It was the UNLV School of Medicine’s Acute Care Surgery Fellowship that brought Dr. Allison McNickle to Southern Nevada from Chicago, where in 2016 she had just completed a general surgery residency through the University of Illinois-Chicago at Mount Sinai Hospital.
“I knew I wanted to be a trauma surgeon (based on) the kind of cases I dealt with in general surgery, but I felt a need for more training,” McNickle said. “The Acute Care Surgery Fellowship offered me that.”
The demand for such fellowships throughout the country has grown alongside skyrocketing demands for trauma surgeons. Dr. John Fildes, the chair of surgery and associate dean for external affairs at the UNLV School of Medicine, established the first fellowship in acute care surgery in the nation approved by the American Association for the Surgery of Trauma .
Today, McNickle is an assistant professor in the UNLV School of Medicine Department of Surgery and section chief of trauma surgery.
Her decision to remain in Southern Nevada punctuates an oft-used axiom by medical school administrators: Where doctors do their post-graduate residencies and fellowships is where they often stay to practice medicine. That’s no small thing in Nevada, which suffers from a severe shortage of physicians. At present, more than 50 percent of residents and fellows trained in Las Vegas stay in Nevada.
While residencies are where many new graduates of medical school learn to perform the responsibilities and duties of their chosen specialties, for others the road doesn’t end there. Because of the complexity of some areas of medicine, training after residency in the form of fellowships is required.
Whether it’s handling gunshot wounds, stabbings, burns, or injuries from horrific accidents, McNickle has developed a reputation at University Medical Center Trauma Center as being one of the best surgeons at saving the lives of the critically injured.
“If she is there, I can guarantee she will be the one to give you the best chance for a successful outcome,” said Dr. Douglas Fraser, the chief of UMC Trauma and the medical school’s division chief for acute care and burn surgery. “Dr. McNickle is the person I would call if I was injured — she is a valuable addition to medical care in Las Vegas.”
In the summer of 2018, McNickle, who regards Fraser as her mentor, completed her fellowship. She says she surprised herself by wanting to stay in Southern Nevada.
“When I came here, I thought Southern Nevada was just about the desert, the Strip, nightlife, and gambling, but I found it was a city much like others with great outdoor recreation and a great trauma center.”
Dr. Kate Martin, the associate dean of graduate medical education at the School of Medicine, is seeing more decisions like that. Residents and fellows frequently stay in Nevada after completing their programs not only because of the excellent physicians they work with but also because they have begun families here and established relationships in the community, she says.
That reality, Martin says, is a major reason why UNLV is making every effort to establish new residencies and fellowships and to expand existing post-graduate programs.
“It’s an important way of addressing the shortage of physicians in Southern Nevada,” she said.
Martin currently oversees 22 programs — 11 residency and 11 fellowship programs — with 338 residents or fellows.
Recently, new UNLV fellowship programs have been created in pediatric emergency medicine, geriatrics, and forensic psychiatry. Fellowship programs have also been expanded to allow more doctors to receive training in critical care medicine and surgical critical care. Expansion of residency programs have included obstetrics/gynecology and psychiatry — more than doubling the number of doctors receiving training in those specialties.
UMC, the medical school’s primary teaching hospital, serves as the home base for nearly all of the graduate programs and is the largest financial supporter of the post-graduate training programs.
Starting fellowship and residency programs can’t be done overnight, taking at least two years for a new program to come to fruition. Partnerships are essential.
A new forensic psychiatric fellowship that will start this summer shows it is virtually impossible for a medical school to go it alone when trying to start a post-graduate program. First, a state-funded grant from the Nevada Governor’s Office of Science, Innovation and Technology provided the important start-up funds to get the program assembled and an application submitted to the Accreditation Council for Graduate Medical Education.
Salary support for the fellows in the new program will come from a partnership with the Clark County Detention Center and State of Nevada via Southern Nevada Adult Mental Health Services. And finally, faculty from the UNLV School of Medicine will be joined by mental health professionals from Southern Nevada Adult Mental Health Services to teach the fellows.
A new endocrinology fellowship program that started this past July bears out the importance of partnerships.
“This was a true grassroots effort,” Martin said. “Dr. Kenneth Izuora teamed up with his internal medicine colleagues to craft an application for the new program, which was ultimately accepted by the [accreditation council]. Despite the School of Medicine faculty putting their time and expertise into the endeavor, there remained a need for funding for the fellows’ salaries, and the VA Healthcare System and UMC pledged the support that made this vision a reality.
"As a result, we now have endocrinology specialists-in-training caring for patients in the local community with hormone-related disorders such as diabetes, hypothyroidism, and osteoporosis.”