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Charting The Future Of Health Care In Rural Nevada

In the fall of 2015, Tonopah’s hospital closed, leaving thousands of central Nevada’s rural residents with no urgent care for a hundred miles. It became the symbol of a rural health care crisis that stretches beyond Nye County, to the four corners of the state.

But some in the medical community had already seen this crisis coming, and started looking for solutions -- from telemedicine to rural residencies. 

Gerald Ackerman is a University of Nevada, Reno, assistant dean and director of the state's Office of Rural Health. 

He said it's difficult to bring health care to a small community with just a few residents. Many hospitals and clinics are struggling because of the razor-thin margins and the difficulty of finding a workforce to staff their facilities

"It's difficult when you're in a little town like Lovelock, Nevadam to compete with the great big metropolitan medical center in Reno or Las Vegas," he said.

Ackerman's office is focused on fixing that workforce issue with a host of training programs designed to bring more health care professionals to underserved areas.

Area Health Education Centers offer training and experience in team-based care for people already working on a degree or certification as a health care professional with an eye to rural areas and underserved urban areas in Las Vegas and Reno.

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They are also focused on finding potential students who are either from a rural area or willing to give it a try.

Ackerman explained that recruiting someone who already understands a rural lifestyle is one of the best ways to fill the workforce gaps.

"There is nobody better to support the Austins ... or the Elys (Nevada) of the world than somebody who might have graduated from high school there, and goes to UNR, UNLV, or Nevada State College or Truckee Meadows, does their training, and then they come back to that community," he said. "They know what it's like, they probably have family there."   

Ackerman said people who grow up in rural areas aren't shocked by the lack of services and amenities.

UNR has also established a program that offers residencies at rural health centers. Generally, doctors end up staying in or near the communities where they did their residencies. University officials and the hospitals they have partnered with hope more residents will choose to stay in rural areas after working there.

While a lot is being done to improve the health care infrastructure in the rural areas of the state, there are still stumbling blocks.

Phil Tobin is the director of the School of Physician Assistant Studies at Touro University. The school is expanding that school as the demand for physician assistants or PAs continue to grow.

He said Touro University would like to get more students into rural areas for training, but there aren't places to live.

"The thing that holds us back is living arrangements," Tobin said, "As soon as our students are going to start doing their clinical rotations, we ask, are they from a rural area that we have a preceptorship set up in."

He said currently Caliente has a place that is attached to the hospital, but in other places like Tonopah, a student might have to rent a hotel room, which gets expensive over time.

PAs can be more cost-efficient than doctors because it takes a lot less money and training to become a physician assistant, but they can perform all of the same functions as primary care physicians. 

When something is beyond their abilities and training, they call on doctors and specialists to help.

A growing program could help with that aspect of health care in rural Nevada. Project ECHO connects primary care physicians in rural and underserved urban areas with groups of specialists through telemedicine connections.

Dr. Mordechai Lavi is the medical director for the project in Nevada. He said the program works to multiple the efforts of health professionals.

"Project ECHO is great for improving health care capacity and can potentially kind of make mini-experts in certain disease processes if they have continued participation in our clinic or months to years," he said.

He said it will help to improve a doctor, nurse, nurse practitioner or physician assistant's ability to learn something more about a subject and get direct feedback from specialists on a patient's case.

Guests

Phil Tobin, Director and Professor, School of Physician Assistant Studies, Touro University Nevada; Gerald Ackerman, assistant dean, rural health, UNR School of Medicine Office of Rural Health; Dr. Mordechai Lavi, Medical Director, Project ECHO, UNR Med  

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