Topeka ? Efforts to maintain the availability of a good ol’ country doctor began more than a half-century ago when the University of Kansas chancellor sought to lure new physicians through a new tuition program.

Those techniques are getting more creative as Kansas struggles like much of the nation to keep up with the demand for providers as health care coverage expands. Nationally, an Associated Press review finds doctors are preparing for backlogs, and patients could find it difficult to get quick appointments.

Attempts to address the shortage have taken on increased urgency ahead of the law’s full implementation on Jan. 1.

“The demand for primary care is going to far exceed supply,” said Susan Page, CEO of the Pratt Regional Medical Center in south-central Kansas.

A report by the American Association of Medical Colleges found that as of 2010 there were 2,387 active primary care physicians in Kansas, or 84 doctors for every 100,000 residents. Further, the report found that 26 percent of the physicians were over age 60.

Kansas Gov. Sam Brownback and his fellow GOP legislators have refused a federal offer to pay for expanding Medicaid coverage for low-income and disabled residents. Instead, the state privatized the system, rebranding it as KanCare in 2012 to blunt the growth in costs of providing services to 380,000 residents. Expanding Medicaid would add as many as 240,000 to the KanCare system by some estimates.

However, higher education spending cuts over the next two years could stymie Kansas’ efforts to boost the number of new providers to keep up with existing demands.

The Kansas Board of Regents approved tuition increases on Wednesday for the coming year to offset the reductions. Without state support for the Kansas University medical school, many students could get priced out of the market, said Regent Dan Lykins, of Topeka. Estimates are the cuts could cost the state 30 students in training.

“These are all students — a good chance — who would have stayed in Kansas. We’re not going to have them now,” Lykins said.

Lt. Gov. Jeff Colyer, a plastic surgeon, said the health care law wasn’t the target of a 2011 initiative to lure residents to rural Kansas, but it has become an effective tool.

The changes target income tax breaks for counties that lost 10 percent of their population over the last decade. In 2012, further changes eliminating income taxes for certain businesses, including limited liability companies which include medical practices, helped sweeten the pot.

Shannon Cotsoradis, president and CEO of Kansas Action for Children, said such tax breaks are “stop-gap” methods at best to address shortages.

“You recycle providers in rural areas until they move on after a few years,” she said. “It’s not a sustainable solution, and it doesn’t provide stability for these residents.”

Cotsoradis said keeping young doctors in rural Kansas will be continue to be a problem with the lure of more lucrative practices and quality of life in urban areas.

The Pratt hospital, which serves patients as much as two hours away, is undergoing a $31 million expansion and renovation. Page said most patients are able to see a provider within 24 to 48 hours of seeking care, but that may be a physician’s assistant or nurse practitioner instead of a doctor.

“All of us are going to be focusing on the health of the population and keeping people well and out of the hospital,” Page said. “It’s a totally different change of thought. It’s scary. It kind of feels like you have one foot in the boat and one on the dock.”

Colyer said health care was a “dynamic process,” and no one solution will suffice.

“I think this helps us get down the road significantly. I’m sure that we will have to do more things as this comes along,” he said.