Southwest Kansans face major health care issues

The numbers aren't promising.
    Close to 38 percent of active physicians in the United States are nearing retirement age.
    The rising cost of running a medical practice is increasing while doctors' revenue streams head south. And while more and more people are enrolling in medical school, fewer are going into general practice.
    This could mean that routine and preventative care will be delayed, prescriptions will go unfulfilled and some patients simply won't receive care, according to the Association of American Medical Colleges.
    But for Dodge City Medical Center administrator Gene Dole, what experts are predicting nationwide is already happening in southwest Kansas.
    "Pretty soon, the country will start seeing what we see here in Dodge," Dole said. "Those issues, that's what Dodge is feeling."
    That's not to say that there aren't any doctors.
    According to a recent study by the AAMC, first-year enrollment in medical school has steadily increased by 20 percent each year since 2002. But with the lure of more money and steadier hours, fewer graduates are going into general practice, preferring higher-paying subspecialties such as anesthesiology, neurology and surgery.

The need for primary care
    When looking at health care in rural Kansas, it's important to first look at the nationwide shortage of primary care physicians. The largest deciding factor is most likely the focus on knowledge. While a urologist deals with one specific area of the human body, a primary care physician is the first line of defense for patients, requiring a general knowledge of a wide range of maladies.
    Primary care physicians keep a list of patients whom they see on a regular basis for everyday medical needs: Physical checkups, routine procedures, et cetera. They're the ones who first diagnose problems and then refer their patients to other specialists.
    For Bob Hostetler, a family practice physician at Dodge City Medical Center, it's a tough job that requires a solid general knowledge of medical sciences.
    "We're often the first provider a patient comes to," he said. "We take care of probably 90 percent of problems a patient has. We address their specific needs, be it acute problems or chronic problems. I take care of babies up to older people."
    But that level of general care can cause conflicts with hours younger doctors are willing to work.
    In the past, primary care physicians often worked at their respective clinics between 8 a.m. to 6 p.m., plus weekend duties as well as call duty for area hospitals. AAMC studies have shown that these long hours have contributed to increased burnout among the doctors.
    Coupled with the advent of diagnostic Web sites like WebMD.com and more medical students heading into subspecialties, it doesn't come as much of a surprise to some that general practitioners are a dying breed.
    Which is all the more troubling, considering the role they play in preventive health care.

The increasing demand
    Between 1996 and 2005, use of primary care physicians across the United States steadily crept upwards to almost 200 million visits a year, according to the AAMC.
    Meanwhile, the number of physicians able to meet that increasing demand began to shrink. More and more reached retirement age, while more medical students began to drift away from general practice.
    Add universal health care — a controversial topic that has garnered increasing support in left-leaning political circles — and Dodge City Medical Center administrator Dole said you can expect the demand to outstrip supply even more.
    "Universal health care is a great idea in theory," Dole said. "But if universal health coverage comes, more physicians will be needed to provide more health care to more people. It significantly increases the pressure on current physicians."
    The tough economy has caused problems for other areas of health care as well.
    With more and more people looking at ways to pinch their pennies, fewer people are seeking preventative medicine, opting instead to wait until something goes wrong. This pushes demand for emergency care up.
    Conversely, doctors are facing the same budget crunch as everyone else.
    This proves a double-edge sword.
    Dole said this means that the steady stream of retiring general practitioners has actually slowed, as fewer and fewer are able to retire comfortably.
   
A constant need
    While the numbers are indeed troubling, many are still holding out hope.
    Recent numbers supplied by the University of Kansas Medical Center confirm that the majority of graduates are heading into subspecialties. According to KUMC, 44 percent of the students who graduated in the 2008 class are going into primary care. The remaining 56 percent is scattered across various specialties.
    However, KUMC spokeswoman Jessica Taveu said that the school was looking at ways to encourage people not only to enter general practice, but to spend time working in rural areas of Kansas.
    For some, it's a necessary need that must be filled.
    "I think there will always be a need for someone to deliver personalized medicines," Hostetler said. "I don't think you can just do that with a computer. Sure, you can type in symptoms and get an answer, but I don't think that will take of people's needs both physically and psychologically. You need a person that can take responsibility and is willing to be the focal care provider."

EDITOR'S NOTE: This is the first in a Daily Globe series about the health care crisis affecting southwest Kansas.

Reach Mark Vierthaler at (620) 408-9908 or e-mail him at mark.vierthaler@dodgeglobe.com.