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March 12, 2012
WICHITA Dr. Beth Loney graduated from the University of Kansas School of Medicine’s Wichita campus in June and then went into practice in Stockton, a town of about 1,300 people in Rooks County, north of Hays.
When she started medical school, she had no plans to become a rural doctor.
"I knew I wanted to do family medicine, but I wouldn't have said I wanted to do rural. I didn't have family that was rural, I didn't grow up going to a rural area, so I didn't know a lot about rural medicine," Loney said.
That changed thanks to an exposure to rural medicine during her second year of medical school. She participated in a "rural health weekend" at Dr. Jennifer Brull's practice in Plainville. That led to a third-year rotation in Plainville.
"That's what made me decide to do rural by the time I went to residency," Loney said. "Early exposure is so important if you're actually going to get people to consider it as an option."
There are others like Loney.
More graduates from the KU Wichita campus chose to practice in rural areas of the state in 2011 than in any of the previous five years.
The KU Wichita campus was expanded last year to include a full four-year program, and a new four-year program was started at KU Salina with hopes that more students would focus on primary care and work in rural or other underserved areas of the state upon graduation.
If last year’s graduating class is any indication, the strategy already may be paying off.
Dr. Brad Poss, professor of pediatrics and associate dean for graduate medical education at the KU Wichita campus, said interest in working in rural Kansas is closely tied to growing interest in primary care among students.
"And having a connection to Kansas is important,” he said. “That's one of the reasons for the opening of the new four-year campus here. Families get established, they get to know the area and they begin to make a life here. So, they then like to do their residency here as well and they become established in Kansas and subsequently have practices here."
Currently there about 776 residents in KU’s medical school — 499 in Kansas City, 264 in Wichita and 13 in Salina. Last year, 121 graduated from KC, 66 from Wichita and four from Salina. Graduating class sizes vary from year to year because residencies last from three to seven years.
Poss said in recent years, about 50 percent of KU Wichita’s students chose to practice in Kansas following their residencies and about 30 percent chose to leave the state. The remaining 20 percent went on to advanced training in fields such as cardiology or neurosurgery, and about half of those specialists stay in Kansas afterward.
In 2011, 32 residents graduated from KU Wichita and set up practice in Kansas. Of those, 18 chose to practice in rural communities, or 56 percent. That's up from 19 percent in 2010 and an average of 35 percent the previous five years, Poss said.
Comparable numbers from the other two KU medical campuses weren't immediately available.
Allure of rural medicine
Loney said part of the allure of rural medicine was the broad range of work involved.
"You're going to work in the ER, you're going to admit your own patients to the hospital, you're going to deliver babies, you're going to do your own procedures — things that in the big city you don't do," Loney said.
But she said she wouldn’t practice in just any rural setting. Loney and her husband — Dr. Mike Oller, also a 2011 KU Wichita graduate — chose Rooks County largely because of the existing medical community there.
The couple own their own practice in Stockton but share emergency room and on-call duty with the three other doctors in Plainville, 15 miles south.
"One of the big factors is going somewhere where you weren't alone, where you could have a great life outside of medicine. You can have a balance. You're not on call every night," Loney said.
Promoting primary care
Expanding KU's medical school campuses in Wichita and Salina was among the 24 recommendations a task force made five years ago with the aim of generating more primary care and rural doctors for Kansas in anticipation of a wave of upcoming physician retirements.
According to a 2009 report from the Association of American Medical Colleges, nearly a fourth of working doctors in Kansas and nationwide were 60 or older. Almost 40 percent were 55 or older.
Meanwhile, the same study found that the number of students enrolled in medical or osteopathic schools in Kansas had increased only 1.5 percent between 1999 (715 enrolled) and 2008 (727 enrolled).
If enacted as approved in 2010, the federal health reform law is expected to mean more than 100,000 additional Kansans will have some form of health insurance beginning Jan. 1, 2014. That’s expected to create even greater demand for medical services.
The reform law also put some emphasis on beefing up primary care, which is seen as one of the ways to help curb health care costs by catching illnesses earlier or preventing them altogether.
Several of the reform provisions were included with the goal of encouraging growth of the primary care workforce, including Medicare and Medicaid payment incentives for primary care providers. But it remains to be seen what those provisions will accomplish or whether they will remain fully funded given ongoing contention in Congress over health reform and federal spending plus a pending challenge before the U.S. Supreme Court.
And convincing medical school students that they should focus on primary care or family medicine is still a challenge, officials said. Despite the new law's incentives, a primary care doctor can still expect to earn about a third of what some high-paid specialists make. Finding students willing to become primary care doctors in a small town can be even more challenging.
Photo by Steve Rasmussen.
Drs. Shelly and Doug Gruenbacher went into rural practice in 2002 for reasons similar to those cited by Loney in Stockton.
Shelly Gruenbacher said she and her husband enjoyed the unique type of practice possible in the small, close-knit community of Quinter, which is just north of Interstate 70 and about an hour’s drive east of the Colorado border.
"It really is cradle-to-grave medicine," she said. "We know our patients well, and we like that. Primary care is different in a rural setting than it is in a city — not better, not worse, just different. There's less ready-referrals in a rural area. You're more inclined to take care of somebody that you might refer in a city.”
Like Loney, Gruenbacher said early exposure in school to rural medicine was critical for getting more students to consider it as a career path.
She also said the Kansas Medical Student Loan Program was effective in steering more students toward rural practice. The program allows up to 30 students a year to work off their student loans by agreeing to practice in rural or other underserved areas once they become doctors.
And perhaps the best way to get more doctors in rural areas is to recruit medical students from small towns, she said. Her husband is from Andale and she grew up in Stockton.
"If you're from a small town, you're more likely to go back. You're more likely to not think it's a big hardship to live without Walmart or Target," Gruenbacher said.
Resident graduates from the KU Wichita campus
• 66 total residents graduated (from Sept.1, 2010 to Aug.31, 2011).
• 17 went to practices outside Kansas.
• 17 went to fellowships.
• 32 stayed in Kansas and set up practice in the following communities:
Rural — 18 total
Augusta - 3
Derby - 1
Emporia - 1
Hesston - 1
Liberal - 1
Newton - 2
Salina - 5
Scott City - 2
Stockton - 2
Urban — 14 total
Kansas City area - 1
Topeka - 1
Wichita - 12
The KHI News Service is an editorially independent initiative of the Kansas Health Institute and is committed to timely, objective and in-depth coverage of health issues and the policy making environment. Find more about the News Service at khi.org/newsservice or contact us at (785) 783-2529.