Policy for continued progress: How Nevada can keep increasing its health care workforce, plus... (Pauline van Betten) It's important that we start now to preserve the ability to see the stars at night.

-Protecting the night sky.

Red Rock Canyon campaigns for international recognition as an Urban Night Sky Place.

What that means, that's this week on Nevada Week.

♪♪ Support for Nevada Week is provided by Senator William H. Hernstadt.

-Welcome to Nevada Week.

I'm Amber Renee Dixon.

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.

-We move now from healthcare to conservation.

Red Rock Canyon wants visitors to enjoy its beauty, not just during the day, but at night as well and, in particular, it's night sky.

That's why Red Rock is seeking designation as an Urban Night Sky Place.

That's one of several designations from the International Dark Sky Places program under the nonprofit DarkSky International.

For example, the Grand Canyon, which you are looking at pictures of now, is designated as an International Dark Sky Park.

Other designations include Dark Sky Sanctuary and Dark Sky Community.

We spoke with Save Red Rock cofounder Pauline van Betten and Dark Sky International program associate Michael Rymer about what Red Rock is out to achieve.

Okay.

So, Michael, Red Rock Canyon wants to be designated as an Urban Night Sky Place.

What does that even mean?

-So the Urban Night Sky Place is an area that is very close proximity to a very densely populated urban area, Las Vegas being for Red Rock Canyon.

And so we are recognizing the efforts of Red Rock Canyon and places like it for what they are able to do to bring the public to the place to experience a night sky.

It may not be a pristine night sky because of that urban center, but it is still significantly better than in the center of that urban place.

So it's a place for appreciation for people to come, and it's also demonstrating what good responsible outdoor lighting is.

So it's kind of two-fold in enjoyment and then an understanding and learning experience for what proper outdoor lighting is all about.

-"Good responsible outdoor lighting," may be a term that some of our viewers have never heard.

We'll dive into that, but I want to ask you, Pauline, why does Save Red Rock want this designation?

-Save Red Rock has a professional mission of keeping Red Rock rural.

And with an interface with one of the major metropolitan areas, it's an ongoing project.

So one of the impacts is light in possibly the lightest city in the world.

And it's important that we start now to preserve the ability to see the stars at night.

And we know that people are so excited about that in response that we get for this mission, and that's really why we really want to make it for all future generations to be able to see the stars at night.

-Michael, what is it going to take for Red Rock Canyon to get this designation?

-Well, it's a very extensive process, or it can be depending on how many resources are allotted for the project itself.

We usually allocate, or at least explain the places to allocate, one to three years.

But it's a lot of education and outreach events, working with local communities nearby to garner that volunteer cooperation to improve not just inside the park, but outside the park, as well, lighting retrofits to make the lighting actually good and responsible, and then measuring night sky quality to track changes over time in a very scientific way.

So there's a lot that goes into this application process, but the folks at Red Rock Canyon are very adept, very knowledgeable about what needs to happen.

So they, they're-- I'm confident in what they're going to do.

-Those measurements, how thorough are they?

They take place over how long a period of time?

-We usually ask for about a year's worth of measurements every four months or so to account for seasonal changes and things like that.

Of course, you want to take your measurements during the new moon, because any natural light at night can throw off the night sky quality measurements.

So we ask for as much data as possible.

There's no such thing as not enough data.

So they are working on putting in some equipment, some devices to take measurements every night.

So there's a lot of different equipment out there that can be done, can be utilized to take these measurements.

-Who's doing the measurements?

Who's paying for them?

-The staff with the Red Rock Canyon BLM are going to be doing these measurements because they know the area better than anybody else.

They know where the darkest places are.

They know where these significant, you know, trailheads and everything are going to be the best spots to take those measurements.

-And so they're looking to prove, hey, the Las Vegas Strip may be over here.

You can see it from here, but it's still dark enough to get this kind of designation?

-That's exactly right.

-Yeah, that's really neat.

You talked about the public outreach, and there was an event held here in Las Vegas during International Dark Skies Week.

What happened there?

And that's actually a requirement of this designation, right, Pauline?

What do you have to do?

-Well, one of the most exciting things is that the Brett Torino Foundation donated a telescope for the public to be able to view the stars.

So we had an unveiling of the telescope, and we all got to see it.

And the images were incredible, just amazing.

And it was so invigorating.

We had someone show us the constellations in the sky, and we had just so much-- there was so much interest in that event, and to really see how people really got engaged.

And really, you know, Michael really gave us some five really simple points about how every person can help with light pollution, and it was inspiring.

So there was a call to action, and I felt like people were really invigorated about this project.

-That telescope is there right now?

We can go out and look through it at night?

-You'll be able to look through it when we have our next stargazing party in June, and we'll keep you posted.

We're gonna have a number of stargazing parties.

That's gonna be our next big mission, to keep the public informed, and you will always be able to look through the telescope at that time.

We're also going to be posting images on our website of what's being seen through the telescope, so we'll all be able to enjoy it.

-Wow.

And I think that is maybe what I struggled to understand is this is going to be-- or one of the benefits listed is that it can be a tourism booster, but we're in Las Vegas.

We already have a ton of tourism.

This does something different, though, at Red Rock that's currently not being done if this goes into place, and what is that?

What will it look like?

What are your dreams for this?

-Well, I think that it's true that just getting people to understand that this is a place where you can see the night sky, will bring people to see the night sky.

And even people, there's-- people in Las Vegas love Red Rock Canyon, and we're just-- and here's another facet.

Here's another facet of what you love so much.

You can look at the sky, learn about the sky, learn about the stars, and that's what we want to offer to people.

