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Wednesday, August 20, 1975
University Daily Kansan
KU Med Center reaches out to help rural Kansas
By PAULA JOLLY Contributing Writer
One of the most important health care problems in Kansas today is the shortage of physicians in rural areas. The rural Kansas doctor often battles the twin plagues of professional isolation and the inability to attract a partner to share the heavy patient load.
However, conditions are changing for physicians in rural Kansas. Today, a continuing medical education seminar may be as near as a neighboring town. A rural physician may even be able to enter joint practice with young doctors who have worked with them as part of the KU Medical Center's curriculum requirements.
THESE AND OTHER improvements are the result of the Med Center's efforts to ease the doctor shortage and improve rural health care in Kansas.
The shortage of physicians in Kansas can be shown statistically. According to the American Medical Program (KRMP) entitled "Physician Manpower in KUMA," the state has only 143 physicians for each 100,000 people, an international ratio is 159 for each 100,000 people.
The report also shows that although 59 per cent of the state's population lives in rural counties, only 37 per cent of the doctors practice there. To compound the problem, more rural physicians than urban physicians are ill-armed by a shortage of more rural doctors than urban doctors will have to be replaced in the near future because of retirement or death.
THE MED CENTER has responded to the general need for more doctors by increasing the size of medical school classes from 130 to 150 students. In addition, the medical school curriculum has been shortened from four to three years. These actions together enable more physicians to graduate in less time, thereby reducing the number of physicians available.
However, the specific need for primary care physicians is more acute than the need for other types of physicians. Primary care physicians are those who take care of the basic medical needs of patients, in contrast to physicians who treat only certain types of diseases.
According to the KRMP report, Kansas has only 53 primary care physicians for each 100,000 people, compared to an optimum number of 80 for each 100,000 people.
This optimum number of physicians is based on the Florida Baseline Physician Ratio, the standard used by KRMP in practice. In future health manpower needs in Kansas.
In 1970 the Med Center responded to the specific need for more primary care physicians by establishing a department of family practice. The size of the department has been increasing ever since, according to J.D. Walker, chairman of the depart-
programs because research and specialized medicine were emphasized by the schools
WALKER HAS SAI that medical schools had traditionally resisted family practice
According to Walker, the emphasis on research and specialization started in World War II, when the federal government pumped money into the search for new medical knowledge. As a result of the new knowledge, the medical profession began to focus on specialized specialties and students entered the specialties instead of general practice.
"Since about 1968, however, about 350 family practice residency training programs have been formed throughout the country," Walker said. "Also, about 25 per cent of the medical students now seem to be interested in becoming family doctors."
"For example, last year we had 60 applications for only 18 position positions in
residents. We have already outgrown our new facility."
WALKER ATTRIBUTED the increased interest in family practice to the public's
Walker said the department would probably retain its present facilities when it acquired the space in the new clinical building. With both locations the department might be able to increase enrollment of minimum of 38 residents in the future, he said.
Though the production of more physicians, and especially of more family practice physicians, will help alleviate the pressure on the doctor to get of getting doctors to settle in Kansas once their education is completed. However, two programs at the Med Center do provide medical students and residents with an opportunity to people what life is like for a Kansas physician.
Preceptorship workshop in Manhattan
ONE OF THESE programs, the preprocessing program, gives each medical user access to all of the data.
desire for family doctors instead of many specialists for each family. Also, in the mid-1960s Medicare and Medicaid were started, and the federal government found that many people couldn't take advantage of the medical care benefits because of a shortage of medical professionals. The government decided that more family practice training programs were needed, Walker said.
A new basic science building is now under construction at the Med Center to accommodate additional students in the medical school, Russell H. Miller, vice chancellor for medical center administration, said. The building, which will provide classrooms and laboratories, is new and modern. It will have a new clinical facility that will be the hub of all patient services at the Med Center, he said.
PART OF THE new clinical facility being built now will be devoted to the family practice department, Walker said. The new facilities are designed to allow for 18 residency enrolments in family practice, be said.
Together, the two buildings make up the biggest single building project to date in Kansas, according to a Med Center fact sheet on the project.
"There is only one problem," Walker said. "As of this July we have an enrollment of 3,072."
weeks with a practicing physician in Kansas, Ralph Reed, director of the preceptorship program, said. The medical school is designed for all medical students since 1921.
"We try to get the student to live in the home of the doctor he's working with," Reed said. "The student gets acquainted with the town in a social way and experiences the family practitioner's round-the-clock responsibility for his patients."
