After four years of medical school, becoming a doctor involves ongoing mentorship from more seasoned physicians during a residency and, for many, a fellowship as well. Cleveland Clinic Lou Ruvo Center for Brain Health has taken a leading role in providing graduate medical education (GME) in Las Vegas, training neurology residents from Valley Hospital and general medicine residents from the University of Nevada School of Medicine, including David Berg, MD (see sidebar).

In 2012, the center was accredited by the United Council of Neurological Subspecialties (UCNS) for its fellowship in behavioral neurology. Aaron Ritter, MD, started in July 2014 as the center’s first fellow. Dr. Ritter has excelled and will be joining the Lou Ruvo Center for Brain Health staff.

Dr. Ritter praises Gabriel Léger, MD, CM, FRPC, Director, Behavioral Neurology and Neuropsychiatry Fellowship: “His knowledge base and passion for neurology are amazing. His patients truly appreciate his thoroughness. When I encounter a difficult case, I ask myself, ‘What would Dr. Léger do?’ ”

Of Dylan Wint, MD, Nevada based Energy Chair for Brain Health Education, Dr. Ritter says, “You can’t help but be influenced by Dr. Wint because of his ability to really listen and to address the patient’s concerns in a personal, collaborative way with honest, straightforward language.”

GME: Who benefits?
Although patients being seen by a resident or fellow may initially think they are not seeing the “real doctor,” the assessment can be more comprehensive than that of a staff physician because trainees are allotted more time to fully explore the patient’s complaints and concerns. Thorough diagnostic and therapeutic discussions occur between the mentoring staff (who also see the patient) and the trainee.

The presence of trainees enhances the environment of a medical practice. Trainees’ developing interest in their new field of study leads to more frequent exchanges with all staff, including advanced practice clinicians, nurses and support staff, which promotes teamwork and cutting-edge approaches.

A behavioral neurologist’s view
Dr. Ritter’s passion for behavioral neurology lies in the brain being the seat of behavior, with altered behaviors being driven by problems that may include dementia, Parkinson’s disease, multiple sclerosis or another brain disease.

“Even though neurodegenerative diseases affect millions of people, the medical community still does not adequately address the needs of patients afflicted with these diseases,” Dr. Ritter says. “The Lou Ruvo Center for Brain Health represents a major paradigm shift in how patients with neurodegenerative diseases are treated and their families are supported. While new treatments are desperately needed, current therapies can help ease many of the symptoms that are associated with these diseases.”

Perhaps that compassion is what prompted Cleveland Clinic to honor Dr. Ritter with its Excellence in Teaching Award for both 2015 and 2016. He was selected from among 1,800 Cleveland Clinic trainees.

 As of July 2016, Dr. Ritter and his mentors, Dr. Léger and Lou Ruvo Center for Brain Health Director Jeffrey Cummings, MD, ScD, are the only fellowship-trained behavioral neurologists in Las Vegas.

What’s next for Las Vegas?
In addition to providing more than 95,000 patient visits since opening in 2009, the Lou Ruvo Center for Brain Health has added new physicians, who will in turn provide even more patient visits, thus exponentially increasing healthcare access for Nevadans.

Due to the vibrancy of their GME experience in Las Vegas, both Dr. Ritter and Dr. Berg have chosen to hang their shingles here, thus improving access for those needing inpatient and neurology care. Their example shows why GME is critical to a city’s growth in healthcare: Seventy percent of physician trainees remain to practice in the city where they completed their GME.

Dr. Ritter predicts that the two new medical schools slated to open in Las Vegas — Roseman University College of Medicine and UNLV School of Medicine — and the resulting increase in GME positions will shape the growth of the medical community, adding new thinkers and fostering new opportunities to improve.

Asked why he and his wife, Susan, a primary care physician who also practices in Las Vegas, decided to stay after he completed training, Dr. Ritter replied, “There are unique opportunities in Vegas and a need for more doctors. It’s a small medical community interested in growing and collaborating.”

As for the Lou Ruvo Center for Brain Health, “It’s truly unique on a national level to have a stand-alone facility devoted to solving brain health problems,” he says. “We have the latest technology and clinical research studies.” Dr. Ritter, who has a passion for research, adds, “A major goal of this center is to find better treatment for these diseases. This is the kind of place that will contribute to finding the cure.”

Until then, we’ll keep training more physicians.

Photo: Provided by Cleveland Clinic Lou Ruvo Center for Brain Health. Left to Right: Dylan Wint, MD and Aaron Ritter MD.