In Focus: Primary Care Physicians in Nevada
Primary care physicians provide direct patient care and counsel patients on the appropriate use of specialists and advanced treatment options. They are often a patient’s first point of contact with the health care system and provide critical preventive care and treatment for chronic disease. Having a sufficient number of primary care physicians leads to better health outcomes in a population, including lower rates of low birth weight, lower all-cause mortality, as well as lower utilization of more expensive services delivered by specialists or hospitals.
By 2030, the estimated national shortage of primary care physicians is estimated to be between 7,300 and 43,100.1 Several factors are behind this trend, including a growing and aging population, a growing number of primary care physicians retiring, and compensation disparities that encourage medical students toward higher-paying specialties.
The shortage of primary care physicians is particularly acute in Nevada, where less than 108 primary care physicians are available for every 100,000 population.2 Primary care physician distribution is especially limited in rural counties,3 and is compounded by an aging and growing population in the state. To simply maintain the current primary care usage rates, Nevada will need almost 850 additional primary care physicians by 2025.4
Cultivating Tomorrow’s Primary Care Physicians
To help address the shortage of primary care physicians and better prepare medical students for care delivery, many medical schools have adopted a Longitudinal Integrated Clerkship (LIC) model of training. Under the LIC model, students develop core clinical competencies across multiple disciplines by participating in care delivery for a consistent cohort of patients over time. Approximately 45 medical schools offered LICs in 2016, growing from 29 schools in 2011.5
Longitudinal medical education emerged in the early 1970s as a response to rural medical workforce shortages, and has evolved to multi-month clerkship model.6 Evidence indicates that students who participate in LICs – particularly in rural areas – are positively influenced towards primary care and rural career choices as a result of their clerkship experiences.7
Modernizing Primary Care in Nevada
To help meet the demands of a growing and aging population, the University of Nevada Las Vegas School of Medicine (UNLV SOM) was established in 2014, with its inaugural class of 60 students commencing study in the fall of 2017.
To help prepare students to deliver care for the area’s diverse population, and supported by a $3 million, five-year grant from United Health Foundation, UNLV SOM is incorporating an 18-month Longitudinal Integrated Clerkship model into its curriculum for 3rd year medical students. The LIC allows students to engage with patients in an outpatient clinic under the supervision of faculty and residents, and simultaneously grow their knowledge of multiple specialties.
Additionally, to grow the region’s access to primary care, UNLV SOM is creating three multi-specialty community clinics. These clinics will serve as the clinical training sites for the LIC model.
[1] “The Complexities of Physician Supply and Demand: Projections from 2015 to 2030, Final Report. Association of American Medical Colleges,“ February 2017.
[2] America’s Health Rankings Annual Report, 2017.
[3] Health Workforce Supply in Nevada. University of Nevada, Reno School of Medicine. March 2017.
[4] State-level projections of primary care workforce, 2010-2030. Robert Graham Center, September 2013.
[5] “Number of Medical Schools O ering Longitudinal Integrated Clerkships.” LCME Annual Medical School Questionnaire Part II, 2012-2013 through 2015-2016. AAMC.
[6] Outcomes of Longitudinal Integrated Clinical Placements for Students, Clinicians, and Society. Medical Education, 2012.
[7] Outcomes of Longitudinal Integrated Clinical Placements for Students, Clinicians, and Society. Medical Education, 2012.