Specialist shortages are a big problem in the Las Vegas Valley and nationally, which can lead to long waits for doctors' appointments.

Compounding the Las Vegas Valley problem is a steady influx of new residents looking for doctors, many of whom are in high demand.

At the end of 2003, when the most recent data became available, Nevada ranked No. 47 out of 50 states and Washington, D.C., with 172 physicians per 100,000 residents, according to the American Medical Association.

The national average was 235 physicians per 100,000 people, and Mississippi, Iowa, Idaho and Oklahoma fared worse than Nevada.

Merritt, Hawkins & Associates, a Texas-based company that consults and recruits physicians nationally, studied wait times for new patients in 15 metropolitan areas and found that the number of days it took for a new patient seeking a nonemergency appointment with a cardiologist, dermatologist, OB/GYN or orthopedic surgeon varied from one day to 153 days with an overall average of 18.8 days.

The study focused on Atlanta, Boston, Dallas, Denver, Detroit, Houston, Los Angeles, Miami, Minneapolis, New York, Philadelphia, Portland, Ore., San Diego, Seattle and Washington.

The study results were as follows:

• Cardiology appointments for a heart checkup averaged between nine days in Seattle and 37 days in Boston with an overall average of 18.8 days for all of the 15 metropolitan areas.

• Dermatology appointments for a skin exam to detect potential cancer or melanoma averaged between nine days in New York and 50 days in Boston with an overall average of 24.3 days.

• An obstetric-gynecology appointment for a well-woman exam averaged from 10 days in Miami to 45 days in Boston with an overall average wait of 23.3 days.

• Orthopedic surgeon appointments for a knee injury averaged from eight days in Atlanta and Washington to 43 days in Los Angeles with an overall average wait of 16.9 days.

Although Las Vegas was not included in the survey of 1,062 physicians' offices in the spring of 2004, local doctors say their wait times can be lengthy.

That's why Dr. Michael Crovetti, an orthopedic surgeon in Henderson, said he is making changes in his practice to reduce the average three- to five-week wait.

"I am in the process of expanding my practice just because of this problem," Crovetti said.

The key is to create a clinic of excellence so that patients can see any one of the five doctors in Crovetti's office and feel that their care is comparable to his, he said.

"When patients are referred over, because it's my practice, they want to see me and I'm trying to change wait times (and) to say everyone here is great," he said.

Two weeks ago Crovetti established a dedicated fax line for patient referrals, which enables his staff to set up appointments quicker.

He said he sees 15 to 20 patients during his two weekly office days while the rest of his week is spent in surgery and at the Medical Education Research Institute of Nevada.

"Once they get to the office they have to wait as well and we tell them that when we book the appointment; otherwise it'd be six months," Crovetti said.

During peak athletic seasons, Crovetti said he sets aside three to five appointments each day for patients who need same-day care.

Dr. Don Havins, executive director of the Clark County Medical Society and an ophthalmologist, said a patient's insurance can affect how quickly they obtain an appointment because some insurers have larger doctors' networks than others.

Nevada lags the nation in every specialty although some specialties are in higher demand than others, he said.

A study by the Southern Nevada Medical Industry Coalition reported that in 2004 Southern Nevada had 1.48 dermatologists per 100,000, compared with 2.5 per 100,000 nationally.

Southern Nevada had 6.48 OB/GYNs per 100,000, compared with 11.4 per 100,000 nationally.

There were 1.48 orthopedic doctors per 100,000 in Southern Nevada, compared with 6.5 nationally.

The coalition did not have figures for the number of cardiologists, but Dr. Anjum Ismail said his specialty has varying wait times with an average new patient waiting one to three days at his office.

He said he makes new patients a priority because he is building his solo practice after five years in a doctors' group.

Between six and 10 new heart patients receive Ismail's care each week during his half-day office hours five days a week, he said.

He said he leaves a few appointments open each day for patients who must be seen right away, such as those with chest pain.

"If the front desk is properly communicating with the doctor, the doctor can quickly judge the severity," he said.

Patients are asked to bring in their old records if they had a cardiologist previously, which can expedite the process once they have an appointment, he said.

Dr. Miriam Bettencourt, a Henderson dermatologist, said she has implemented a variety of practices to make her clinic more accessible to new patients, which wait up to two weeks for nonemergencies.

She keeps a few appointments open each day for emergencies, hired a physician's assistant to treat minor conditions and holds community skin cancer screenings at no charge to the public.

"If we go by the book and don't open up the schedule, you won't be able to get in for three months," she said, adding that some of her new patients have come from dermatologists who had three-month waits. "We have a very transient population. We need to make our schedule open to new patients because people come and go."

Bettencourt's office averages 15 new patients per day, which are seen full days Monday through Thursday, half days on Friday and one Saturday a month, she said.

She said her office staff is most accommodating to seniors who are more prone to skin cancer, patients who have been seen by their primary physicians and patients who are truly concerned and feel they have an emergency.

"The more specific the patient is during the phone call -- what they are coming in for -- (the better) and if they are truly concerned, we don't want anybody suffering over anxiety at home. I'd rather have them here for a visit," she said.

The community cancer screenings provide access for new patients, too

"Not everybody has insurance (and) we have a lot of insurance here -- 60 percent has HMOs, which delays access to the specialists and they have to go through the gatekeeper of the primary physicians," she said. "At least you're helping those people who don't have direct access to the specialists."

Dr. Warren Volker, an OB/GYN in northwest Las Vegas and the chief of obstetrics at Summerlin Hospital, said his practice stays so busy he has only a few slots for new patients.

"Most of our patients will make their appointments six months to a year in advance just to make sure, but I'm usually booked three to four months out," he said, adding that his first opening for a new patient is the first week of November.

The six-physician office keeps a few openings for patients who must get in and a list of patients who would like an appointment if there are cancellations, Volker said.

"We added a new physician this year (and) are able to take more new patients because of that," Volker said, adding that the group sees between 45 and 50 new patients each week.

"A lot of patients who can't get into me in two weeks, they'll see one of my other doctors and then they'll follow up with me," he said.

One way Volker is compensating for the influx of new patients is by staying late during his four office days and giving up lunch hours.

"Another thing I started doing is on Wednesdays, I do surgeries in the morning and come in in the afternoon and I see patients until 8 at night," he said. "That actually worked really well for me."

Doctors need to be flexible in their schedules because "patients are extremely loyal to their OB/GYN," Volker said.

All of the local doctors cautioned that patients should look at more than the wait time when choosing a doctor.

Michelle Swafford covers health care and small business for In Business Las Vegas and its sister publication, the Las Vegas Sun. She can be reached by e-mail at swafford@lasvegassun.com or at (702) 259-2326.