”Most people don’t think about healthcare until the last six or eight months of their life,” says Ann Lynch, ‘ vice president of marketing and public relations for Sunrise Hospital and Medical Center and Sunrise Children’s Hospital in Las Vegas. “Therefore, it’s not a state of mind.”
Nevadans expect that when they are ill they can go to a doctor. When that illness is catastrophic they expect fully staffed hospitals with waiting beds. But as Bill Welch, president/CEO of the Nevada Association of Hospitals and Health Systems (NAHHS), points out, hospitals are closing beds due to a lack of staffing. The process is referred to as being “on divert,” and some ambulance services in Las Vegas have to contact different hospitals to find out what services are on divert before arriving with patients. Though considered a rarity, the situation could worsen over the next five or 10 years as the state’s population continues to grow.
A growing crisis
For now, Nevada hospitals seem to be staying just ahead of the curve, putting huge efforts into recruitment and retention of healthcare professionals. But simple math says Nevada may be in for a crisis. According to the Report on Health Care Education in Nevada, prepared for the Nevada Legislature by the University and Community College System of Nevada (UCCSN), projected growth for a majority of healthcare occupations exceeds the average projected growth for all occupations in the state through the year 2006. In addition, projected healthcare employment growth across all industry segments exceeds national projections. In 1996, there were 37,425 people employed in healthcare occupations. By 2006, that number is expected to rise by 68.41 percent to 63,026.
But that number will only rise if there are professionals willing to accommodate Nevada’s burgeoning demand for healthcare services. Where will all these professionals come from? Not from the UCCSN. “We are what I would consider a debtor state when it comes to healthcare professionals,” says Welch. Projected annual job openings are estimated at approximately 2,800 per year. Projected degrees and certificates awarded by the UCCSN for 2000- 2001 total less than 1,700, leaving a deficit of 1,100 for the coming year alone. If those jobs are to be filled, they will have to be filled from out-of-state. And recruitment is no easy task in a state know primarily for gambling.
“Even though we have a lot of other industries,” says Lynch, “and state [officials] are out ballyhooing business, the average citizen in this country sees us as a gambling Mecca and has a hard time thinking people live here.” It is one of the same problems in attracting qualified teachers. “People don’t think of us as a destination for a career,” she explains. “They see us a destination for a vacation.”
Dr. Robert Daugherty, until November 1 the dean emeritus and professor of healthcare policy at the University of Nevada School of Medicine in Reno, cites the high level of HMO penetration in the Nevada market as another key issue causing problems with recruitment. Lots of HMOs means physicians are paid less on average than they would be in other markets. Physicians also refer to a much higher “hassle factor” when dealing with HMOs because someone other than the physician is deciding an awful lot about the healthcare of the insured.
Nursing, rural healthcare bracing for hardest hits
Problems of recruitment and training of adequate healthcare professionals in all areas of health management are a problem throughout the state. But industry watchers point out two areas again and again as especially critical. The first is a challenge of numbers. There simply are not enough nurses to fill even current demands. The second is a challenge of geography. Rural communities are scrambling for healthcare professionals, and sometimes coming up empty-handed.
Julie Johnson, Ph.D., RN, director of Orvis School of Nursing at the University of Nevada, Reno, says Nevada is in the middle of a nursing shortage, and the rest of the nation is on the brink of its own. Though nursing has always been considered cyclical in terms of its numbers, the current shortage has a different look to it. “It’s not just a shortage of nurses who work in hospitals and community agencies,” says Johnson, “but also a shortage of nurse educators. We’re running out of teachers.” This factor, new among the profession, could lead to a catastrophic nursing shortage within years. The nursing school can only have eight students per faculty member. ”We would love to teach more students,” she says, “but we need more faculty.” The graying of the work force is evident in nursing, with the average age of nurses being 40 five years ago and 45 now. New nurses, especially at the Ph.D. level, are not appearing.
Also hurting nursing is the wide range of career opportunities available to the well-educated woman. Lynch explains that female high school graduates 20 years . ago went into college with two solid career choices – nursing or teaching. Now a woman can do anything, and many women who would have chosen nursing then are now opting to be physicians or lawyers. Bill Hale, CEO of University Medical Center (UMC) in Las Vegas, says women are simply entering careers they find more attractive.
Choice is also one of the factors hurting rural communities’ efforts to attract healthcare professionals: “Having lived here 19 years,” says Daugherty, “I don’t know why anyone wouldn’t want to live here.” Daugherty does acknowledge a preference for urban convenience and the fact that many people don’t want to live in the desert may be contributing. The problem extends beyond simple issues of healthcare supply and demand: when a hospital in a rural setting is the top employer in its community – which is often the case – the staffing of that hospital becomes critical to the vibrancy of the entire community.
Healthcare educators statewide understand the importance of filling the vacuum. Though the primary role of the School of Medicine is to train physicians, enrollment comprises only 52 students a year, so recruitment must come into play. “It’s safe to say,” according to Daugherty, “that for every rural community with at least one doctor, the School of Medicine either trained or helped the community recruit that physician.” Because it has been shown that people from rural communities are more likely to practice in rural communities, recruiting rural students into healthcare professions is also important. The School of Medicine has a full-time staff in Elko and a program that visits area schools to get children interested in the healthcare professions at an early age.
