Nearly 65% of Nevadans live in an area that has a shortage of primary care healthcare professionals.

That's according to the Nevada Health Workforce Research Center at the University of Nevada, Reno School of Medicine.

Yet, at the same time, a recent report from the nonprofit nonpartisan Wynn Center claims that Nevada has made considerable progress in expanding its licensed healthcare workforce in just the past decade.

This is not a discrepancy, though, and here to explain why is John Packham, Associate Dean of the Office of Statewide Initiatives at the University of Nevada, Reno School of Medicine.

Thank you for joining Nevada Week.

-Happy to be here.

-Okay, so how can both of those make sense?

(John Packham) Well, the research center has been documenting provider shortages across the state, in Clark County, rural areas, and so forth for the better part of three decades.

What we've also been tracking is progress we've made as a state in addressing those shortages, what policies work, and, as the Guinn Center report that I'm collaborating on indicates, what's moving the needle.

And not just in Nevada, what policies at the state level can we take to alleviate those shortages, recruit and retain providers, including physicians, registered nurses, allied health to the state of Nevada.

And I'm a little bit bullish in the sense that we know what works.

And the big issue is, do we have the resources and the political will to carry that out?

And what we hope to do with the study that I'm working on with the Guinn Center over the coming year is to inventory those so that, anticipation of the next legislative session, we can bring some well-vetted solutions to addressing these issues.

-You're already thinking about 2027.

-Yeah.

-And we're in 2025.

But the reason that this seeming discrepancy exists is that population just continues to boom here in Nevada, and you can't keep up with that pace.

-Yeah.

And the population growth obscures that progress, because what we've seen in the state, if we look just at the physician workforce or the registered nurse workforce, we've made really steady gains in increasing the number of licensees, producing more here in the state, but also attracting them from other states and jurisdictions across the country.

The problem is that we've barely been keeping pace with population growth.

The State of Nevada over the last 20 years has been 1 or 2 in terms of ranking for the fastest growing states in the country.

And so it's kind of what I would call a "treading the water" effect, in that we're making progress, we know what works, but we're up against population growth.

And I would also add population aging that generates demand for specialty care in a wide range of services that are needed by an aging population.

-And the amount of people that are moving here who are over 65 years old-- -Continues to increase.

I work with the hospital out in Mesquite, and I would say that the majority of the population in that community is over the age of 65.

And that's putting additional demand on a hospital that's well equipped and capable of taking care of those patients, but they continue to struggle to find specialists that are needed-- cardiologists, oncologists, and so forth.

-And there are multiple reasons behind that.

Could you point to one or two?

-Reasons for?

-The lack of specialty.

-Okay, yeah.

Well, in the case of medicine, the issue has to do with available training programs to train physicians in those specialty areas that I alluded to.

And what we've seen in about the last 10 years and, again, why I'm optimistic that we can address this is when Governor Sandoval, then Governor Sandoval, implemented his Graduate Medical Education program in 2015 and 2016, we saw a really nice increase in the number of programs that train physicians in residency and then the more specialized training that you would get in a fellowship program.

The number of programs increased, the number of physicians entering those programs increased, but, more importantly, the number of graduates from those GME programs and those who stayed in Nevada have all increased.

And that doesn't mean there's not plenty of unfinished business.

There is.

And what we're trying to spell out in the upcoming study that we're currently working on is, where do we need to target those resources?

We know we need more dollars in graduate medical education, but an additional challenge will be identifying areas of need and then targeting dollars and resources to those areas.

-And there is legislation for graduate medical education funding this session.

I believe it's $4.5 million for 2025-26 and 2026-27.

Any idea on whether that will go forward?

-That's Senator Pazina's bill, and I think it's, it's got legs.

I think that there is a recognition on both sides of the aisle and in the Governor's office that that continues to be a need and a priority for healthcare because we've made great strides in this state in reducing the number of uninsured, improving access, but at the end of the day, if there's not a physician and a registered nurse available and prepared to take care of those individuals, it's all moot.

So workforce represents its own type of access barrier.

-I know you are thinking about 2027, but let's talk about 2025, and Governor Joe Lombardo is set to unveil his healthcare bill on Thursday, which is when this program debuts.

