Kansas Health Institute | Information For Policy Makers. Health for Kansans.

By Sarah Green

KHI News Service



TOPEKA A recently graduated family practice doctor found a small, rural town she liked. It offered the chance to work with friendly colleagues in a welcoming community.

But she didn"t want the job because she was concerned she wouldn"t be able to meet and marry a husband, said Dr. Rick Kellerman, chairman of the Department of Family and Community Medicine at the University of Kansas School of Medicine in Wichita.

"I couldn"t argue with her on that," he said.

Young doctors who choose rural practice, despite concerns of personal or professional isolation, get a chance to "ply their trade," in ways that their big-city counterparts might not, Kellerman said.

When he practiced in Plainville, a town of 2,000 in Rooks County north of Hays, a typical day"s work could include well-child check-ups, caring for people with pneumonia, tending patients who had been in a serious oil field or farming accident, and stabilizing a trauma patient seriously injured in a car accident.

"You use all your talents," he said. "The training has to be very broad-based to take care of all of those things.

"Some medical students are very interested in doing one thing," he said. "I think medical students and residents who will be potentially successful in rural areas have to buy into the philosophy of comprehensive care, of seeing the patient as a whole person, not just as a procedure. They understand that the patient has a family and certainly lives in their community."

Those trained in family medicine or primary care are considered best suited for rural practice.

Kansas leads the nation in producing physicians who choose family medicine over other specialties, but in the next five years the state is expected to experience a widespread shortage of physicians, particularly in rural areas.

"There have been very few retiring family physicians over the last 20 years," Kellerman said. "In three to five years, we"ll start seeing 20, 40, and 50 retiring every year as they hit age 65. We"ve not dealt with anything like that in our state before. We"re not producing enough family docs to even keep up with the retirements. In rural areas of the state, we foresee real workforce shortages ."

There are a number of programs in place that try to pipeline physicians to rural areas: The Smoky Hill Family Medicine Residency Program in Salina focuses on rural health issues. A "bridging" program forgives student loans in exchange for three years" service in rural areas. Another program sends substitute physicians from the KU medical school to fill in for physicians in small towns when they need help in hopes that students exposed to that type of practice might find it appealing.

But more should be done at the state and federal levels to promote rural medicine, Kellerman said, including:

* Building stronger K-12 science and math programs to give future physicians a good foundation;

* Better funding for state medical school programs and residency programs that train for practice in underserved areas.

* Tax credits or other incentives for those who move to rural and underserved areas;

* Changes in federal reimbursement and grant programs to encourage practice in rural areas.

And, Kellerman said, communities hoping to attract physicians should keep basic economic development ideas in mind. They should promote good local schools and have attractive entrances to their towns.

"(These) are things we can"t do anything about," Kellerman said. "There are certain issues outside of the medical system that people are thinking about, in terms of their own personal and family issues. Communities need to be alert to that."

-Sarah Green is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. She can be reached at sgreen@khi.org or at 785-233-5443.