When a community needs a physician, the school will coordinate a community effort and even contact foreign medical schools on the community’s behalf. In addition, the school’s medical students each spend one month during their senior year in a rural community with a rural physician. There is also a program to help healthcare professionals pay back their considerable student loans. A physician, physician’s assistant, nurse practitioner or midwife can get up to $20,000 in loans paid off for two years of service in a rural community- Studies have found that if a program can get someone to stay in a community for two years, there’s a high likelihood he or she will stay longer.
“Only so much we can do”
The good news in the healthcare professions is that the students who do graduate from Nevada programs tend to stick around. According to Carol Harter, president of the University of Nevada, Las Vegas, the majority of its healthcare graduates live in the greater Las Vegas metro area. The School of Medicine shows at least 30 percent of its graduates are staying in-state. The Orvis School of Nursing loses just three or four nurses to other states each year.
As Nevada’s population continues to grow, and as that population is notoriously unhealthy – ranking in the top five worst states in the categories of suicide rate, prenatal care, community hospitals, healthcare expenditures, childhood immunization, immoderate alcohol consumption, smoking and total mortality – the need for qualified healthcare professionals will become more and more pressing.
There’s no indication the state is prepared to meet that need adequately. The UCCSN numbers show eight occupational categories characterized by a substantial imbalance between both current and projected demand and supply of personnel, 11 occupations characterized by a significant imbalance and four categories with a rough balance. No healthcare occupations in Nevada are characterized by a surplus necessitating a reduction or elimination of existing UCCSN programs.
Currently the UCCSN offers healthcare education programs designed to train and prepare individuals to enter 21 of the 32 fields examined in the report. Of those 21, only six include plans for expansion of statewide capacity to meet growing needs. Those six include:
- Dieticians and nutritionists – according to campus master plans, UNLV is developing plans for a dietetics program (RD in dietetics) and a bachelor’s degree program in nutritional sciences;
- Registered nurses – through expansion of existing programs;
- Respiratory therapists – through expansion of existing programs;
- Dental hygienists – through expansion of existing pr(Jgrams, with Truckee Meadows Community College planning to develop an associate degree program;
- Radiologic technologists and technicians – still in the exploration stage;
- Nursing assistants – also still under exploration.
This includes two of the eight categories with substantial imbalances between supply and demand and three of the 11 categories with significant imbalances. More needs to be done.
”We are creating programs as fast as we can afford to,” says Harter, “but the need is outstripping our ability to fill it right now.” She cites resources necessary to hire faculty as one of the biggest obstacles in the state. Also, much of the equipment needed for teaching, as well as finding enough clinical sites for residencies, is hampering efforts to evade or minimize the coming shortfall. “Training is incomplete without the ability to be in a clinical setting,” she says. “Not just hospital-based, but also clinic-based or doctor’s office-based.”
Ann Diggins, director of recruitment of the School of Medicine, says the state needs to address the number of students who go on to college. “We’re one of the lowest [in terms of college attendance rates], and you can’t become a healthcare professional without going to college.” Her office spends a lot of time with kids as young as elementary school-aged. They go into the schools and get kids excited about science as early as possible and try to ensure their science education is a high-quality one.
Daugherty says officials and healthcare professionals also face an increasing obligation to look at the needs of Nevada’s growing elderly population more carefully. That care “demands a whole different healthcare system than taking care of young families,” he notes. ‘They require more resources and HEALTHCARE more time, so in many ways they are more costly.” He feels that a true master plan for healthcare would need to look at all areas of Nevada, see what each area needs and recruit appropriately depending on projections of each area’s growth.
More pediatricians and family practice professionals are the areas Lynch would like to see emphasized. She sees Sunrise playing a significant role in bringing in pediatricians as they see quality facilities exist in the state. The switch from specialists to family practice, she says, will be a natural pendulum swing in the career orientations of physicians. But the responsibility for the future healthcare of the state needs to be shared by the entire state, in her view. “It’s not a weed that just grows,” she says. “It has to be nurtured and respected, and there has to be a determination by the public of what they expect from it in the next 15 years. What place does it hold in their society? Where is it in their priorities?”
Hale wants to see fewer restrictions on training numbers. He would like to expand UMC’s residency program, but there is a cap on the number of residents whose costs are partially reimbursed under Medicare. Financial incentives to students are on his wish list, too. “I think the Millennium Scholarship program is an excellent idea. I would like to see us give some award to enter the healthcare field when they receive the scholarships.” Welch agrees, and the NAHHS has made just such a proposal to the governor.
Welch comes across more and more demands placed on the various professions, on staffing and facilities. With a growing and aging population, as well as reductions in reimbursements, it is bound to get worse. “We can’t magically make more nurses,” he says, “or turn on the money printing machine. There is only so much we can do.” Hopefully, with a united, concerted effort, that so much will be enough.