VA Medical Center battles doctor shortage

In a nutshell, that’s the dilemma VA Southern Nevada Healthcare System Director Isabel Duff faces as she tries to stave off criticism from veterans who complain about long waits and canceled appointments. She said appointments are prioritized based on a patient’s condition and availability of doctors for specialized needs.

“People do have priority for care and how those get appointed,” Duff told the Review-Journal in an interview last week at the $1 billion medical center that opened almost two years ago. “There are some specialties that we want to provide further enhancement in services.”

She said pushing back appointment times for nonemergency care doesn’t necessarily translate to shoddy care.

However, some delays have resulted in what the VA describes as “adverse events” in which a patient’s care was suspected of resulting in death or serious injury. There were more than 500 of those cases at VA facilities nationwide last year, according to a statement Friday from the U.S. House Veterans Affairs Committee, but only one such case was reported by the VA in Las Vegas.

The committee, chaired by Rep. Jeff Miller, R-Fla., has had hearings and launched probes into scandals in which whistleblowers at the Phoenix VA medical facility and elsewhere were accused of keeping two sets of appointment documents, one that tracked actual excessive wait times and another set sent to headquarters that showed timely appointments in order for administrators to obtain bonuses.

Former VA Secretary Eric Shinseki resigned in the face of those and other allegations about failure to hold top VA officials accountable.

As morale dwindled, some physicians quit there jobs including one recently at the North Las Vegas VA Medical Center.

Duff confirmed that a doctor walked off the job two weeks ago for unknown reasons but declined to name him, citing privacy laws. “I don’t have any information about the one physician.”

MORE DOCTORS SOUGHT

Duff noted, however, that the number of doctors has increased by six since last year to 190, and an effort is being made to bolster the medical staff through incentive hiring and the prospect of increasing residency training programs with the University of Nevada School of Medicine and a fledgling medical school program planned for UNLV.

“We are increasing in the number of veterans that we take care of here at an unprecedented (annual) growth rate of 12.6 percent. The percentage increase in our nation is 0.8 percent. That translates into probably about 7,000 new veterans that are going to join our ranks by the end of this fiscal year,” she said.

As of September there were 48,588 veterans enrolled in the VA Southern Nevada Healthcare System and 184 medical doctors, or one doctor for every 264 patients. There are also 10 nurse practitioners, one doctor of osteopathy, and 12 physician assistants, four emergency room doctors, two emergency physician assistants and 10 contract emergency room medical professionals.

A recent government audit of scheduling practices at VA facilities found that the lack of doctors increases wait times for veterans to receive health care.

The American Medical Association projects a nationwide shortage of 62,900 physicians in 2015. If the trend continues there will be a shortage of 130,000 physicians by 2025.

And Nevada, Duff noted, is among the lowest-ranking states for the number of physicians relative to population. Currently Nevada ranks 46th for general and family practitioners, and 50th for psychiatrists.

Asked whether the reluctance of doctors and their families to move to the Las Vegas Valley is attributable to the notion that public schools are not held in high regard, Duff said, “As we know, Las Vegas may have a different perception (than) the rest of the nation.

“Many people will say to me they never knew that anything existed beyond the Strip. So they have a perception of what Las Vegas is,” she said. “If you do have a family, you’re going to search out the schools, you’re going to search for those amenities and the environment that you want for a family. Unfortunately, some of what gets presented in the media is not always very favorable for Las Vegas.”

LOOKING TO RESIDENCY PROGRAMS

In June, Rep. Dina Titus, D-Nev., introduced legislation with colleagues on the House Veterans Affairs Committee aimed at reducing the doctor shortage.

The Underserved Veterans Access to Health Care Act would increase veterans’ opportunities to obtain timely health care by adding 2,000 residency positions at VA hospitals in areas such as the Las Vegas Valley, El Paso, Texas, and San Bernardino County, Calif. Residency training is designed to groom doctors for specialty fields such as internal medicine, cardiology and psychiatry.

Duff, who earns $173,600 per year not counting an $8,680 bonus for last year, said she hopes that more emphasis on residency training and more specialized fellowship programs will help cure the shortage.

“Most VAs have an affiliation with a medical school and a residency training program. And that is a critical gap here for the Las Vegas community and our VA,” she said. “Medical schools and residency training programs bring providers in that have a different bend to the reasons they practice medicine. They’re more mission-driven. They’re interested in academia, in teaching, (and) research.

“Obviously their mission, their purpose for going into practice is not as much economic as it is those other mission drivers. And we don’t have that here,” she said.

Dr. Miriam Bar-on, University of Nevada Medical School’s associate dean for graduate medical education, said there are currently three residency training positions and two fellowships in a program that works collaboratively with the VA Medical Center and University Medical Center in Las Vegas. As the participants advance into specialized fields, she hopes they will remain where they were trained.

“Our goal is we would like to keep our doctors in Nevada,” Bar-on said Friday.

The medical school that educated them has 73 students and is associated with the University of Nevada, Reno, where they spend their first two years.

FUTURE: UNLV MEDICAL SCHOOL

But help is on the way too at the University of Nevada, Las Vegas where the planning dean for the School of Medicine, Dr. Barbara Atkinson, would like to see more residency training spots open up locally and particularly at VA Medical Center’s North Las Vegas campus when the first medical students hopefully begin undergraduate classes at a university educational building in 2017.

“Right now for every medical student that graduates, there’s not a spot for a residency program. They have to wait a year. This kind of thing helps fix that problem,” she said about the potential at VA facilities.

“We’d definitely like to be a partner and we think they’d like to be a partner,” she said about the local VA medical staff.

“We see them as a very important partner and this will help them recruit doctors to teach, recruit and do research,” said Atkinson, who started in May after being the dean of the University of Kansas medical school for 10 years.

A team from her office has planned to meet this week with the local VA medical staff chief Dr. Ramu Komanduri.

“They really do need more doctors, and they are growing so fast,” Atkinson said. “It has been hard for them to catch up.”

Contact Keith Rogers at krogers@reviewjournal.com or 702-383-0308. Find him on Twitter: @KeithRogers2.