by Deb Clements, MD, FAAFP
Medical Education heading in right direction to better Kansas physician workforce
After several sweltering weeks in August, the days have gotten cooler, football season is underway and classes are back in full swing. The University of Kansas School of Medicine-Salina campus opened to much fanfare with the first class of eight students featured prominently on the front page of the New York Times on July 22, 2011.
Possibly the smallest medical school in the country to offer a four-year degree, our hope is that training physicians from the beginning in the environment where they’re needed the most will lessen the hurdles to eventual practice in rural and frontier Kansas. And for most of the eight students, Salina was their first choice of campus. The medical education community is watching closely. Barbara Barzansky, co-secretary of the Liaison Committee on Medical Education, said, “It’s an interesting model, and if the outcomes are good, it could be a stimulus for other schools to do it.” At the same time, the KUSOM-Wichita program matriculated the first four-year class of medical students, also a group of eight who expressed a preference in training in Wichita.
Here are some basic realities about the Kansas physician workforce. In 2009, according to the Association of American Medical Colleges (AAMC), 5,903 physicians practiced in the state, of which 2,324 were classified as “primary care,” placing us 32nd of 50 states in access to a primary care physician. This ranking does little to illustrate distribution of physicians throughout the state, which we know is not uniform. The situation is worse than the numbers indicate.
We do a better job in terms of medical student enrollment, ranking 24th of 50 in students per 100,000 population at 25.9. Even more promising is that nearly three-fourths of our medical students are Kansas residents at the time of admission; making it conceivable that these physicians will remain in the areas they’re needed once they’ve completed their training.
Unfortunately, the pipeline narrows considerably after graduation from medical school. Residents are measured per 100,000 population, just as practicing physicians are., KU consistently ranks at or near the top of medical schools graduating students into family medicine residency. Yet despite that, of the 25.4 residents in ACGME programs per 100,000 population in Kansas, only 10 are in primary care. These ten include family medicine, general internal medicine and pediatrics. What’s more troubling is the number of the physicians leaving our Kansas medical school campuses. ,A mere 36.7% of our medical school graduates remain in Kansas for residency training in any specialty. From there, we plummet to 40th of 50 states in retention of physicians in practice, keeping only 38.1% of Kansas-residency trained physicians in practice in the state. Just a fraction of these are family physicians destined for rural communities.
According to the November 2010 report from the Department of Agricultural Economics at Kansas State University, the health care sector is a vital component of the Kansas economy. This report outlines the positive economic impact of health care on local economic development, indicating that three important linkages must be recognized: attracting and maintaining business and industry growth, attracting and retaining retirees and creating jobs in the local area. In terms of fiscal impact, the health care service sector accounted for nearly $16.5 billion in total sales or about 5.6% of the total state revenue. Health care is the fourth largest aggregate employer in the state, accounting for nearly 10% of all jobholders. Beyond the direct financial impact, health care jobs preserve the population base of our rural counties, invigorate communities and school systems by bringing young families into our towns and enhance the services offered to everyone. Yet ongoing and consistent access to basic health care services continues to be a problem for too many Kansans.
So how do we continue to bring both better care and an improved economic outlook to the least populated and most underserved areas of our state? Admissions processes must continue to focus on service commitment and understanding the needs of our patients combined with an appreciation of life in rural communities—in addition to strong GPAs and MCATs. One successful strategy has been the Scholars in Rural Health program. Since 1997, 40 of the 104 candidates selected have completed medical school, with 21 matching into family medicine. Of these, 16 (84%) practice in rural or urban medically underserved communities in Kansas. Since 1992, the Kansas Medical Student Loan program has provided tuition and living expenses for students who agree to a year of primary care service for each year of funding. In the past 19 years, more than 66% of recipients have completed their obligations by working in the neediest parts of the state. The recent changes in undergraduate medical education training sites are encouraging and will hopefully result in an increase in the candidate pool for all Kansas family medicine residencies.
The realities of graduate medical education funding and increasingly burdensome Accreditation Council of Graduate Medical Education regulations threaten the sustainability of small residency training sites, even when enthusiastic candidates and dedicated faculty are available. With the increase in medical students interested in rural family medicine, establishment of an additional residency program in a medium-sized Kansas community should be considered, provided sufficient faculty leadership and commitment from a sponsoring hospital or community health center can be established. Our communities must work together to meet the challenges of training and placing family physicians. These challenges cannot be met by our educational institutions alone, but require a community-wide response involving government, business and municipal leaders who recognize the infrastructure needs of a robust training program.
I look forward to continuing to serve as your president this year. Please call, drop me a note, an email or a tweet if you have suggestions, concerns or ideas.
Sincerely,
Deb Clements, MD, FAAFP
President
References:
Making Small-Town Doctors Starting in a Kansas Small Town. Nytimes.com, accessed 8/3/11.
http://wwww.aamc.org/workforce/statedatabook/statedata2009.pdf accessed 9/4/11.
Chumley H, Honeck S, Kennedy M, Meyer M. The Kansas medical student loan program: a successful tuition-service exchange model. Acad Med 2011;85(11):1676.
Kallail J, McCurdy S. Scholars in Rural Health: Outcomes from an assured admissions program. Fam Med 2010;42(10):729-31.