage and evidently not on any fast track to passage.
In 2015, the state approved $10 million to create more residency programs across the state.
Meanwhile, the primary care physician shortage stems from more than just training — and retaining — doctors.
Palmer says physicians who practice specialties make more money than primary care physicians, which can make it challenging to entice doctors to become primary care practitioners.
As of May, about 660,000 Nevadans are eligible for Medicaid, roughly 400,000 of them made eligible with the expansion of Medicaid under the Affordable Care Act. But with the low reimbursement rates, it’s hard to attract doctors to work in communities that are more likely to rely on Medicaid. “Increasing the demand for primary care at the lowest reimbursement rates exasperates the shortage,” Palmer says.
Jones says there has to be ways to incentivize medical professionals to work in low-income and underserved areas. Both state and federal programs offer a loan repayment assistance for doctors who choose to work in these communities.
The Division of Public and Behavioral Health also administers a physician visa waiver program, which brings international medical graduates to serve in underserved areas. There are 15 applicants for primary care doctors and specialists, 11 who will practice in Clark County.
Palmer also points to outside factors that could hinder Nevada’s ability to attract more doctors.
“Physicians are highly educated individuals and tend to place high value on educational opportunities for their children,” she says. “Nevada ranks poorly in K-12 achievement measures, which can make it difficult to attract younger physicians.”
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