Graduation season is upon us, including the graduation of some of our residents and fellows.
For example, in my case, I completed three years of an internal medicine residency, followed by a year as a chief medical resident, and then three years as a hematology/medical oncology fellow. This year, the Kirk Kerkorian School of Medicine is graduating 76 residents and 22 fellows. Of the graduates, 46 of them, or about half, are from primary care programs.
Residency and fellowship training, also known as graduate medical education (GME), is an essential part of the training of a physician and it is during residency that physicians learn the skills needed to practice in their areas of interest. It is also of particular interest that physicians are 30 percent likely to practice in the same state where they completed medical school, but over 70 percent likely to practice in the state where they did both medical school and residency. In a physician shortage state like Nevada, keeping doctors in state is imperative, which means we need more residency programs.
In Nevada, we are woefully under-resourced from a residency position perspective. Residents and fellows are funded in large part by the Centers for Medicare & Medicaid Services (CMS). This is because residents provide a significant amount of care for beneficiaries of both of these federal programs taking care of both the elderly and the underserved. In 1997, the Balanced Budget Act capped the number of residents and fellows funded by CMS.
Unfortunately, Nevada, and particularly Southern Nevada, was a very different state back then. Our population has increased 15 percent over the past decade. As a result of a small number of residency and fellowship positions and a growing population, Nevada ranks at the bottom of funded residency positions as compared to New York, which has 25 times the number of funded slots per 100,000 population.
What can be done? Fortunately, CMS has provided funding for 1,000 additional positions across the country and the Kerkorian School of Medicine has applied for new CMS-funded positions. Additionally, our state has announced pilot funding for new residency positions funded outside of CMS, and we are in the process of applying for new positions. Despite a small increase in residency positions through these programs, the effects that these programs will have will only be modest due to the overall small number of residency trainees we have as a state.
We need to continue to advocate for increased federal and state support to have the residents and eventual physicians to serve the medical needs of our state. We also need to expand residency programs into areas where there are no training programs in the entire state. As examples: despite being in the sunbelt, there are no dermatology residencies in Nevada; despite our aging population, there are no fellowships in hematology/medical oncology, ophthalmology or urology; and the list goes on.
We congratulate the latest class of residents and fellows. We wish them luck and hope that many of them choose to practice in Southern Nevada. However, we cannot lose sight of the fact that in order to meet the needs of our community, we need an even greater number of graduates of our GME programs. We look forward to the day where we have graduates across the entire spectrum of specialties and subspecialties.
