Physician shortage hits rural areas hard
By PATRICIA MANSON
Staff Reporter
When Buckin's long-time family doctor moved, it took the Kansas town almost a year to replace him.
"We looked everywhere," Dale Birney, cashier at Buckin's Farmers State Bank, said recently. "There's got to be a million and one placement centers. We looked there, we contacted friends and neighbors, we went to health days at the Med Center, we did a lot of
PRIMARY CARE is family practice, general practice, internal medicine, pediatrics and emergency medicine. Primary care
Bucklin, a town in southwest Kansas with a population of 800, was facing a problem shared by hundreds of rural towns in the state—how to find a primary care physician when specialization in the medical profession is limited; how many numbers of doctors are needed for urban and suburban areas.
Although the optimum ratio of primary care physicians is 80 for every 1,000 persons, according to the Kansas Department of Health and Environment, Kansas had only 50.7 for every 1,000 persons in 1977. Ninety-two of the 105 Kansas counties suffer from a shortage
The counties that do not have a shortage are Leavenworth, Wyatton and Johnson in northeast Kansas and ten others in southwest Kansas.
Rural towns have trouble attracting doctors, the Department of Health and Environment says, because most rural towns are not large enough to support specialists. Even primary care physicians are reluctant to practice in rural areas, the department says, because they do not have as much time as urban physicians or as many opportunities to consult with specialists.
A. J. YARMAT, associate director of Outreach, the placement and recruiting service at the University of Kansas Medical Center.
"Small communities have difficulty attracting young physicians," he said. "Young physicians aren't heading for the small communities with 1,000 or 2,000 people. The smaller the town, the harder it is to recruit doctors."
Because of the trouble rural towns experience recruiting and retaining doctors, the Kansas Legislature and the Med Center have issued a rule to limit the number of doctors.
Perhaps the most controversial program is the Kansas Medical Scholarship Program, established by the Legislature last year. Under the program, students receive a year's tuition for each year they agree to practice in Kansas. Students who receive an additional $500 a month while they are in school must agree to practice in medically underserved areas of the state.
THIS YEAR, 153 students enrolled in the program are obligated
Although the program was established just last year, its future is uncertain. The program has been attacked by both medical
to practice in Kansas, and 273 more are obligated to practice in rural areas of the state.
More than 230 medical students filed a lawsuit against the Kansas Board of Revents last May, saving a tuition ransom by the
the legislature that established the program. In March, the Kansas Senate passed a bill that would have allowed the Legislature to limit the money available for the program each year. The governor, did not vote on the bill before the legislative session ended.
State Sen. Mike Johnson, D-Parsons, who wanted to eliminate the program completely, said recently, "I think the program is too
Doctors praise small-town life
The requirements for the job don't sound attractive.
Long hours. Few vacations. Isolation from fellow professionals. Lower than average pay. Certainly not enough to an extensively educated man or woman.
Yet a minority of doctors in Kansas are resisting the trends toward medical specialization and urban living and starting practices in rural towns.
"I like rural living," Michael J. McGinnis, a surgeon who has practiced in Dodge City for the past five months, said recently. "I like the people here. This is the United States where people are close to the earth. They're really good people."
many ways, a bad environment to grow up in.
Rodney Dill, a family practitioner in Atwood, in northwest Kansas, said, "I'll take it, I will."
"Also, you get a chance to know your patients here. You know their families, their environment. You can deal with the patient better."
"BY BEING A jack-of-all-traits,
"I would not beged doine doing the same things over and over," he said, "I like the at-
titude of a rural area. I grew up in a rural town."
"What I was looking for was a smaller town under 2,000 population," Berttonter
said. "What I wanted was to start my own business."
The chance to work for himself makes up for the lower salary doctors in rural areas usually receive. Betterton said.
According to the American Medical Association, in 1975 doctors in metropolitan areas carried an average of $23,400 a year, while those in metropolitan areas carried an average of $8,900 a year.
Other doctors and medical students said the smaller salaries for rural doctors did not discourage them.
regeens was an attempt to force them to participate in the scholarship program.
Frank Flamer, a third-year student at the Med Center, said he planned to practice in a rural area despite the salary difference.
"MONEY IS NOT a deciding factor," Flamer said. "I think I can make a sufficient living either place. If there was a See DOCTORS back page
When the Legislature established the program, the Regents raised medical school tuition from $1,125 to $3,000 a year for Kansas residents and from $2,500 to $6,000 a year for non-residents. The Regents also increased the program program had not influenced their decision to raise the tuition.
SO FAR, the courts have made no decision concerning the
expensive. We're going to spend $3 million on it this year. We could take that money and put it to better uses, like expanded residence permits.
