Though 25 percent of Americans still live in rural areas, only 10 percent of doctors do, according to the National Rural Health Association, and finding physicians and other medical professionals willing to work in the hinterlands remains a serious, growing problem in Kansas and other parts of the United States.
But in Kearny County, on the High Plains near the Kansas-Colorado boundary where there are only about five residents per square mile, one small hospital has adopted a distinctive approach to recruitment that in a relatively short time has produced a staff that includes five doctors, five physician assistants and a growing volume of patients.
A sixth doctor and a sixth physician assistant are scheduled to start work at the hospital next year.
“We have more candidates interested in coming here than we have room to hire,” says Benjamin Anderson, chief executive at Kearny County Hospital. “It’s not rocket science, but to do it requires a hospital to be mission-focused and it requires the right kind of mission-focused governance and leadership, and I think not every organization has that.
“But any hospital has the ability to do this,” he says, “and we would hand the blueprint to anyone who wants it for free.”
Four types of doctor
Earlier in his career, Anderson worked as a physician recruiter and saw four general types of doctors willing to work in rural areas:
“And the fourth kind is the missionary,” Anderson says, “the one driven by mission or purpose” to treat those in need. “And we have intentionally chosen that fourth category.”
Those that Kearny County Hospital recruits, he says, “aren’t that interested in country clubs, not that interested in ego and money and prestige and elite social clubs. What they are there for is to serve. That doesn’t mean our community is Third World and it doesn’t mean it is inferior. There is need everywhere.”
The hospital serves patients from nine counties, including many who have come to the area to work at the Tyson Foods slaughterhouse in nearby Holcomb.
Among the beef packing plant’s 3,300 employees are immigrants from 30 or 40 countries.
Anderson says part of the pitch the hospital makes to “missionary” doctors is that “they get to serve anywhere in the world by serving in Lakin, Kansas.”
“It’s a big draw for the people we are recruiting because our employees spend their vacation time serving in the places those people are from,” he says.
Among the perks the hospital offers the doctors are eight weeks off each year to accommodate their interests in overseas mission work.
“We recognize the tie between international and domestic service,” Anderson says.
The doctors, who are employees of the hospital, also have four-day work weeks and limited emergency room calls.
“We have very, very reasonable ER calls to protect their quality of life in that way,” Anderson says.
The Zomba-Lakin connection
Three of the hospital’s doctors have been through Via Christi’s International Family Medicine Fellowship, a one-year post-residency program that focuses on teaching family practice physicians the clinical skills needed to go “where others won’t” and to deal with the variety of conditions and difficult working circumstances one might expect to find in the world’s poorest and most remote corners.
Dr. John Birky, for example, is a fellowship-trained physician at Kearny County Hospital who can pull teeth, a skill he put to use earlier this month on a mission trip to Zomba, Zimbabwe, a village in southern Africa.
He traveled there with Anderson, fellow Kearny County physician Dr. Arlo Reimer and 14 others.
Anderson says it was his fifth trip to Zomba in four years. On this latest journey, the hospital group delivered 115 gift boxes put together by hospital employees and Lakin residents for the village children.
Zomba, Anderson says, “is becoming a sister community of Lakin.”
Back home, Kearny County Hospital has used its doctors to launch a program called Pioneer Baby, which, among other things, is attempting to improve prenatal care and reduce the area’s relatively high rate of gestational diabetes and cesarean deliveries.
It developed from the hospital’s growing obstetrics services.
“OB-GYN is a risky endeavor,” Anderson says. “If we’re going to do it, we need to be good at it. And to really be good, we need to do a lot of it.
“These mission-minded doctors are very popular,” he says. “Women will drive two hours to have them deliver their babies. Our hospital delivered 195 babies last year (up from 112 in 2009) and 82 percent were from outside our county, and that’s really because of the care they receive from these doctors.”
The initiative has been helped along by a grant of more than $200,000 from the Children’s Miracle Network, according to Lisette Jacobson, a faculty member at the University of Kansas School of Medicine in Wichita.
Jacobson helped write the hospital’s grant application and is putting together a team from the medical school to evaluate the Pioneer Baby program and find ways to reduce gestational diabetes and related health conditions, which Jacobson says occur disproportionately among Hispanic, Asian and American Indian women.
The grant money has been used to buy equipment for the hospital’s birthing program, which has become a collaborative effort that includes the hospital, KU and the United Methodist Mexican-American Ministries, which operates health clinics in Garden City, Dodge City, Liberal and Ulysses.
Jacobson says though there are ways to help prevent gestational diabetes or minimize its likelihood, little is known about effectively treating it once it is a problem. It is usually detected about the time a woman is in the 22nd week of pregnancy.
“The literature is just very vague on evidence-based intervention,” she says.
A potential benefit of the Pioneer Baby initiative is that it could produce successful treatments or responses.
“This is a very unique project,” Jacobson says. “If we find something that works, that could elevate it to other rural areas not limited to the state of Kansas. We’re hoping this project will lead to the kind of model project that other states could model their interventions after.”
There are other care initiatives under way or in the works at the hospital, Anderson says, including a telemedicine project aimed at dealing with wound care, using a remote specialist.
“Wound care is a challenge out here,” Anderson says.
The hospital also is looking at telemedicine for follow-ups with patients after surgery.
Despite the hospital’s success recruiting doctors, serious needs remain in the region, particularly for certain specialists.
“We have our share of problems,” Anderson says. “We have no endocrinologist in our region. Our family practice doctors are managing all the diabetes.”
There is only one dermatologist in that part of the state, and “she’s booked out for six weeks.”
And Anderson says there are no psychiatrists living west of Hays.
“It’s really a problem, and on top of that mental health is poorly funded,” he says.
It is on the hospital’s “radar” to recruit psychiatrists using the same mission-driven approach it has used to attract other doctors, he says. “But we need the infrastructure in place first to do it.”
Decent, affordable housing is so scarce in Lakin that when Anderson sees a good rental property come open, the hospital leases it so that it will be available to rent to new staff moving to town.
“Housing is a major problem and at the rate our organization is growing, there’s not enough,” he says.
Financially, the hospital continues to run “on a thin margin” as it waits for the “upfront investment for future growth” to pay off, he says.
“We made a lot of investments in physicians and equipment and infrastructure that will probably take a year to mature,” Anderson says. “It’s a gamble we’re taking. We think it is a pretty good gamble, but it is still a gamble to hire that many doctors and support staff that quickly.”
Mike Shields is managing editor of KHI News Service, an editorially independent reporting program of the Kansas Health Institute.