Spring 2012
Residency programs growing to meet state needs

synapse: University of Nevada, Reno School of Medicine

Three medical students

Kanchan Kanel, M.D., left, reviews medical information with fellow internal medicine residents Ahmad Eter, M.D., and Sheryl Yu, M.D., at UMC's Lied Clinic. Photo by Edgar Antonio Núñez

With a mandate to help meet the growing health care needs of Nevada, the University of Nevada School of Medicine significantly increases its offerings in graduate medical education programs in 2012.

By Anne McMillin, APR

Academic historians looking back on the 2011-2012 year will mark it as one of tremendous growth for residency programs at the University of Nevada School of Medicine.

A reallocation of residency slots, a new residency program and further outreach into Nevada's rural communities are pushing the School of Medicine's graduate medical education program to new frontiers within Nevada.

Cap increase

Working with partner hospitals University Medical Center of Southern Nevada and Renown Health, the School of Medicine is increasing its physician training program capacity this year, thanks to a reallocation of residency positions by the Centers for Medicare and Medicaid Services, a federal agency.

The Centers for Medicare and Medicaid Services announced this redistribution of more than 1,300 medical education slots under the Affordable Care Act's unused residency slot redistribution program last summer. A total of 58 hospitals nationwide, including UMC and Renown, are receiving additional residency positions, based on their applications for need.

"Because Nevada has a very low medical resident-to-population ratio, we ranked in the top 10 states nationwide to receive additional positions," said Miriam Bar-on, M.D., associate dean for graduate medical education, who spearheaded the effort for the School of Medicine working in collaboration with UMC and Renown officials. Seventy-five percent of these positions will be used to expand primary care residency programs.

"This redistribution of positions gives us the potential to increase our graduate medical education complement of medical and surgical residents and fellows from 283 to 354, an increase of 25 percent," she added.

For Nevada, this reallocation translates into 50 new positions at UMC in Las Vegas and 21 at Renown in Reno. The School of Medicine trains resident physicians at both hospitals.

School of Medicine residency programs increasing their complement of doctors as a result of the reallocation include internal medicine and family medicine in Reno and pediatrics, surgical critical care and internal medicine in Las Vegas.

Residency training location is a strong indication of where physicians will likely practice medicine following completion of their training and has strong implications for the future availability of health care professionals, research shows.

In recent years, nearly 60 percent of physicians who complete residency training in Nevada remain in the state to practice.

Otolaryngology

Last fall, the School of Medicine received approval for establishing Nevada's first residency training program for otolaryngology and earned a three-year accreditation cycle for the program from the American Council on Graduate Medical Education.

The five-year residency training program in head and neck surgery will begin in July following a search through the National Residency Match Program for a qualified candidate. The program will be based at the School of Medicine's partner hospitals, University Medical Center and MountainView Hospital, and various surgery centers across Las Vegas. One candidate will be added each year until the program is full with five residents.

The otolaryngology program resides within the School of Medicine Department of Surgery's otolaryngology-head and neck surgery division. William A. Zamboni, M.D., professor and surgery chairman said: "This is an example of the department's commitment to create new training programs in the surgical subspecialties so that School of Medicine students will have the opportunity to stay and train in Nevada."

The training program provides residents with education in comprehensive evaluation, as well as medical and surgical management of patients of all ages having diseases and disorders of the ears, upper respiratory and upper alimentary systems and related structures, and the head and neck.

The new program, led by faculty otolaryngologist Robert Wang, M.D., surgery professor and chief of otolaryngology, will follow ACGME program standards. Wang has been trained at Harvard University and M.D. Anderson Cancer Center and has more than 25 years of academic and clinical experience.

"This was an eight-year project to get going," said Wang, adding that faculty members were recruited and hired in that timeframe to support the program.

In addition to Wang's expertise in head and neck oncology, use of robotic surgical devices and thyroid/parathyroid surgery, Matthew Ng, M.D., a USC and Johns Hopkins fellowship-trained neuro-otologist; T.J. O-Lee, M.D., a Loma Linda University and Stanford University fellowship-trained pediatric otolaryngologist; and Paul Johnson, M.D., a general otolaryngologist; complete the division's faculty.

