RX for Change: Confronting the health care crisis in Kansas

Dec. 4, 2005

By KURSTEN PHELPS

The Garden City Telegram

It's a fact of life for many rural Kansans: If they require the services of a physician, they'll have to drive some distance.

In 69 of the state's 105 counties, there is just one practicing physician for every 1,000 residents, a 2005 report shows. That makes it tough not only to find a doctor but also to schedule an appointment with a general or family practitioner — unless patients are willing to travel.

Lee Tiberghien, Garden City, opted to drive last summer to Wichita for surgery because Garden City didn't have a full-time oncologist at the time.

“I'm willing to make that choice,” Tiberghien said. “It's part of living where I live, knowing there are limitations.”

The 2005 Kansas Hospital Association Annual Stat Report lists 39 full-time doctors of medicine and surgery for Finney County, which has a population of 39,271. That's one doctor for every 1,007 people.

The situation is considerably worse in Cherokee and Linn counties. Cherokee, in far southeast Kansas, has just one physician for every 2,743 residents and Linn, farther north, has one doctor for every 4,888 residents.

Large population hubs in Kansas sport much lower doctor-to-resident ratios. In Wyandotte County, home to the University of Kansas Medical Center, there are 289 people for every physician who practices solely in that county. Neighboring Johnson County offers one doctor for every 316 residents, and in Sedgwick County there is a physician for every 451 people. Nearby Reno County has one physician for every 540 residents.

Some less-populated areas do better in recruiting doctors. Smaller towns have more recruiting power, health professional said, if they offer a technology-rich infrastructure and cultural and social attractions.

Ellis County, in northwest Kansas, has only 27,060 residents, but benefits from Fort Hays State University and the Hays Medical Center, which offers many medical specialties and serves as a regional hospital. The county has more than 71 doctors, one for every 381 residents.

Even farther northwest, tiny Norton County, with little more than 5,000 people, had 11 doctors last year, a 527:1 ratio. Norton County Hospital Chief Executive Officer Richard Miller said that despite Norton's size, the county is less than 100 miles from Hays and Kearney, Neb., which helps bring part-time doctors to the area.

But Norton also benefits from longtime doctors who haven't retired yet — one local physician has been at Norton for 35 years — and recruiting hometown graduates. One physician returned to Norton after completing medical school, Miller said.

The complex problem of bringing and retaining doctors in rural areas boils down to one simple factor — location — says Toni Pickard, assistant professor of Health Service Management and Community Development at Wichita State University.

Most rural communities that fail in attracting high volumes of physicians, Pickard said, lack technological support and proximity to high-tech areas.

“The training is such that even if a doctor comes from a rural area or small town and goes into their education with the intent of going back to under-served areas, by the time they get through with their education, they feel comfortable using the tools they're taught on,” Pickard said.

“When they choose to go to areas that don't have the same level of technology, it's uncomfortable. And a lot of people are just not willing to go back into that zone. It's self-perpetuating.”

The lack of resources and abundance of patients — particularly in rural Kansas where the population is aging — make it difficult for doctors to stay in under-served areas, Pickard said, because they can earn as much or more in urban locales.

Programs attempt to bolster the number of doctors in rural areas. The University of Kansas Medical Center has a rural health department, and its Kansas Recruitment Center works to help rural communities attract and retain doctors. It also has a program to forgive rural physicians' medical school loans and a system that uses KU residencies and faculty to cover temporarily for rural physicians so they can take time off.

At other times, though, the only incentives for keeping physicians in rural areas involve a contented spouse or immigration rules.

Greensburg's only doctor, Lebanon native Nizar Kibar, ended up in this town of 1,500 in Kiowa County because foreign medical school graduates with J-1 visas can stay in the United States while working toward permanent residency if they work in an under-served area.

Kibar says being the only doctor in town means he has to provide a broad range of services.

“ ... I cannot be just an internist. We do everything here but delivering babies and surgeries.”

Kibar, who completed an internal medicine residency at the University of Kansas Medical Center in Wichita, says fewer younger doctors are willing to move to small towns as older doctors in rural Kansas retire.

“If you are an American doctor and you don't get married to someone who doesn't want to leave (a small town), and you don't have all your family there and then you have all the United States open to you, why would you want to go to western Kansas?” Kibar asked.

“ ... Why do kids leave here at 18 and never come back? There's nothing to keep them here. They need more options, more food, more clothes, more entertainment. That's why it's hard to keep anyone here. If a doctor can make the same money elsewhere, are they going to stay?”

Yet rural areas do breed some future small-town doctors.

Ray Kenoyer, a Syracuse general practitioner trained in vascular surgery, doesn't perform many surgeries because he lives far from any major care centers.

“I like rural medicine,” said Kenoyer, a Hugoton native. “I love rural people. I think they're good people, they're fun to treat, and I can speak their language because I grew up out here.”

Easing the way for Kenoyer to stay close to home is his wife, who also is a native southwest Kansan.

“I think you can recruit doctors to go anywhere. What you have to do is recruit my wife,” Kenoyer said. “So my advice to boards is, don't grow your own doctors. Grow your own doctor's spouses.”