We are speaking a day ahead of time.

You got an advanced copy of that bill.

What do you like about it?

-There's a lot to like in this bill.

It addresses graduate medical education, more the administration than the dollars necessarily, but one of the things it does, it's a brand new program that the bill is proposing.

It's the creation of the Nevada Healthcare Workforce and Access program, and what I believe the Governor's intent is, is to set up basically a grant program where they vet applications or proposals from entities across the state that can demonstrate that what they're proposing is addressing an acute need and if it can be sustainable and possibly leveraged with other types of state and federal funding.

-Okay.

What is it missing that you are looking to have implemented in 2027, if possible?

-Well, let's see how it plays out, because, again, I think there's a lot to like in that bill.

So there's the grant program, which is new, and I would incidentally say that there's a lot of overlap with a bill that Senator Cannizzaro introduced and spoke to a couple of weeks ago, Senate Bill 434, which also creates, again, a statewide grant program to address many of the same issues that are identified in the Governor's bill.

I would also say that the Governor's bill has some interesting pieces.

It has changes, proposed changes in scope of practice for dental hygienists and for EMS techs and paramedics, which is it's interesting because those provisions of the bill, they don't create one more dental hygienist or one more paramedic, but they, they stretch the existing workforce.

And so the paramedic provision in that bill is interesting because it allows them to perform work in hospitals and other acute care settings when they have downtime.

And it's a, it's a great utilization of, again, individuals already working, particularly in rural communities.

-I think that I heard you talk about something similar that happened maybe 10 years ago with physician assistants.

-Well, it was registered nurses, actually.

In 2013, the legislature passed and the Governor signed a bill that would allow advanced practice nurses to practice independently of physicians.

So what we saw there with, again, without creating one nurse practitioner, is an incentive for advanced practice nurses from other states to practice in the state of Nevada, practice independently, prescribing authority, and so forth.

And we saw a doubling, almost a tripling, of the number of nurse practitioners over the past decade as a result of that.

You spoke earlier to primary care access and workforce issues.

It's hard to imagine how severe those primary care workforce shortages would be had we not enacted that legislation back in 2013, so huge win.

-All right.

So this Guinn Center report that came out this year, even though you say you are working on, I think you called it a monograph for 2027, this came out this year.

And one of the reasons there is a shortage is because so many more people have become insured in Nevada over the past decade, largely due to Medicaid.

Well, now that is at risk of being cut across the country and here in Nevada.

What's your outlook on how impactful that would be?

-Can you ask me in a couple of months, and I'll-- no, I think what I've witnessed in Carson City, particularly over the last couple of weeks, is a frustration again with lawmakers on both sides of the aisle with the fact they don't know what's coming down the road with potential Medicaid cuts.

And I think it's important to point out that currently 1 in 4 Nevadans is-- gains insurance through that particular program.

And the last thing we want to be doing right now, particularly if we're concerned about an economic recovery and continuing that recovery, if we're concerned about access, particularly in rural areas of the state that have larger populations on both Medicare and Medicaid, is pulling back insurance coverage for those individuals.

We think about, appropriately, the end beneficiaries of the Medicaid program.

But I'd also point out that rural hospitals and clinics, safety-net providers here in Clark County, that's revenue that they need for a variety of purposes, operating revenue, as they say in the biz.

But what they are really concerned about is that's going to just undercut efforts to expend resources on workforce issues, among other things.

So there will be ripple effects if some of those cuts or proposed cuts happen.

-And what about on the coming children's hospital, the first standalone children's hospital in Nevada?

Hopefully will open in 2030, but let's say these cuts are in effect then.

-Right.

Well, it's worth pointing out, and I think policy makers know this, that the majority of babies born in Nevada are born to women who are Medicaid recipients.

And that's even more emphatic in the case of a children's hospital, which I would say 50 to 60% at a minimum of the kids that they will be seeing are covered by Medicaid in the state's SCHIP program.

There will be pushback on what's being proposed, because, again, it's not just simply the Medicaid beneficiaries and low-income and disabled individuals who will suffer.

The facilities that rely on that stable Medicaid funding will suffer as well.

-John Packham, thank you so much for joining Nevada Week.

-Pleasure to be here.