To complement the faculty ranks, Wang reached out to community physicians to get them involved and has been well received for his efforts.

"Our emphasis is on top-notch education for the new generation of otolaryngologists for Nevada and reversing the trend of sending patients out-of-state for treatment. We now attract tertiary level referrals from Utah, California and Arizona to our practices," Wang said.

Bar-on said she is particularly thrilled with the establishment of this highly competitive residency program.

"More than 99 percent of the ear, nose and throat residency positions nationwide are filled each year, so we expect our program to attract many highly qualified candidates," she said.

"The addition of this new program increases the portfolio of surgical specialty training programs offered by the School of Medicine and our affiliated hospitals to patients in the Las Vegas community."

Currently, there are 1.8 otolaryngologists per 100,000 people in Nevada; the comparable number for the U.S. is 3.3.

Rural network

The Nevada Rural Health Network, a partnership between the School of Medicine's Department of Family and Community Medicine in Las Vegas, the High Sierra Area Health Education Center, Humboldt General Hospital and Winnemucca-based physicians, formed last summer to bring education, training recruitment and retention opportunities to the health workforce in Nevada's rural communities.

Backed by a three-year, $540,000 grant from the Health Resources and Services Administration, the Nevada Rural Health Network blends a critical access hospital, frontier family medicine physicians and the School of Medicine's graduate medical education program together. Doing so will initiate a health workforce strategy that connects community practitioners to local health conditions and prepares trained physicians to work in areas affected by geographic disparities.

Kelly O'Shaughnessy, the network's director, said: "Once established, the Nevada Rural Health Network will serve as an education and health delivery hub for the rural northeast part of the state and support initiatives like the Advanced Life Support Obstetrics (ALSO) training program and the family medicine rural residency expansion."

An additional grant from the Health Resources and Services Administration will support Las Vegas-based family medicine residents working the final two years of their residency at Humboldt General Hospital beginning in 2013.

Already more than just a vision, the Nevada Rural Health Network, working in conjunction with faculty and staff from the Department of Family and Community Medicine, conducted an ALSO training course at Humboldt General Hospital in the fall of 2011.

The course is designed to enhance the skills of health care providers to manage potential obstetrical urgencies and emergencies effectively, a needed skill in rural areas where distance plays a significant role in access to medical care.

It emphasizes labor and delivery room emergencies but also covers prenatal risk assessment, first-trimester complications, miscarriages, assisted deliveries, vaginal bleeding in late pregnancy, risk factors for preterm labor, consultant relationships and patient safety.

One challenge faced by rural health care workers covered in the course was practical methods for addressing labor and delivery in the back of an ambulance on rural roads.

Seven paramedics, two emergency medical technicians, four nurses and two family medicine physicians, all based in Winnemucca, participated in last fall's ALSO training which also yielded a local certified program instructor: family medicine physician Brad Granath, M.D.

In addition to earning his ALSO instructor certification, Granath has been selected as the site director for the Winnemucca residency program, where Kurt Kracaw, M.D.'90, will serve as the assistant site director. Both are local Winnemucca-based community physicians.

Other Winnemucca community physicians are volunteering for residency rotations.

Debi Bell, RN, who is also based at Humboldt General Hospital, serves as the rural training track residency coordinator.

O'Shaughnessey said this is a wonderful time to be working with Humboldt General Hospital because of recent expansion efforts at the hospital: a new walk-in clinic and clinical office spaces as well as strong support from Winnemucca's elected leaders and the community.

Long-term outcomes for the rural network include increased access to care for underserved populations, more physicians electing to practice primary care in rural communities and increased access to educational opportunities for Humboldt County health care professionals.

"It is exciting to bring improved care access to rural citizens and work toward achieving the school's goal to provide medical care for all Nevadans," O'Shaughnessey said.

"It is our hope that the network's efforts in Winnemucca will serve as a pilot for similar endeavors in other rural communities."