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

TOPEKA — According to one informed estimate, Kansas currently is short about 500 to 750 doctors -including about 400 primary care or family practice physicians.

The shortages are particularly keen in the state’s less populated counties where doctors, dentists and other providers are likely to be few and far between.

Thanks to a new federal grant match to an appropriation by the Kansas Legislature, the state this year will be able to increase by a handful the number of doctors it can lure to service in rural areas with promises to help cover their education costs.

But unless something changes soon, Kansas won’t be tapping into the millions of dollars of inducements to attract health care providers to the countryside now potentially available to it as a result of the economic stimulus law signed in February by President Obama.

Kansas, like many other cash-strapped states, won’t be able to participate in that potential windfall of federal assistance unless someone figures out a way to come up with the required state or local matching funds.

The problem

The University of Kansas graduates about 30 students a year who choose to go into family medicine, a field which makes them well-suited for rural areas where physicians are counted on to perform a wide variety of procedures and services.

But two-thirds of the KU medical graduates leave the state, which means fewer than a dozen a year stay here potentially available to fill the needs of rural Kansas.

“Things like physician tuition repayment programs are critical for the state of Kansas to attract doctors back into the state,” said Dr. Michael Kennedy, associate dean of Rural Health Education at the University of Kansas Medical Center in Kansas City. “Not only do we need to keep as many graduates from our own programs as we can, but we also need to attract doctors from surrounding states, maybe even the coasts, to help with the dire needs that we have.”

A formal, Kansas-specific needs assessment has not been completed, Kennedy said, but a general estimate based on national averages indicates Kansas, on average, is short about 50 doctors for every 100,000 residents. And in some areas the shortages are worse.

With major health reform thought to be on the horizon and millions more people likely to gain health care coverage, federal officials are keenly aware of the need to put a dent in the shortages of health care providers, especially in the primary care arena.

Kansas is not alone in having shortages of primary care providers. It is a major problem in rural areas across most of the U.S.

“We cannot sustain a functional health care system without an adequate workforce — and that workforce is going to need to be digitally literate, culturally adept and fast on its feet to deal with the changes that are unfolding in health care,” said Mary Wakefield, administrator for the federal Health Resources and Services Administration, in an August speech to primary care experts. “The scarcity of health professionals is particularly acute, and getting worse, in rural America — where seven out of 10 of our primary care shortage areas are located and a predominance of dental and mental health shortages as well.”

Wakefield was appointed to the agency in February. Before that she was associate dean for rural health at the School of Medicine and Health Sciences at the University of North Dakota, where she also was director of the university’s Center for Rural Health.

Struggle to find matching funds

The Legislature each year since 2006 has agreed to spend $150,000 for the state’s recruitment program. This year, that sum coupled with a HRSA grant, puts $300,000 at the state’s disposal. That will allow the state’s school loan repayment program to include as many as 14 doctors, instead of seven.

Kansas before 2006 tried to meet the match with money from local sources such as a hospital, doctor’s office or clinic that was trying to recruit a medical professional.

But Robert Stiles, director of the Primary Care Office at the Kansas Department of Health and Environment’s Bureau of Local and Rural Health, said local funding was spotty and difficult to raise.

Under the federal grant rules, any money given a recruited doctor or provider for student loan repayment had to be in addition to whatever was given the provider in salary.

“We have had a lot of difficulty coming up with the match,” Stiles said. “They couldn’t, say, put up $25,000 of a provider’s salary for loan repayment. They have to pay the provider the going rate, and any local contributions have to be outside of that. It wasn’t very successful.”

When HRSA announced the new American Reinvestment and Recovery Act expansion of its grant program earlier this year, KDHE decided not to apply for additional grant dollars because it did not have money to match. The agency had already used its available funds earlier in the year to match HRSA’s existing State Loan Repayment Program and officials had been thrilled to see that double to $300,000.

Not alone

Kansas wasn’t alone in not having the matching funds to go after the ARRA grants. When HRSA last month announced $5.8 million in state awards, Kansas and a number of other states weren’t listed among the recipients.

Stiles said before the grants were awarded he had received an e-mail from HRSA asking why Kansas didn’t apply for more ARRA funding and if there was anything the agency could do to make it easier for Kansas to participate in the grant program.

“Several states did not apply for funds because they either could not secure the matching funds or did not have enough time to identify them in their budgets,” said David Bowman, a HRSA spokesman in an email to KHI News Service, explaining why several states received nothing.

Stiles said he informed HRSA that it would have been easier for Kansas to apply if the 100 percent local or state match requirement were eased.

“What would be beneficial to us is if they could lower the local match, maybe make it 50 percent” to the federal grant, he said.

But Bowman in his e-mail to KHI said the law prevented the match requirement from being lowered or waived. Instead, he said, HRSA intends to give states more time to complete their applications for the fiscal 2010 request cycle when the agency expects to award states another $10 million.

That money is part of a much larger pot of ARRA money –about $300 million - directed to the agency to help cure workforce problems. Most of that $300 million will go to expanding the National Health Service Corps.

More time to fill out applications may help some states next year, but Stiles said given the budget situation in Kansas he considers it unlikely legislators will earmark more money for the recruitment programs.

But, he said, “if the Legislature felt like this was an important thing to put funding in, I’d be happy to ask the feds for more money.”

-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, ext. 118.