Winter 2019
Filling Health Care Gaps in Wide-Open Spaces

synapse: University of Nevada, Reno School of Medicine

Filling Health Care Gaps in Wide-Open Spaces

Photo: Brin Reynolds

UNR Med expands access to health care in rural and frontier Nevada

By Tessa Bowen

Nearly one in every five Americans lives outside the hustle and bustle of urban living. In Nevada, choosing a quiet life has its advantages, with communities located among some of the state's most desirable and picturesque landscapes. Those who call the more rustic side of Nevada home have the opportunity to work and raise a family while enjoying a relaxed, peaceful lifestyle, including an abundance of year-round outdoor adventure.

Nevada, the seventh largest state by area, is 110,000 square miles - with the urban centers of Reno to the north and Las Vegas to the south drawing nearly 90 percent of the state's three million occupants. With a No. 47 ranking in the U.S. for physicians per capita, access to basic health care in Nevada is already limited. Living in one of the many rural communities sprinkled throughout the Silver State can be a downright challenge.

Doctor shortages, from primary care to obstetrics, hit wide-open places hardest. Fewer people means less patient demand for a host of medical services. Though in some ways, there's more need per individual, as residents in rural communities tend to be older on average than those in urban areas.
And when it comes to finding specialty health care - rural Nevadans have to look even farther. For the 300,000 rural Nevada residents, it's not uncommon to have to drive 300 miles for specialty health care.

"Improving health care access in rural areas of Nevada will require addressing a complex set of issues," said John Packham, Ph.D., associate dean, Office of Statewide Initiatives at UNR Med. "It's a hospital issue, a hospital staffing issue, a Medicaid reimbursement issue, a physician workforce issue, and a physician burnout issue. The list goes on in terms of the rural health care issues and we need to get back to the foundations that we are training family physicians to be adequately equipped to provide quality care in rural areas."

Elko Family Medicine Residency Program opens

Rural Nevadans now have more options and resources for their health care, thanks to a new Elko Family Medicine Residency Program that launched in July 2018. The University of Nevada, Reno School of Medicine and Nevada Health Centers (NVHC), who are partnering on the residency program to expand health care for local residents, celebrated the official grand opening of the Elko Family Medicine Residency Program in October 2018.

The Elko Family Medicine Residency Program aims to increase the primary care physician workforce in Elko and the surrounding areas, through the training of resident physicians under the supervision of experienced UNR Med faculty physicians.

Nevada's ranking near the bottom of all states in physicians per capita is attributed largely to the critical shortage of graduate medical education (GME) positions in the state. The residency program is an example of a new and expanded training program made possible by a $1.4 million grant from Governor Brian Sandoval's Task Force on Graduate Medical Education, approved during the 2015 legislative session to address this physician deficit.

The program is based within a newly renovated section of the Elko Family Medical and Dental Center at 762 14th Street in Elko, with resident physicians and UNR Med faculty physicians seeing patients and Nevada Health Centers managing daily clinic operations.

Daniel Spogen, M.D., chair of UNR Med family and community medicine, and Richard Williams, M.D., UNR Med residency program director, oversee the Elko Family Medicine Residency Program medical staff, which includes UNR Med clinical faculty Steve Lore, M.D., and Jacqueline Huynh, M.D. The program currently includes four residents, which will expand to six residents in July. It is anticipated that six residents will serve the needs of approximately 6,000 Elko patients. The average resident will see approximately 35 patients per week in the clinic.

Residency training location is a strong indication of where physicians will likely set up their medical practices following completion of residency and has strong implications for the future availability of health care professionals in a given area.

Tower on main street in Elko

"The Elko Family Medicine Residency Program is a prime example of UNR Med's commitment to expanding health care access to rural Nevada and providing exceptional care for rural residents," said UNR Med Dean Thomas L. Schwenk, M.D. "We are extremely pleased to team with NVHC to extend our medical training and clinical care reach to Elko and surrounding communities, and we thank Governor Sandoval and the Graduate Medical Education Task Force for their support in expanding these resident programs."

The Elko Family Medicine Residency Program benefits rural Nevadans through comprehensive family medicine outpatient care services. Family medicine is a specialty that is devoted to comprehensive health care for people of all ages. It is a division of primary care that provides continuity of care for all ages, genders and diseases. It emphasizes disease prevention and health promotion for the entire family. Family physicians are the first contact for many patients.

"We're thrilled about opening a clinical practice which will not only serve the health needs of rural Nevadans but also educate future health care providers about the importance of collaboration and continuity between family medicine and other medical specialties," said Walter B. Davis, MBA, president and CEO of Nevada Health Centers. "We strive to provide access to quality health care services throughout Nevada."

Graduate medical education programs play a critical role in training future doctors and are key to addressing Nevada's physician shortage. According to the Association of American Medical Colleges, data shows a 77 percent likelihood that a medical student who completes medical school and rural residency training in Nevada will remain in the area to practice.

National Rural Health Day summit led by UNR Med

The National Organization of State Offices of Rural Health sets aside the third Thursday of every November to celebrate National Rural Health Day. In honor of Nevada's rural health care providers, and to highlight the unique health care needs of rural Nevada, Governor Brian Sandoval proclaimed November 15, as Nevada Rural Health Day.

On the same day, the University of Nevada, Reno School of Medicine (UNR Med) Office of Statewide Initiatives, Nevada State Office of Rural Health and Nevada Rural Hospital Partners hosted CEO's and clinicians from nearly 20 rural Nevada communities at a Rural Health Day summit to address the challenges and solutions to the statewide shortage of primary care doctors and specialists. Health care leaders discussed ways to reduce the disparities in rural access to care.

Joining UNR Med leadership at the summit were leaders from Great Basin College, Orvis School of Nursing, UNLV School of Nursing, Truckee Meadows Community College, UNLV School of Medicine, Roseman Health Sciences University, Touro University, Nevada Rural Hospital Partners, Nevada Hospital Association, and the Nevada Primary Care Office.

The group addressed top health care challenges, including workforce in primary care, nursing and mental health and creating a pipeline for recruiting and retaining the next generation of health care providers; access to primary care and mental health services and financially stressed rural hospitals and clinics.

Project ECHO helps bridge Nevada's health care gap

One solution for areas short on doctors is Project ECHO, an acronym for Extension for Community Healthcare Outcomes.

Project ECHO connects University of Nevada, Reno School of Medicine faculty physicians and specialists to primary care providers in rural and under-served areas, extending specialty care to their patients with chronic, costly, and complex medical illnesses.

By putting local clinicians together with UNR Med specialist teams during weekly virtual clinics or teleECHOTM clinics, Project ECHO shares knowledge and expands treatment capacity. The result: better care for more people.

Project ECHO telehealth services vary from helping providers with a diagnosis to choosing a prescription for minor medical issues, to ongoing management of chronic conditions, especially helpful for older Nevadans. Patients' lab results, current prescriptions, and other key health data are sent from their primary care provider for Project ECHO specialists to review during the virutal clinic sessions.

Project ECHO is an alternative to costly travel and long waits for patients who need specialty care in the antibiotic stewardship, diabetes and general endocrinology, geriatrics, mental health, pain management and sports medicine.

An early Project ECHO adopter, UNR Med is now one of more than 220 sites worldwide replicating Project ECHO telehealth solutions and changing how millions receive health care who would otherwise go without.