Though preceptorships are available in specialties as well as in family practice, a survey of medical school graduates from 1971 to 1974 indicated that in each class, students chose to do a preceptorship in family practice than in any of the specialties.
THE SURVEY, DONE by Joe R. Kimmel, associate dean for faculties and academic affairs at the Md Center, also indicated that physicians are more likely to doctor family practice in a town of less than 5,000 people. The students surveyed thought that physicians in those circumstances were more likely to practice outside of the
"They frequently mention that they learn it is easier to have a part in doing something about community problems in a smaller town than in a metropolitan area," he said. "You can easily see the physician being an active, influential force in bettering the community."
Because of this, preceptorship are no longer set up with solo practice. u small towns, Reed said. Instead, medical students do preceptorship in group practices.
According to Kimmel, medical students interviewed for the survey were impressed with the involvement of the physician in community and civic affairs.
HOWEVER, WHILE A preceptorship in a small town may have some influence on a nurse's ability to perform well in Kansas, national data show that the prime factor in determining where a physician will locate is the location of his residence. Another factor is the venue vice chancellor at the Med Center, said.
Therefore, residences at the Med Center include the option of taking an outreach residence training program that provides information away from the Med Center. Mills said.
"If you want a doctor to locate in Garden City, he should have some experience there as a resident," Mills said. "In 1972, we started sending a surgery resident there to work in a group practice for three months. An attempt is made to bring the resident's house to provide housing for them also, so that the whole family can see what life is like there."
In addition to spending time in Garden City, surgery residents in the outreach residence program rotate to Topeka, to Bethany Hospital in Kansas City and to Shawnee Mission Medical Center in Johnson County.
MILLS SAID the program was successful because at least one person had settled in Garden City as a result of the residency program there.
According to Walker, participation in the outreach medical program is required of all family practice residents. Six doctors have graduated so far from the family practice residency program, and three of them did locate in Kansas. he said.
In addition, the Med Center has been active in formulating new plans for insuring adequate physician distribution in the state. In the fall of 1947 an ad hoc committee was formed at the Med Center to examine the health care delivery system in Kansas and to make suggested changes. According to the chairman of the committee, the suggested changes would possibly lead to solutions for the problem of physician distribution.
THE COMMITTEE has suggested a plan for regionalization of health care in Kansas, Wuker said. The plan calls for a network of health care centers throughout the state.
munity that can serve their area and then work with that community to improve its professional environment, including the presence of a small hospital and adequate office space, so that the community could become a primary health care center.
If each town in Kansas can't attract a doctor, Walker said, it would be better for the state to hire a dentist.
The community should also be an attractive place to live, he said, with good parks and recreation facilities, shopping centers and other features that would attract young people.
Efforts would be made to recruit doctors for that town only, instead of efforts being made to recruit doctors for every town in the area, Walker said.
The primary care centers would be supported by a smaller number of intermediate health care centers in the state. Walker said the intermediate centers would provide consultation, referral and other services to the intermediate centers. Specialists and more sophisticated facilities would be available in the intermediate care centers.
THE INTERMEDIATE centers would be backed up by three tertiary care centers located at the Med Center, in Wichita and in Topeka. These centers would provide everything in sophisticated medical services, Walker said.
The execution of a regionalized health care plan couldn't be done by the Med Center, Walker said. If the plan were to be implemented, he said, it would have to be by some other state agency and would have to be supported by most Kansans.
In addition to its programs for increasing the number and improving the distribution of physicians in Kansas, the Med Center has also been active in lessening the
professional isolation of physicians already located in rural areas. This is done through courses offered by the division of postgraduate medical education.
According to Jesse D. Rising, chairman of the division, directors of many similar programs in the United States have come to recognize that effective techniques used in the division's programs
THE POSTGRADUATE medical education division also has an international reputation. Rising said he had been a professor at the University of Southern Australia in 1966, and that he had also been a consultant to the Australian Postgraduate Committee on Medicine. In addition, he was invited to Spain for a conference on continuing medical education in 1971.
In addition to a variety of courses offered at the Med Center, the division of postgraduate medical education offers circuit courses in different Kansas towns for nearby health professionals. Last summer six programs were offered in each of eight towns during a circuit course series (Rising, Raising, Mini-circuit seminars, Mini-circuit problems are also offered. The division also offers a circuit course for nurses.
HOME STUDY COURSES are another offering of the division, Rising said. Continuing education credits are given upon completion of the program and an examination.
Health care professionals from other states also benefit from the division's business model. The division bus had enrollments from almost every state in the union for 15 years.
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