Special Reports

February 28, 2013

Doctor shortage to hit rural areas hardest

Doctors are in short supply in Kansas – especially in rural Kansas. As of 2010, the state ranked 39th in active physicians in relation to the population.

Doctors are in short supply in Kansas – especially in rural Kansas. As of 2010, the state ranked 39th in active physicians in relation to the population.

Nationwide, as the population ages and nearly one-third of all physicians will retire within the decade, the need for medical practitioners gets greater.

“The national projected shortage exceeds 91,000 physicians by 2020,” said Christiane Mitchell, the director of federal affairs at the Association of American Medical Colleges. “We’ll see a shortage that is 50 percent primary care and 50 percent specialty care.”

This nationwide shortage will hit rural areas the hardest.

“I would not consider Wichita underserved,” said physician Paul Callaway, the program director of the Wesley Family Medicine Residency, one of the first four family medicine residencies in the country. “It’s easier to attract physicians to a larger city.”

But even in Wichita, certain specialty areas such as neurology and rheumatology are difficult to fill. Even the University of Kansas at Wichita struggles with getting neurologists to teach at its program.

For the most part, though, metropolitan areas, such as Wichita and Kansas City, are where many newly graduating doctors seek to practice. Many of these new graduates are women, and many, Mitchell said, are looking for a more flexible schedule and, like their male counterparts, the amenities that urban areas provide – from schooling to museums to the arts.

Because of the increase in female college graduates, more women are entering the medical profession. The University of Kansas at both its Kansas City and Wichita branches has nearly an equal distribution rate between men and women. In 2012, women made up about 44 percent of the medical students. This translates into more women completing their residencies and then practicing medicine. This trend is similar nationwide.

But so is the trend of the shortage of practitioners in rural settings.

“Kansas is uniquely rural,” said Mark Meyer, the associate dean for student affairs at KU Medical School and a professor and doctor of family medicine. “The rural areas are underserved.”

Because of the already increased need for rural doctors, even before the national shortage hits, KU Medical School and the state have been on the offensive.

“The Kansas Medical Loan Program is the best way to address this issue,” Meyer said. By providing financial assistance to medical students who commit to practicing in rural areas of the state, those areas obtain more physicians.

The program, approved by the Legislature, provides up to $2,000 a month for tuition and living expenses for the four years a student is in medical school at KU. In return, the person promises to practice full time for four years in a Kansas county other than Sedgwick, Johnson, Shawnee or Douglas.

But rural counties want to hold on to these doctors after the required period of practice ends. That is why the KU medical school focuses on recruiting in the outlying counties.

“If you recruit from an underserved area, they are more likely to serve in an underserved area,” Meyer said.

KU, which is known as one of the national leaders in producing primary care physicians, also has a rural training option in its summer and clinical programs and utilizes the Scholars in Rural Health, an early admissions program that pairs students from rural areas with mentors, and the Kansas Bridging Plan, a loan forgiveness program for doctors who agree to practice for three years in rural areas. Many of the physicians that graduate from the Wichita and Salina campuses stay in the area or return to a rural community.

With the expansion of the existing campus in Wichita and the new campus in Salina, the KU School of Medicine can enroll 211 Doctor of Medicine students each year, up from 175 in 2010. The KU Health Education Initiative would allow the school to expand further, increasing enrollment to 236 Doctor of Medicine students.

Mitchell said KU, like many other medical schools across the country, has increased the number of physicians it trains; some schools have done so by as much as 30 percent. But, once the physicians graduate, they must obtain a residency at an accredited program.

“The residencies in the state are static,” Meyer said. “They are defined and regulated at the federal level.”

By increasing the number of U.S. medical school graduates and leaving the residency positions static across the country, there is going to be what Meyer terms a “log jam.”

“In 2011, there were 24,857 first-year medical students at U.S. schools,” Mitchell said. “Currently, there are an estimated 25,000 to 26,000 first-year residency positions.”

It is estimated that by 2016, there will be 26,700 first-year medical students from both medical and osteopathic schools to fill the same number of residences that exist today.

“Unless the federal government expands its support and doesn’t cut current support,” Mitchell said, “the number of first-year residency positions will remain at about 25,000 to 26,000.”

All residency programs in Wichita are sponsored by the KU School of Medicine-Wichita, and administered by the Wichita Center for Graduate Medical Education, which includes the KU School of Medicine-Wichita, Via Christi Hospitals and Wesley Medical Center.

Via Christi, whose residency program is accredited for graduates of both osteopathic and medical schools, is home to the second-largest family residency program in the country. This year’s class has 13 of the 20 slots filled by women. Wesley, Via Christi and KU hope to keep their graduates in Kansas.

“We hope that once they train here, they don’t want to leave,” Callaway said. “A fair number will want to practice in an area near where they train.”

Usually physicians stay within a 150-mile radius of where they trained.

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