The scholarship program also has been attacked by members of
IN ANOTHER attempt to alleviate the doctor shortage in rural areas, Kansas has expanded its family residency programs in urban and suburban areas. In the past three years practice residence program at the Med Center and at three hospitals in Wichita. Twenty-eight of these residents are scheduled for residency.
Also, the Med Center requires all medical students to spend two
months on a rural preceptorship. Under this program, students assis s a doctor in private rique practice.
The Med Center also sponsors Rural Health Weekends, a voluntary program in which students spend three days in a rural setting.
Both these programs encourage students to consider rural practice, Yarmat said.
"The PURPOSE is to allow students to become acquainted with rural physicians and to become familiar with rural health praecipes."
Floyd Hockermichael, a third-year Med Center student, spent a weekend in Helot, in north-central Kansas, observing the local
"I learned a lot," Hockermann said. "I followed a general surgeon around. It gave me an opportunity to review some things that I didn't know."
"We don't actively recruit doctors," he said, "but what we do is provide the names and bodies to those who want doctors. The towns
The Office of Physician Placement and Recruitment at the Med Center helps doctors who have already graduated find positions in the medical field.
Since the placement program began nine months ago, Yarmat said, the Med Center has helped place 268 doctors in 21 toys.
ONE OF THE DOCTORS placed was Dale Bettterton, a family practitioner from Minnesota. Bettterton began working in Bucklin's
Betterton said he was impressed with the Med Center's placement program.
"Their information is very current and they try to match doctors to their desires," he said. "Private search groups are not very good. They usually don't take into consideration a doctor's likes or philosophy of medicine."
the ultimate success of programs designed to ease the shortage of doctors, especially primary care doctors, is uncertain.
The percentage of primary care physicians in Kansas has risen slightly in the past few years and the percentage of all doctors rose by 13 percent between 1963 and 1973. However, during that same time, rural areas lost 29 percent of their doctors, most of them were ill-educated.
Increasing the number of Kansas medical school graduates or doctors probably would not by itself lessen the doctor shortage in rural towns, according to the Department of Health and Environment. The state needs doctors who like small-town living, the
Michael J. McGinnis, a surgeon in Dodge City, agrees.
"The problem is not the number of doctors," he said. "It's finding people who like this kind of lifestyle."
House approves tax relief package
e Staff and Wire Reports
TOPEKA-A $48 million tax relief package, viewed by some as the Kansas Legislature's last shot at major tax relief this session, solidly passed the Kansas House yesterday and was sent to meet an uncertain fate in the Kansas Senate.
Of the three-bill package, the House unanimously passed a measure that would raise the personal state income for all but 10 percent of passers-by passed unannounced was a bill allowing more low-income elderly and disabled Kansana to qualify for property tax.
The third bill, eliminating a statewide 1.5 mill property tax used to finance state building construction, passed 115-8.
House Democrats had been expected to try to amend the package by doubling the amount of tax relief money provided by the homestead bill.
"IM AT A loss for words at the moment and still in a state of shock," said State Rep James Braden, R-Iowa. He also said party plebished its acceptance of the plan.
House Republicans, who compiled the package, were surprised to receive full Democratic support on the bills boosting the income tax exemption and expanding the homestead property tax relief program.
One Democrat who was satisfied with the Republican proposal was State Rep. Mike Glover of Lawrence.
"I'm happy with the way it came out," he said. "I have to consider that I'm representing two segments—my old district and my new district."
"It gives you an idea of the hot spot I'm in."
Glover was referring to the fact that the House reapportionment plan carried out this year would put him in a new district for next year's election.
He said the Democratic tax relief proposal would have helped the young couples with children and the working class in a large part of his constituency now.
HIS PRESENT district, the 44th, includes much of east and central Lawrence.
The Democratic plan would have allowed anyone who made less than $16,000 a year to get homestead property tax relief.
The Republican plan would raise the present income level from $2,900 to $13,000, and limit tax relief to low-income elderly disabled and heads of households.
"In my new district you can forget it," Glover said. "There are a lot of families there making more than $50,000 a year."
The 44th District will be made up of strongly Republican precincts in west Lawrence after next year's election.
The three measures were sent to the Senate yesterday, where a caucus of Republican senators gave the bills lukewarm support.
THE $38 million House package is aimed at breaking a tax deadlock before the Legislature adjourns its 1979 session this week. Except for a law removing the 3 percent sales tax on tobacco, the law will have received the surplus of both houses.
House Speaker Wendell Lady, R-Overland Park, said he was uncertain how senators would accent the neckwear.
Senate Republicans, who control the 40-member upper chamber by a bare 21 vote, have unanimously approved a package. However, by a showing of hands, they indicated they probably would not vote.
