Unionized Town Simplifies Management for Nevada Practice

Andrew Smith
Published: Sunday, May 08, 2016
James D. Sanchez, MD

James D. Sanchez, MD

When James D. Sanchez, MD, moved to Las Vegas and joined the practice that’s now known as the Comprehensive Cancer Centers of Nevada (CCCN), he hoped to trade Ohio’s cold winters and economic stagnation for ample sunshine and rapid growth. He knew Vegas was booming—its population has surged from 1 million to 2 million since he arrived—but CCCN’s proportional growth has been much greater. The four-physician practice where Sanchez began has become a 50-physician practice with 15 offices in southern Nevada and northern Arizona.

CCCN’s exponential expansion is, in part, a result of both the surging local headcount and the national trend toward oncology practice consolidation. “As our city has doubled in size, the need for oncologists has more than doubled. We don’t just need twice as many people offering the services that patients could get here before. We also need specialists who can offer patients here the sort of unusual treatments we could not offer here when the market was smaller,” said Sanchez, who is now the practice’s president.

The practice’s growth is also a reflection of an ambitious vision: to make CCCN a cancer treatment hub for patients from across the country. “Continued growth of the local population will further increase our ability to provide specialty care in the city rather than sending patients to major cancer centers elsewhere,” Sanchez said. “In fact, we hope that Las Vegas will evolve into a destination for cancer treatment. There are two university-affiliated medical schools that will be opening their doors soon, and we hope to work with them and the local hospitals and existing partners to become a world-class cancer hub—a hub with the sort of amenities that would naturally make traveling patients choose us over other places.”

In many ways, CCCN’s growth mirrors that of other successful practices in other big cities. It started as a partnership between medical oncologists, who then joined forces with radiation oncologists, surgeons, and pulmonologists to provide integrated care to patients who needed multiple treatment types. It also teamed up with academic institutions and pharmaceutical companies to offer patients access to clinical trials and has opened its own diagnostic labs and CyberKnife center.

As the practice grew, it continued to open new offices across Las Vegas rather than concentrating its resources in one or two large facilities—a strategy that saves very sick patients from long drives and maintains the personal feel at what is actually a large organization. In other ways, CCCN’s choices reflect the quirks of its home market.

The geography of Las Vegas is almost entirely manmade, and it is dominated by the one part of the city that nearly everyone knows: Las Vegas Boulevard (aka The Strip). That most famous of roads, which is paralleled a block to the west by I-15, makes east-west travel nearly impossible for much of the day.

Although the 27-mile drive from Sanchez’s home to his office takes less than a half-hour early in the morning or late at night, it can easily take two hours at other times. CCCN keeps this in mind when it chooses office locations. The north-south distance between practice locations, which is easily driven, tends to be substantial, but the east-west distance may only be a couple miles.

Working With Self-Insured Unions

Las Vegas is also unusual, at least among big cities, in having a single industry dominate its economy and having so many of its residents belong to the handful of unions that service the resort casino industry. Those unions are large enough to set up self-insurance plans for their many thousands of workers, and they negotiate directly with service providers such as CCCN.

“Las Vegas may be the biggest small city in the world. It has a huge population, but a handful of casino executives and union officials make a lot of the decisions that affect life for everyone here. Having a reasonably close-knit group with deep roots in the community provides an opportunity for businesses that also have deep roots in the community. It gives you the chance to talk to the people who make decisions rather than dealing with middle men,” said Sanchez. “For example, we have a direct relationship with the culinary union, which funds its own health insurance, and that union is easier to deal with than almost any health insurer. There are never any surprises from them, and we try to make sure they’re never surprised by us.


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