LaDonna Regier knows the problem all too well.
Regier, a family practice physician in Colby for more than 35 years, chose to practice in a rural setting because that’s where she grew up. But she knows there’s a shortage of people like her and sees it all the time. Specialists are few and far between, and some patients travel more than 50 miles across northwest Kansas to her practice.
Though some specialists come in from Hays and Denver on a monthly basis, it can be difficult, especially in emergencies, to get patients the care they need.
Meeting the need
It’s a problem being tackled by KU Medical Center — the primary provider of trained physicians for the state.
“There’s definitely a need for more family physicians,” said Regier, a KUMC graduate. She warned that it’s not for everyone. “You’re going to have to expose medical students to small towns and to rural medicine.”
Many of the state’s family physicians come from KUMC’s Wichita campus. Of the 1,608 medical students who have graduated from the Wichita school since 1975, almost half have gone on to practice in Kansas.
Still, it remains difficult to convince some that it’s a worthwhile profession, said David Wilson, dean of KUMC-Wichita. Family practice doctors who work in rural Kansas can expect to make $200,000 or so a year — if they work really hard, he said.
“Specialists can make three or four times that and play golf on Wednesdays,” Wilson said.
He’s pushed for higher reimbursements for doctors from Medicare and Medicaid to create more of an incentive for students who choose to practice in a rural setting.
Communities can have a role, too, Wilson said, by actively identifying office space, offering some incentives like a potential signing bonus and highlighting amenities and recreational opportunities.
“Young physicians today are very interested in a lifestyle,” he said. “They want to get a night out once in a while, and to be able to take their sweetheart to the symphony.”
Finding the right people
Overall, about 37 percent of the people who train as physicians in Kansas stay in the state, said Mike Kennedy, associate dean for rural health education at KUMC. Finding and developing doctors to go to rural areas is his passion.
“It’s really more about identifying those who have, for lack of a better term, ‘the right stuff,’” said Kennedy, who practiced as a rural physician in Burlington before taking a job at KU five years ago.
That often means finding people who embrace rural values, such as those who have spent a significant time in rural communities. One KU program identifies juniors in college in good standing from rural areas who want to practice in rural communities.
They are exposed early to rural health care through a variety of programs, and then are virtually guaranteed admission to KUMC if they maintain their grade point averages.
Other programs, like a student loan forgiveness program for those who agree to practice in rural areas, and a student interest group, have also met with success, Kennedy said.
“We really owe it to Kansas as the state’s only medical school to just pull out all the stops and do what we have to do,” he said.
However, the growing primary care shortage is a crisis that’s getting worse before it gets better, Kennedy said, adding it’s a problem KU needs to address now, before a growing number of baby boomers retire in the coming years.
“We have to start now. We can’t wait,” Kennedy said. “It’s a full seven years from the time a student begins training before they start practicing.”
Branching out, staying put
In addition to its activity in Wichita and Kansas City, KUMC is planning a new campus in Salina — pending accreditation and funding for the program.
The plan calls for a campus housed at Salina Regional Health Center that would serve 32 medical students.
“We know that when they’re trained in a rural area, they’ll stay in a rural area,” said William Cathcart-Rake, a Salina oncologist who has been named director of KUMC’s Salina expansion. “When you can see the bright lights in the big city, it’s hard to go back to the farm.”
The days of having a family care physician in each small town may be over, but for primary care, people tend to not like driving 50 or 60 miles to their doctor’s office, Cathcart-Rake said.
There’s an economic development aspect to having physicians in small town, too, he said.
“Sometimes the physicians are the lifeblood of the community. If you lose your physicians, you lose your hospital,” and then more and more people will move away, Cathcart-Rake said. “The economic lifeblood just kind of gets sucked right out.”