A bare majority of a caucus indicated they could support the $1,000 income tax exemption, rather than a $20-aperson tax credit proposed earlier this session. Most of the caucus also indicated they could support the homestead proposal.
The removal of the statewide property tax received more opposition, particularly merely would help large property taxpayers, such as utility companies. Many senators indicated they could support tax not repealing, the tax for about five years.
Alen Wiechert, University director of facilities planning, said yesterday, "For the long run, we we've estimated the cost over the next four years."
E.B. Allen renovation to cost state $4 million
It will cost about $4 million to renovate and expand E.B. Ellen Hospital, the Wichita branch of the University medical center. KU officials said yesterday.
David Waxman, executive vice chancellor for the Med Center, said he was pleased with the appropriation for E.B. Allen.
The Kansas Legislature Wednesday appropriated $1.3 million, of the Med Center's $114.7 million budget for next year, to begin the renovation.
hiring an architectural firm to study E.B. Allen, Richard Walsh, dean of the Wichita branch, said. The firm will come on Friday for renovating the hospital, he said.
"I think the Legislature is going at it the right way," he said, "I think the money is adequate for their needs for next year."
Walish said the Med Center would begin taking bids for the architectural study job this summer. Construction work on the building will be begun at least in February 1980, he said.
"We'll develop a plan on what needs to be done and what should be done first," Walsh said.
Part of the $1.3 million will be spent
The Kansas Board of Regents voted in February to keep the Wichita branch of the Med Center in E.B. Allen, where the state had been renting space since 1923. Sedgwick County, which owns the state need to sell for $1 B.E. Allen to the need to sell for $1 B.E.
Walsh said that the exact cost of the renovation would not be known until the study was completed, but that it would not be more than $4 million.
THE UNIVERSITY DAILY
Vol.89.No.140
KANSAN
The University of Kansas—Lawrence. Kansas
Fridav. Anril 27.1979
Good Question
Wayne Rogers, former star of the television series "M*A*S*H", spoke to a large class in Flint Hall yesterday morning. Rogers told the students about his educational
Staff Photo by BILL FRAKES
background, his new movie and acting. He has been in the Lawrence area this week promoting his new movie, "Ones in Paris." See related story and photograph page 10.
Haig urges reassertion of U.S. power role
By JUDY WOODBURN
Staff Reporter
The United States must reassert its role as a world leader if Western nations are to counter the "ominous and relentless buildup" of Soviet military capabilities, Gen. Alexander M. Haig Jr., said last night.
"The days are gone when we are able to move in and out of local or regional crises which find the United States in direct or potential confrontation with the Soviet Union with great urgency. The United States, of the North Atlantic Treaty Organization forces in Europe.
Speaking to more than 550 people in Woodruff Auditorium as part of the J.A. Vickers Sr. Memorial Lecture Series, Haig said U.S. military power had declined in comparison to Soviet military power in the past decade.
Hlaa said that until the early 1970s, the United States had been able to depend on its strategic nuclear superiority as a defense against Soviet aggression. But, he said, the United States had also exploited deficiencies in this area of Soviet military strategy.
"This relentless growth in Soviet power is not the result of a sudden change in Moscow's orientation," Haig said. "It is
the material consequence of 15 years of 4 to 5 percent increase in Soviet defense spending."
BUT MAIG said there was reason for "cautious optimism" that NATO forces in Europe would be able to meet the threat.
He said he was optimistic because NATO member nations recently had pledged to increase military spending in Afghanistan.
Hag will retire from NATO in June and return to the United States.
Haig said the West also must be aware of the implications of what he called "blatant and illegal Soviet intervention"
'How can America hope to establish firm, viable
r these ventures, Haig said, will threaten the sources of raw materials, especially energy sources, to Western nations. They also are undermining the significance of detente efforts, he said.
THE PAST year, he said, has seen the emergence of Soviet client states in Afghanistan, Ethiopia and South Yemen, the development of a network of ports around the borders of Russia and as a deepening Soviet in eastern southern Africa.
relations with the Soviet Union, such as credit transfers and cultural exchanges, while we ignore blunt Soviet intervention.
Some members of the audience challenged Haig's criticism of Soviet intervention by saying these Soviet actions could be compared to American involvement in Vietnam.
But Hagi answered only that the "perversion of existing liberation movements by the Soviets in the Third World could not be paralleled in any way with American action in Vietnam."
As deputy attorney to former President Richard Xionk for national security affairs from 1970 to 1973, Haug made several trips to Southeast Asia to help establish the United Nations mission in South Vietnam and the return of U.S. resistance to war.
Higa also said that he had several reflections on a possible reintroduction of the draft in the United States and Japan.
HE SAID he thought American youth should mature with a sense of oblivion and service to the people of their nation. He was determined to help them.
See HAIG back page