Fall 2013
Rural Nevada: Serving our third campus

synapse: University of Nevada, Reno School of Medicine

Rural Road in Nevada

In spite of vast distances between populations, the School of Medicine has formed partnerships with rural communities to bridge that distance and serve the health care needs of rural Nevada communities. Photo by Keith Clark

The University of Nevada School of Medicine’s mission to serve the health care needs of all Nevadans truly is tested by the state’s widely dispersed population centers spread over an enormous landmass.

By Anne McMillin, APR

To better serve the rural communities, the School of Medicine created the Office of Statewide Initiatives as the umbrella office to coordinate the numerous programs encompassing a statewide impact.

These programs include the Office of Rural Health, the Nevada Office of Health Professions Research and Policy, the Nevada Health Service Corps, Nevada Area Health Education Center Program, and continuing education programs.

The office supports the academic and clinical missions of the School of Medicine through partnerships with specific departments and throughout the Nevada System of Higher Education.

“The School of Medicine has three campuses: Las Vegas, Reno and our rural communities. Our office’s role is to integrate these rural communities into the University of Nevada School of Medicine in a broad way through programs, service and outreach,” said Evan Klass, M.D., associate dean for statewide initiatives.

“We have historically offered continuing medical education programs, technical assistance and conferences to Nevada’s rural communities, but we want to link providers to the School of Medicine in a more comprehensive way.”

To illustrate the importance of the School of Medicine’s third campus, the School of Medicine has had administrative offices and programs located on the campus of Great Basin College in Elko since 1989.

According to Gerald Ackerman, who directs the Elko office: “Having an office here has allowed Elko to become a major teaching site for the School of Medicine. An example of this is the clerkship in which two third-year medical students spend 16 weeks in Elko training with internal medicine and pediatric physicians in the community. Having this office has also allowed a rural site to participate in the third year training just like Las Vegas and Reno.”

Nevada State Office of Rural Health

The Nevada State Office of Rural Health was created by the state legislature in 1977 with a mission to assist rural communities. The Elko-based office provides coordination and technical assistance for rural Nevadans seeking health resources, conducts community development activities and advocates for rural health issues.

“We are about working in partnerships and that has always been one of our strong points,” said Ackerman.

Annually, the office has contact with more than 50 communities statewide, facilitating activities including education and training, technical assistance to hospitals, clinics and health professionals, emergency management services, health policy and workforce development and analysis activities.

Two federal grant programs, the Rural Hospital Flexibility Program and the Small Hospital Improvement Program, provide financial and operational technical assistance to Nevada’s 15 rural and frontier hospitals.

Technical assistance from these grants is designed, implemented, and evaluated in close collaboration with the Nevada Rural Hospital Partners, an organization established out of a School of Medicine grant proposal and charged with supporting the viability of its member hospitals through shared services, resources and advocacy.

“We work collaboratively with the medical school through these two grants to improve processes and quality through procuring equipment, financial assistance and implementing best practices among our member hospitals,” said Joan Hall, president of the Nevada Rural Hospital Partners.

She added that her organization’s member hospitals benefit from resources derived from these grants to meet reporting requirements of Medicare.

Nevada Office of Health Professions Research and Policy

Under the direction of John Packham, Ph.D., the Nevada Office of Health Professions Research and Policy assists health care institutions and policymakers understand and meet Nevada’s need for well-prepared health professionals and to better inform public and private investments in Nevada’s health workforce and health care system.

Current office activities focus on health workforce research and analysis, health sector economic impact analysis and financial feasibility assessments, rural data collection and analysis, and coordination with state and national health workforce planning. The office produces the Nevada Rural and Frontier Health Data Book on a biennial basis which serves as the planning reference at all levels of the state’s health care system.

“That book is very helpful in strategic planning, as we go to write grants and for our community health needs assessments,” Hall said.

Nevada Area Health Education Center Program

The mission of the Nevada Area Health Education Center program, established by the Nevada Legislature in 1987, is to enhance access to quality health care, particularly primary and preventive care, by improving the supply and distribution of health care professionals through Nevada. The program reaches out to areas with shortages of health care professionals offering continuing education classes, information services, student programs, library services and innovations in distance linkages to provide better practice opportunities for rural health practitioners. Examples of current programming include:

On-line Emergency Medical Services Education Program in partnership with the Nevada State EMS Office and local county EMS services. An on-line program was developed for coursework to facilitate workforce increases statewide in EMS. This program has had a direct positive impact on the shortage of providers in volunteer EMS services across the state. The School of Medicine also has sponsored Nevada’s rural EMS conference for more than 20 years, providing education and training to rural and frontier first responders.

Sexual Abuse Response Team Program in collaboration with the State of Nevada Division of Child and Family Services and community members. The SART program offers telemedicine linkages and support for a local practitioner providing forensic examinations in Elko. This program improves the ability of local law enforcement to respond to reports of child sexual abuse and helps the physician to work toward the optimal physical and mental health of young victims. SART service has expanded to White Pine and Lander Counties, and will be expanding to Eureka County.

Medical student and resident training support The Area Health Education Center program supports medical students by coordination of rural clinical rotations, and provides housing and support for health professions students from multiple training programs. This support is made possible through partnerships with rural hospitals and rural clinician faculty.

