Within the next five years, an estimated 372,000 new patients will begin lining up outside the doors of physicians' offices and clinics across Nevada.
Newly covered by this year's federal health-insurance reform law, the patients probably will be joined by a similar number of Nevada residents who put off medical care in the past because of inadequate insurance.
The numbers cause alarm in a state that's already near the bottom in most measurements of the supply of physicians, nurses and other medical professionals.
The solutions, which are likely to come together over decades rather than months, range from efforts to woo more medical students into practice to changes in the way that medical services are delivered.
No one is sure exactly how many new patients will arrive. The estimate of 372,000 Nevadans assumes that the national figure for people without any health insurance 14.3 percent holds true in the Silver State.
But health-care experts are certain that Nevada faces some big problems as the health reforms unfold over the next four years.
"We have a lot of challenges," says Lawrence P. Matheis, executive director of the Nevada State Medical Association. "Right now, Nevada is not ready."
The state already stands in a deep hole.
John Packham, director of health policy research at the University of Nevada School of Medicine, told participants in a health summit called by Nevada Attorney General Catherine Cortez Masto in June that Nevada ranks:
* 47th among U.S. states in the number of medical doctors per capita.
* 48th in the number of registered nurses per capita.
* 46th in the number of primary care physicians per capita.
* Lower than other states in the Mountain region in numbers of physicians in 33 out of 39 medical specialty areas.
Matters are far worse in rural areas of the state.
"It's pathetic," says Ole Thienhaus, M.D., dean of the University of Nevada, Reno School of Medicine.
Packham told the health summit last month, "With few exceptions, the number of licensed health professionals per 100,000 residents is much lower in rural versus urban counties."
Even without the demand created by health reform, physicians in Nevada are getting busier as Baby Boomers need more medical attention at the same time that a growing number of physicians enter retirement age.
Some physicians, Thienhaus says, might bail out of the traditional insurance-paid model entirely, opening instead boutique practices that cater to people who can pay for their own care.
When health-care experts in the state talk about solutions, they start with ways of increasing the number of medical students who decide to practice in the state.
The state already does well in that regard. More than 80 percent of the medical students who complete their education and residencies in Nevada end up practicing in the state a figure that ranks second in the United States.
But the numbers are fairly small. The University of Nevada, Reno School of Medicine graduated 55 in 2010.
Expanded medical school enrollments a difficult task when the state budget is severely limited and expanded programs for resident training of physicians will prove important, says Matheis.
Development of physicians to meet the needs of rural areas may need to start as early as elementary school, says Elissa J. Palmer, M.D., director of the Rural Track Residency program at the University of Nevada, Reno Medical School.
Among the factors that may lead students to focus on a career in rural medicine, she says, is a strong role model in a young physician's hometown.
Targeted recruitment of students from small towns into the medical school, scholarships and other incentives and education that places more emphasis on primary care also might help, Palmer says.
Thienhaus says the pressure on physicians' offices and clinics also is likely to spur development of alternative ways to deliver primary care.
Advanced-practice nurses such as nurse practitioners may be used more commonly. Nurses who have earned doctorates in nursing practice might provide services without the direct supervision of a physician.
Also getting a closer look, Thienhaus says, are concepts such as the "Patient Centered Medical Home."
In that team-based model of care, a patient has a personal physician who is responsible for coordinating medical services ranging from routine checkups to treatment of acute illness and end-of-life issues.
Supporters of Patient Centered Medical Homes say they deliver medical care efficiently, leading to reduced hospital admissions and mortality and reduced Medicare expenditures.
On the other hand, Thienhaus says, current medical reimbursement systems often aren't set up to pay for care as it's delivered by Patient Centered Medical Homes.
Medical assisting course
The demand for medical professionals is felt throughout the educational system.
Carrington College the new name of the institution previously known as Apollo College says it will add a medical assisting program at its Reno campus. Classes begin Sept. 13. The school currently offers a registered nursing program.
Leslie Berry, executive director of Carrington College in Reno, notes that medical assisting is ranked by the U.S. Bureau of Labor Stastics a one of the fastest-growing occupations in the United States.
