Western Kansas Physician Shortage

Nationally, 21% of the population is rural, but only 10% of general practitioners practice in rural areas. Kansas is predominantly rural, especially the western half of the state, where this discrepancy is felt acutely. The KU school of medicine reports that 101 of the 105 Kansas counties are partially or fully designated as shortage areas for primary care physicians.

At the Stevens County Hospital, we are blessed with three medical providers: Dr. Samer Al-Hashmi “Dr. Sam”, Dr. Edwin McGroarty and Jana Morris, APRN-BC. We know how lucky we are.

Many factors play into the shortage equation:

  • Physicians are trained primarily in urban areas, where they become accustomed to the amenities of city life. Many have never been exposed to the alternative joys that rural areas can offer.
  • When a spouse is involved, it becomes harder to convince two people to relocate to a rural area than just one.
  • There is a greater income potential for primary care physicians in urban areas due to the fact that more patients are covered by insurance in urban and suburban areas, versus a higher population of Medicare patients in rural areas.
  • Primary care typically does not offer the high salaries that specialty medicine does.
  • Many of the medical students hail from urban areas, and plan to maintain their residency there.
  • As exhausting as it is for the doctor, many are on call “permanently” in rural areas, because they are the only available physician, and they don’t turn their backs on emergencies.

There are other factors that set rural health care apart from urban health care, including:

  • While there are significant gains made in reimbursement, Medicare payments to rural hospitals and physicians are less than their urban counterparts for equivalent services. This correlates closely with the fact that in the past 25 years, more than 470 rural hospitals have closed in rural America.
  • One-third of all motor vehicle accidents occur in rural areas, but two-thirds of the deaths occur in rural areas due to a greater time and distance necessary to transport the injured to a hospital. In addition, the time it takes for EMS to respond to a call is greater due to the increased travel distance both to the injured and back to the hospital. The national average response time for EMS in motor vehicle accidents is urban areas is 10 minutes. In rural areas, it is 18 minutes.
  • People suffering from heart attacks, strokes and other immediate health crisis of an emergency nature also face a longer travel time to the hospital versus their urban counterparts, with survival rates reflecting that.
  • Due to the self-employed status of the many agricultural families that comprise a significant portion of the rural population, rural residents are less likely to have employer-provided health care coverage or prescription drug coverage.

Kansas is not alone, but due to our high rural population, we are one of the states with the most acute problem.

There are some creative alternatives being implemented to combat this shortage. In nearby Hamilton county, where they have not had a doctor at the Hamilton County Hospital for nearly eight years, people had to travel miles for health care. The addition of tele-medicine in the form of a robot has been great advantage to the hospital and to the area.

This complex piece of equipment has a 12-fold magnification so that the doctor can examine things like skin lesions better than with his or her own eyes. This robot gives the hospital the opportunity to see patients dealing with many different conditions. It is relatively simple to work, and many people working at the hospital can maneuver the robot to allow the attached camera to get an up-close view. The doctor is in a remote location, and can log on a computer or tablet in the clinic or the ER while he or she sits in the office or home.

In urgent care situations such as a heart attack or a stroke, time is of the essence. This service will save lives by virtue of decreased response time. Many diagnoses would have been made after the patient was airlifted or transported by ambulance to a larger hospital, which would take more time away from immediate treatment. These patients are now able to remain in the local hospital. If the patient has greater medical needs that require transporting them to a larger hospital, they can be stabilized here and given everything possible before they leave.

This robot is a bargain, according to the bottom line. If just one patient per month stays in the hospital there without getting shipped out, it will pay for itself.

Greater than breaking even is the fact that this service will likely keep the doors to that hospital open, when closure seemed imminent not long ago. They are now setting a new standard of healthcare not just for rural western Kansas, but for rural health care across America. Many providers have signed on to provide these tele-medicine services, opening many new doors.

It was mentioned that the vast majority of physician training programs are located in large cities. There is an exception to this rule in our state. Kansas University offers a full four-year medical education in Salina, with a maximum of eight students enrolled in the program. It is billed as the smallest in the nation, and one of its primary goals is to better prepare students for the realities of a rural practice. Research supports this notion.

Another means of addressing the shortage is to recruit students from rural areas, with the hopes of them return to practice rurally after graduation. Some schools give rural students preference for admission, and others who commit to practice in rural areas can qualify for loan forgiveness.

While this shortage is projected to continue for at least the next 50 years—research has borne this out—there are other creative ways that medical care will likely be offered in the near future.

Kansas University has another novel approach to fight the shortage. Students at KU are working on a prototype of what they call a “WellCar.” This medical office on wheels has devices integrated and is advanced enough to send medical data to hospitals and clinics where it can be evaluated. Some treatments could be given, and some prescriptions could be written by the nurse practitioners who staff it.

Any of us who have lived in western Kansas for a significant amount of time know that the amenities are not those of a large city, but there are other benefits to a rural life. Our medical providers seem to know this very well, and for this, we are grateful.