KU Medical Center faculty hit the road to reach more patients.
He was, in the words of his Douglas County father, an "extremely active" toddler.
"He didn't understand when we said 'No,'" said the father, who asked that his family's name not be used in this story. "He just does things without thinking them through."
In the late 1980s, the boy, now 13, started meeting with a child psychologist at the Kansas University Medical Center. The boy was diagnosed with attention deficit and hyperactivity disorder.
At first, the meetings required monthly drives to the teaching and research hospital in Kansas City, Kan., and a day of missed work for the boy's father.
In 1992, the psychologist, Michael Rapoff, began meeting the boy and other patients in Overland Park, which somewhat reduced the family's commute.
Since January 1995, Rapoff has been meeting the boy in Lawrence, at the office of a local pediatric group. Rapoff spends one day a week there.
"It brings the service to the community rather than the community going to the service," said Dr. Charles Loveland, one of the Lawrence pediatricians who shares his office space with Rapoff on Tuesdays and with another KUMC child psychologist on Thursdays.
Loveland said he thinks some patients are more comfortable seeing Rapoff in Lawrence than they would be seeing him at the medical center.
Beyond improved convenience and comfort for patients, however, Rapoff's weekly trips to Lawrence illustrate a nationwide trend in academic medicine.
University health centers across the country are under intense pressure to lower their costs and increase revenue to pay for teaching and research that insurers no longer want to subsidize.
Besides trimming costs wherever possible, the medical centers are asking their faculty members to hit the road and bring their expertise to surrounding and sometimes distant communities.
Patients in those communities get improved access to medical professionals. The medical centers get new patients -- and new revenue.
"I think part of this is really a general philosophical agreement that our mission is to meet the needs of all Kansans," said Randy Attwood, a KUMC spokesman. "We have a long history of outreach activities. Certainly as a tertiary care facility, the more primary care networks we can become members of, the more referrals we may receive."
While outreach clinics for KUMC child psychologists may be relatively new, other KUMC specialists, like cardiologists, are used to traveling throughout the state.
"It may be intensifying because of managed care, but it's been going on for many, many years," said Lorene Valentine, director of rural health education and services for the medical center and for its campus in Wichita, where she is based.
In addition to running clinics in Overland Park and Lawrence, the KUMC pediatrics department sends a child psychologist to Hays once a month, and later this month will begin weekly clinics in Liberty, Mo., east of Kansas City.
The KU Medical Center, which includes a 464-bed hospital and medical, nursing and allied health schools, also runs neurology clinics in Topeka and Hays and cancer clinics in Pittsburg and Parsons.
Medical center doctors also have pioneered the use of video conferencing equipment so that doctors in Kansas City, Kan., can consult with doctors and patients across the state.
Research by the wayside
While the push to treat more people in more settings may be good news for patients in Lawrence and other communities, there can be a downside for the medical center's researchers. Because Rapoff is seeing more patients than he used to, he has less time for his research.
"I think the pressure in academics is on the research part," said Rapoff, chief of behavioral sciences in the KU Medical Center's pediatrics department.
He studies how well children comply with taking medications as prescribed, and later this year will begin a research project involving children who must cope with the pain of arthritis.
"The states are going to have to decide if they're going to support this endeavor or not," Rapoff said. "I don't think there's any way academic medical centers are going to compete with private practitioners or private entities like HMOs. If they want it, they're going to have to pay for it."
For the time being, however, the KUMC psychologists are, in effect, competing head-to-head against more than a dozen full-time psychologists in Lawrence, including several who specialize in child psychology.
"I would still like the pediatricians in town to continue to refer patients to me," said Donald Moss, a Lawrence clinical psychologist. "At the same time, I can understand if they have one right in the same building, it's a little more convenient for referrals."
Loveland said his referrals to the KUMC psychologists have increased since they started coming to his office. There's a two-month waiting list for new patients who want to see the KUMC psychologists in Lawrence.
But it's a worthwhile wait for patients who are uncomfortable meeting a psychologist at KUMC, Loveland said.
"The medical center is an imposing place, and I think it's sometimes difficult for people to see that it's important for them to go there," Loveland said.
Rapoff said he thinks the outreach effort has brought psychological services to some patients who might otherwise have missed or avoided them.
"I really think there are some people who wouldn't come if we didn't have such an accessible clinic," Rapoff said. "It's kind of like if you have an exercise facility at your plant. You're much more likely to use it than if you have to drive across town to use it."