Telemedicine, telehealth and special projects

The Office of Statewide Initiatives partners with agencies to increase telemedicine and educational services using distance technologies, with a current focus on access to mental health services. Partner agencies include the State Health Division, the Nevada System of Higher Education and its institutions, State of Nevada Rural Clinics, Access to Health Care Network, Communities in Schools, Renown Regional Medical Center, Nevada Rural Hospital Partners, Indian Health Services and numerous rural hospitals and clinics.

Project ECHO Nevada, an interactive telehealth system, connects rural providers with School of Medicine faculty to extend specialty services for management of complex, chronic health problems including diabetes, arthritis, infectious diseases and mental illness. Regular clinic attendees include practitioners in Ely, Hawthorne, Pahrump and Carson City.

Nevada Health Service Corps

The Nevada Health Service Corps, established in 1989, was created to help recruit health care practitioners for rural and frontier communities across Nevada. The program supports health care professionals including doctors, dentists, nurse practitioners, physician assistants and others with a willingness and desire to practice in underserved areas.

The Nevada Health Service Corps links underserved communities with professionals who receive loan repayment funds. According to Keith Clark, program administrator for the Nevada Health Service Corps, more than 100 physicians have benefitted from this program and have collectively given years of service to the state’s rural and underserved communities.

William Katschke, M.D., a family medicine practitioner who returned to Lincoln County to establish his practice in Caliente, said the Nevada Health Service Corps loan repayment program has been a “perfect fit” for him.

“The program has eliminated my financial burden in 10 years instead of the usual 30 years and been a huge help to me and my family,” he said.

“It has allowed me to return home and kept me here to build a practice with three physicians, one physician’s assistant and a medical building. The Nevada Health Service Corps has helped our community and opened possibilities and access to health care for our patients,” he said, adding: “I’ve been able to recruit other physicians to come here through this program.”

Continuing education

Continuing education is provided to health practitioners statewide as part of the ongoing commitment to ensure high quality care for all Nevadans. Working under the Office of Statewide Initiatives, the Area Health Education Center, the Nevada AIDS Education and Training Center and the Nevada Geriatric Education Center each provide targeted education and trainings reaching hundreds of practitioners and granting thousands of hours of continuing education each year.

The Nevada AHEC provides a broad array of educational topics through live and interactive video programming. An ongoing collaboration with the Nevada Nursing Association and the School Nurses Association enables targeted trainings for special education needs. A similar collaboration with the Veteran’s Administration resulted in a statewide training project addressing veteran’s mental health issues.

The Nevada AIDS Education and Training Center, directed by Patricia Charles, Ph.D., is part of a federally-funded nationwide network of programs whose mission is to provide up-to-date scientific and clinical care information and education to health professionals. The center serves as a statewide resource to health providers treating people living with HIV/AIDS through multi-disciplinary education and training programs and linkages to the most current information to assist them in the provision of high quality, compassionate care.

The Nevada Geriatric Education Center, under the leadership of Patricia Swager, is a federal-state joint venture committed to improving the health of older adults through continuing education, information, resources to health professionals and by forming partnerships with agencies across the state.

The Office of Statewide Initiatives supports the academic and clinical missions of the School of Medicine as demonstrated with its close partnership with the Las Vegas family medicine department, which has resulted in several successful outreach efforts, including:

Advanced Life Support in Obstetrics Program Since 2007, this program has provided training in obstetrical emergencies using simulation to enhance the skills of maternity care providers. To date, this program has trained more than 180 Nevada providers, 38 percent of whom are from rural communities, and 42 providers have been trained at the instructor level.

Care Team OB Focused on patient safety in maternity care units of hospitals, this program has trained physicians and nurses in Winnemucca at Humboldt General Hospital, as well as hospitals in Las Vegas and Reno. To date, 18 physicians and 30 nurses have been trained, and expansion to four additional hospitals is planned for 2014.

Rural Residency Training Program A partnership between the School of Medicine and Humboldt General Hospital has enabled the development and implementation of a rural specific training track for medical residents. Program accreditation is expected to occur this year with the first class of residents beginning training summer 2014.

Nevada Radiation Exposure Screening and Education Program Provides statewide access to health care and detection of cancers for individuals who lived downwind of the Nevada Test Site during atmospheric nuclear testing, and former test site workers, to learn more about their health status as it relates to possible exposures to radiation. The program annually provides more than 1,525 health screenings and assistance to more than 500 people applying for federal compensation.

Joan Hall best sums up the impact of the School of Medicine’s rural and frontier outreach initiatives: “All of Nevada’s rural communities have benefitted in one specific way or another, at one time or another, from the School of Medicine’s service and we are very grateful for its presence in our state.”

Nevada Rural Health Day

St. Mary's Art and Retreat CenterPhoto by Nolan Reese

As part of a national effort to bring attention to the health care needs of rural America, the School of Medicine is partnering with the National Association of State Rural Health Offices to host the Third Annual Nevada Rural Health Day at the site of Nevada’s oldest standing health care facility.

This year’s celebration will honor some of Nevada’s health care providers who have had a significant impact over time on improving health in the state’s rural and frontier communities.

Nov. 21, 2013 1:30 p.m.
St. Mary’s Art and Retreat Center (Formerly St. Mary Louise Hospital), Virginia City

For more information

Susan Hill
Director, Marketing and Communication, Division of Health Sciences and School of Medicine
(775) 682-8567

Gerald Ackerman
Statewide Director, Area Health Education Center
(775) 738-3828

Nevada 150th Anniversary of Statehood logo.