Small-town hospital administrator Benjamin Anderson's introduction to the physician shortage in Kearny County was painful.

He was told in 2013 when hired to manage the county hospital in southwest Kansas that the facility was in the market to hire five doctors and was about to lose one of four physicians on staff. The remedy formulated in the tiny hospital in Lakin, a city of 2,200 people marked by economic pendulums of the agriculture and energy industries, is now being replicated to address the shortage of primary care doctors infecting Kansas and other states.

The answer at Kearny County Hospital to the uneven distribution of health care providers necessitated a culture shift at the hospital, Anderson said. Every physician had to be a full-spectrum provider in terms of working in the emergency room, delivering babies and sharing the on-call duties equally. The role of physician assistants and nurse practitioners was amplified. Staff salaries were brought in line with industry rates.

In an unorthodox move, Anderson began recruiting doctors completing professional residency programs by offering contracts with an eight-to-10-week window each year for overseas humanitarian work. The quest was to entice people wired to serve in medically challenged countries, which often aligned new doctors with the constellation of refugees and immigrants moving to western Kansas.

"We agreed the millennial generation was full of mission-driven people. When they work with purpose, they are very, very engaged," he said.

Anderson said the recruiting-and-retention campaign blossomed into another project to fly job candidates to western Kansas for a personal introduction to communities seeking their expertise.

Kearny County Hospital filled its physician vacancies in about one year and draws about 20,000 patients annually from more than a dozen counties. That's double the patient volume of six years ago.

Surveys and studies have documented the decades-old problem with placement of primary care physicians in Kansas. Health professionals, not just primary care physicians, persist in gravitating to jobs in urban locales, which they believe provide solid career opportunities and a quality of life for their families.

United Health Foundation, through America’s Health Rankings, ranked Kansas as the 27th healthiest state in 2018. Colorado was eighth, while Missouri was 38th. In terms of primary care doctors for every 100,000 residents, Kansas ranked 31st in the nation for the third consecutive year. That headcount included doctors in general practice, family practice, obstetrics and gynecology, pediatrics, geriatrics and internal medicine.

"Like many states, Kansas is facing a physician shortage," said Michael Kennedy, associate dean of rural health education at The University of Kansas Medical Center in Kansas City, Kan. "What makes the situation acute is that there is an uneven distribution of physicians, which leaves underserved areas with critical shortages."

 

By the numbers

The Robert Wood Johnson Foundation ran numbers based on 2015 data that offered insight into the range of coverage by primary care physicians from county to county in Kansas. The population-to-doctor ratio in Kansas averaged 1,320 residents for every doctor. Nationally, the 90th percentile benchmark was 1,030:1.

Here is a sampling of the diversity in patient-to-doctor coverage among counties in Kansas: Johnson County, 830:1; Brown County, 890:1; Sedgwick County, 1,150:1; Douglas County, 1,180:1; Saline County, 1,270:1; Shawnee County, 1,390:1; Ellis County 1,610:1; Finney County, 1,860:1; Ford County, 2,030:1; Wyandotte County, 2,550:1; Kingman County, 7,690:1; and Linn County, 9,540:1.

More than two dozen Kansas counties have been declared frontier areas in medical terms, because there are two or fewer primary care doctors in each.

The three medical schools in Kansas are affiliated with The University of Kansas and operate on branch campuses in Wichita and Salina, as well as the original complex in Kansas City, Kan.

The Salina campus, founded in 2011, was conceived with the understanding it would focus on addressing the ever-growing need for primary care doctors in rural areas. With eight students per class, KU Medical Center officials said the Salina campus was suited for self-starters who could be a better fit at health facilities in rural communities, where resources may differ from larger hospitals or clinics.

The Wichita campus was born in 1971 out of the need for hands-on clinical training for students in their final two years of medical school. It grew to become an integral part of the training of primary care physicians practicing throughout the state. The Wichita program, which expanded to four years in 2011, is a community-based enterprise with more than 1,000 volunteer faculty located at three partner hospitals. As a result, KUMC said, students benefit from exposure to a wide variety of clinical experiences, especially family medicine.

The American Association of Medical Colleges ranked the KU School of Medicine in the 96th percentile in producing doctors working in rural settings 10 years to 15 years after graduation.

Garold Minns, dean of KU School of Medicine-Wichita, said the ranking meant the university's graduates were working with underserved populations from the urban core in Kansas City, Kan., to sparsely populated areas along the Colorado border. However, he said, more should be done to deal with the shortfall of primary care doctors. The gaps can be geographic, given the distances between clinics and patients, or demographic, resulting from a concentration of low-income residents.

"We need more primary care physicians in Kansas. Primary care physicians are the foundation of medical care systems," he said.

Tom Bell, executive director of the Kansas Hospital Association, said academic scholarships and college loan repayment programs had produced more medical school graduates in Kansas. There remains a shortage of post-graduate training residency opportunities across the state, he said.

"We are graduating physicians," Bell said. "We really could use more residency slots. That would go a long way."

 

Welcoming new doctors

Anderson, who began developing his novel approach to doctor recruitment while working for a hospital in Ashland, said the key to retention of medical professionals in underserved regions involved development of a sense of community sought by new arrivals. The loneliness felt by a Texas-trained doctor living in Lakin resembles the separation experienced by immigrants to Kansas, Anderson said.

The ongoing work, he said, was to demonstrate that a cure to doctor shortages required building upon an educational foundation with professional opportunities and a commitment to community.

Anderson said one of the most important duties he and his wife performed recently was serving as babysitter for a 2-year-old child so a physician and his wife could go on a date. On a recent evening, Anderson and some of his immigrant friends hosted a gathering for prospective hires.

"We have the answers," Anderson said. "Raising two fingers off a steering wheel is not hospitality. The question is: Will we share our dinner tables?"

He said rural Kansans are among America's best-kept secrets. If they let newcomers into the circle of trust, he said, people find hardworking, honest, faith-driven people who can form "friendships for life."

About 18 months ago, Anderson was in Texas to help recruit a physician to the Kansas community of Tribune. He asked a group of residents — doctors finishing their training and ready for the marketplace — if they would be willing to visit southwest Kansas if flown there by charter.

Eventually, 20 agreed to explore Kansas. That initial group had a steak dinner in Garden City. Gov. Jeff Colyer, a surgeon, spoke to the group. Some of the recruits signed contracts to work in Kansas.

The fourth such recruiting flight bringing health professional prospects to Kansas is scheduled for Feb. 1.

Interest is high enough that job applicants have been referred to other Kansas hospitals with management that subscribes to the recruitment framework piloted at Kearny County Hospital.

Anderson, raised on the West Coast and educated on the East Coast, said the hospital in Lakin had proven quality prospects were hungry for careers in locations that offered professionally and culturally safe environments for constructing a medical career and raising a family. While doctors and nurses audition for jobs in Kansas, he said, so must residents of communities in demand for those medical services.

"There are more mission-driven, well-trained millennial family physicians interested in practicing in rural Kansas than there are safe places to hire them," Anderson said.

He said he believes a reasonable 10-year goal should be: One primary care physician within a 30-minute drive of every Kansan.