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It’s hard enough to find a good doctor in the cities of Nevada, which ranks 48th in the country for doctors per capita.
So imagine living in rural Nevada, where towns with a limited economic base can’t find doctors and nurses who want to work there.
Desert Companion magazine reported that seven rural hospitals in Nevada are now vulnerable to closure.
Some have already closed. When the only hospital in Tonopah closed last year, residents had to drive 100 miles for checkups in Hawthorne, Nevada, or Bishop, California.
"In Tonopah, it is a crisis," said Donna Miller, a co-owner of LifeGuard International, a flying ICU company.
Miller and her team of pilots, nurses and paramedics had to modify their role in the community of Tonopah after the hospital closure, becoming a crucial part of the emergency dispatch process.
The current model, however, is not a sustainable one.
"Usually we are paid by insurance companies," Miller said. "But in Tonopah, that's not necessarily an option."
According to Miller, only about 20 percent of the area's 2,500-odd population actually have commercial insurance.
But making the decision to leave isn't an easy one.
"I'm a nurse, and you become part of the community," Miller said.
As of Aug. 8, however, LifeGuard International will no longer operate as the primary dispatch for Tonopah.
A little farther south, in Beatty, Nev., residents do have the Beatty Medical Clinic. But thanks to a change in ownership last year, the for-profit status made it tough for at least one nurse practitioner to continue her work.
Diane McGinnis, a Doctorate of Nursing Practice who now works for Searchlight Healthcare in Henderson, used to make the 132-mile trip to Beatty from her home in Las Vegas on Sunday evenings, and then return on Fridays to spend the weekend with her family.
"I grew up in a small town in Idaho, so I feel the need," McGinnis said.
McGinnis also operates her own house-call business, called McGinnis Mica Medical, where she meets patients where they need her on a case-by-case basis.
Filling health care needs in rural areas is not a new problem, nor a Nevada-specific one. Everyone is competing for the same workforce.
Which is why Melissa Piasecki, the exective associate dean of the University of Nevada Reno School of Medicine says the best solution is to "grow your own."
"The best way we know is to help people see the need," Piasecki said. "All of our fourth-year medical students have a required rural rotation, where they go into different communities and have this rural health care experience where they provide care to patients side by side with a local provider."
If there is no local provider, however, that's another story.
The university has programs such as Project ECHO, which aims to increase the capacity for specialty care between a specialist and a group of primary care providers.
Other solutions, such as telemedicine, are also starting up. But telemedicine machines require one very important component - internet.
"Being in Tonopah, right in the middle of town, you may have the luxury of having internet, but outside of that area there is no internet access," Miller said.
There's no easy solution for this growing crisis. Rural residents needing medical attention are having to drive further and wait longer than ever before - especially in such a geographically dense state as Nevada.
Federal grant programs can be a good incentive - but in McGinnis' case - disappeared with the new clinic ownership.
McGinnis and Miller are both active in the state's legislature, working with representatives of the local and state level to come to solutions. As usual, it all comes down to funding, which may or may not exist.
Melissa Piasecki, executive associate dean, University of Nevada, Reno School of Medicine; Donna Miller, RN, owner, Flying ICU; Diane McGinnis, DNP, Searchlight Healthcare