-Michael, you live in Denver, so you came into town for that event that I mentioned.

What do you think when you see the Las Vegas Strip?

Does that just hurt your stomach?

-It presents an opportunity.

Obviously, we're not going to try to shut down every single light on the Las Vegas Strip.

That would be impossible.

But what we want to do is mitigate the light pollution where we can, you know?

So the surrounding communities around Red Rock Canyon, what can they do to improve the night sky around the park?

The Vegas Strip is going to be the Vegas Strip, so we can only do so much.

But if we get the right people in the room at the table talking about what we can do, maybe we can change some minds and hearts to say, look, you can still have these lights.

They can still serve their purpose, but maybe let's kind of take a step back from how much we're using and maybe the ones where we can use them more responsibly, let's try to implement that.

-Wow, Michael!

Those are some big goals.

-We'll do what we can.

-One step at a time.

You talk about developments around Red Rock Canyon.

Right now there is a planned housing development for the area.

How could that impact this?

I mean, let's say Red Rock gets the designation, then this housing development is built, might you take the designation away if they don't follow light guidelines?

-Well, ideally, we want the surrounding communities and those who work very close, maybe even inside the park, to be on board with this designation.

The lighting management policy that the park has to implement only pertains to what is in their own jurisdiction.

So what we really want to see through the application project is that there's this cooperation with these communities, that it's a volunteer effort.

So that's why events like, you know, what we had during Dark Sky Week here is so important is because we want to show that this is the carrot, you know, this is what we can be rewarded with, not what we're trying to drive, you know, folks to do maybe against their will.

We want to show them the reason for doing it and that it's in good faith.

-Okay.

Do you have any concern, Pauline, about the current communities that exist around Red Rock?

-Well, I'd like to also add that in 2003, Clark County passed an ordinance, a Red Rock Overlay.

And the Red Rock Overlay gives guidelines for development in the Red Rock Canyon, because we have private land within the Red Rock Canyon and adjacent to the Red Rock Canyon.

And a large part of that code is about low-level lighting that's required for new development.

So the-- we-- there's a current development that you spoke of on the hill, and the last plan that they submitted had very extensive low-level lighting plans in that.

So we're very optimistic that the developers will jump in.

And I think that is a selling point, you know?

It's just they-- it's a rural, it's a rural community, and they're coming to have a rural experience, and seeing the stars is part of it.

-Have people forgotten how cool it is to see stars?

-I think some people don't even know.

It's unfortunate.

I think maybe some people who live deep in the heart of Las Vegas and other cities like it may have never gone out to Red Rock Canyon and taken a look at the night sky.

So we don't really know what we're missing.

So that's why it's such a great opportunity with the certification to draw more attention to Urban Night Sky Places so that folks in these highly urbanized areas can see what's going on beyond the light-polluted areas in which they live.

-You said "responsible outdoor lighting."

What does that mean?

-Yeah.

So we have developed these five basic principles for responsible outdoor lighting, which means if you adhere to all of these principles together, you will significantly reduce the amount of light pollution that any light fixture will produce.

So the first principle is determining whether a light is useful or not and if it's even necessary.

The second is using shielding to direct the light only downward.

We do not live and work up in the sky; we only work here on the ground, so that's what we need to light.

We need to use less of the light, less intense light, because if we direct it more towards the ground, we don't need to use as much light as possible.

We want to use warmer light, meaning like an amber color.

That is better for sky glow, reducing sky glow, which is what blocks out the stars at night.

And then, finally, we want to control our lights better, make it so that they can turn off on their own without us having to remember to turn off a light switch.

So motion detectors, dimmers, timers, these are great things to implement when we're not using them.

-How well aware do you think, both of you think, this issue of light pollution is to people?

When did you first become aware of it?

-Well, I worked on the Red Rock Overlay, and so that was, like I said, a big part of our focus, and that was in 2003.

So it's been on my radar for a while.

-Do you have trouble explaining it to people who don't understand it?

-I agree with you.

I think that people really don't appreciate, let's put it, light as pollution.

You know, we think we're turning on our porch light and we're just illuminating our house.

We're not appreciating that we're impacting nocturnal animals.

We're impacting even our circadian rhythm.

We're impacting so much of the natural world.

But to your point, I don't think that people have associated that, but I think we really need to bring that to the forefront, that it does impact us and that less light-- I love what Michael said.

It's so easy.

They just turn off a switch.

-And I also didn't realize the impact on animals.

How impactful is it?

-Well, I mean, a lot of species live and hunt, migrate, reproduce at night.

That's just how they evolved.

And so when we introduce too much light into their ecosystem, they are not able to do those things under the cover of darkness, for which they have been able to adapt over so many years.

So when we impede that for them, it can have some harmful downstream effects.

A lot of these species are pollinators, so they make sure that the food that we eat or the flowers that we love, the agave, you know, that makes tequila, you know, there are species of bats that pollinate that.

These are things that we as humans kind of depend on.

So when we kind of take that away, the opportunity for them to survive and thrive, then that impacts us as well.

-We certainly do depend on tequila, huh?

-Yes.

[laughter] -Michael Rymer with Dark Sky International and Pauline van Betten with Save Red Rock, thank you so much for joining Nevada Week.

-Thank you so much for having us.

-Save Red Rock is teaming up with the Bureau of Land Management for these efforts with the Brett Torino Foundation as a lead sponsor.

You can learn more about this endeavor, as well as read some of the healthcare reports referenced earlier in this show on our website vegaspbs.org/nevadaweek.

And I'll see you next week on Nevada Week.

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