Jon Stewart has a mission: to make family medicine cool again.
"In the United States, we make TV shows about the emergency room," said Stewart, the CEO of Lawrence's Heartland Community Health Center. "We don't make TV shows about primary care. By comparison, it's not edge-of-your-seat excitement. It's very routine and boring. But it's the difference maker."
Lawrence, like many communities, faces a shortage of primary care providers, a problem that could be worsened if, as expected, the Affordable Care Act adds millions more people to the health-insurance rolls.
As doctors from the baby boomer generation get set to retire, health care providers in Lawrence are working overtime trying to recruit young physicians to the community. While 65 primary care providers — the category includes family and internal medicine, as well as pediatrics — are needed to adequately care for the local population, Lawrence has only about 30 under the age of 60, according to research done by Lawrence Memorial Hospital.
How did the shortage get this way in the first place?
One of the main reasons, experts say, is economics. The pay for primary care doctors lags in comparison to that of many specialty physicians.
"If you become an anesthesiologist, you can make $7 million more in your career than a primary care doctor," said Joshua Freeman, chair of the family medicine department at the Kansas University School of Medicine.
In the recent Douglas County Community Health Plan, access to care was identified as one of the five major challenges facing the health of the community. The county's 2012 health assessment had found that about a third of Douglas County residents hadn't been to a doctor for a routine visit in the past year, while one in five didn't have a primary care provider. Lack of awareness, health insurance and the number of physicians accepting Medicare and Medicaid were a factor, but so was the shortage of primary care doctors.
One of Christy Hitoshi's first tasks after moving to Lawrence three years ago was to establish a relationship with a primary care provider. That proved more difficult than she would have thought.
"I personally found that Lawrence lacked primary care providers in general," said the 40-year-old health care administrator. "It was even more difficult to find one that was within my insurance network. Of the ones that I did locate, they were all on the west side of town and I live in the far east side, which was unfortunate."
She eventually had to choose between two nurse practitioners. After a bad experience with the first one, she fortunately found a better match with the second.
Dan Partridge, director of the Lawrence-Douglas County Health Department, said he believes part of the reason for the shortage locally is that Lawrence has to compete for doctors with nearby big cities with more amenities, like Kansas City, St. Louis and Dallas.
Another challenge Lawrence faces is that it isn't classified as "underserved," meaning that doctors who practice here aren't eligible for tuition reimbursement from the federal government like those who set up shop in rural communities, said Gene Meyer, CEO of Lawrence Memorial Hospital. Meyer said he doesn't foresee the Affordable Care Act making the primary care shortage worse in Lawrence in the immediate future.
"My initial response was that's this is going to be a huge problem right away," he said. "But the fact that Medicaid did not get expanded in Kansas and the insurance exchanges are probably not going to ramp up as aggressively as we initially thought means that the thousands of folks getting new insurance is probably not going to happen for two to three years."
For Heartland Community Health Center, at least, the shortage is affecting them now. Funding in the Affordable Care Act made the clinic a federally qualified health center, giving it the capacity for about 12,000 to 14,000 patient visits a year. To serve that many patients, Heartland would need 5.5 primary care providers; as of now, it has just a part-time medical doctor and full-time nurse practitioner. Heartland plans to hire another provider in the coming months and one more by next summer.
A new generation
JuliAnne Rathbun never thought about doing anything but primary care. Having grown up in a rural Kansas community, she knew the difference family physicians make in the lives of residents.
"They're the doctor you go to for everything," said Rathbun, 24, a student at the KU School of Medicine. "People are very comfortable with family doctors. It's kind of hard when you meet someone once and that's all you see them. They don't get the whole story."
Jonathan Pike, a 25-year-old student at KU's medical school, said the relational aspect of the job can't be overlooked. That really sunk in with him when he worked with a family doctor in his hometown who was delivering the babies of women he once birthed as infants. "To see life through from the beginning to the end, I think, is a real special privilege that not a lot of people are afforded," Pike said.