Program seeks to draw doctors to western Kansas

LAKIN, Kan. (AP) — Rural hospital director Benjamin Anderson has discovered a secret that’s enabled him to recruit several new doctors to sparsely populated and chronically under-served southwest Kansas, first in Ashland and then in Lakin.

As a result, instead of continuing to turn people away, the 25-bed Kearney County Hospital where Anderson is CEO and an affiliated local medical clinic are both today accepting new patients from out-of-county.

And more help is coming.

“We’ve been turning away 50 patients a week for the last 18 months, conservatively,” Anderson said last month. “We were closed to out-of-county patients. As of Aug. 1, that changed. We now have the capacity to see people. The presence of these doctors is the reason we were able to deliver 210 babies in the last year.”

Now, Anderson is looking to build on that success by creating a network across the dusty plains of Kansas, to both support the doctors he has brought in and help other rural providers find quality physicians, The Hutchinson News reported.

The key? Tapping missionary hearts.

To find the doctors, Anderson partnered with Dr. Todd Stephens and the Via Christi Family Medicine Residency in Wichita. He first struck upon the concept in 2009 while CEO of Ashland Health Center.

“They have an International Family Medicine Fellowship which recruits medical missionaries to work in under-served areas of rural Africa,” he explained.

The post-family medicine training in Wichita headed by Stephens teaches physicians how to be the only doctor serving in hundreds of miles in the African bush. They spend five months overseas under a missionary surgeon developing rural hospitals, Anderson said, and then back in Wichita to work in the St. Francis burn unit, in orthopedics and dentistry.

A sense of purpose, or mission, drives the doctors in the program, as opposed to financial gain, he said.

“We’ve hired four doctors out of there,” he said, including two this fall and two in previous years. “What we’ve figured out is we’re able to offer them time off to do mission work overseas, and we’re able to show them the need, the under-served nature of where we live. They find gratification in both places.”

Southwest Kansas offers a unique draw in that it is home to some 30 nationalities, offering an experience in many ways similar to the Third World countries where the doctors are going.

“Those refugees are a primary attraction for these physicians,” Anderson said. “We look at it as creating opportunity to infuse primary care access into one of the most under-served regions in Kansas.”

Key is allowing the physicians to continue their missionary work overseas – granting them paid time off to do that work – while also showing them the need in western Kansas.

“We’ll tell you, if you want to go to Burma, we’ll pay you for the time off to go serve there part of the year,” he said. “But for the rest of the year, we have a Burmese population 15 miles east of us. If you want to go to Somalia, Sudan or parts of South America or Central America, we’ll support and go with you. We encourage that. But the same nationalities exist here.”

By having the overseas experience, Anderson said, the doctors are better culturally equipped to serve in southwest Kansas.

“And by serving here, they’re better equipped to move overseas,” he said.

“Some are goers,” Anderson said. “If they come work for us here for three or four years, we’ll help prepare them to move overseas. The community becomes a sending point for them. We will support and encourage them. Some are senders, who will live here for their career and just visit as goers two or three weeks a year. It’s very invigorating, both for the long term and the short term. A balance between goers and senders is a healthy consideration.”

Another benefit to the physicians under the program is, with a long-term commitment, their medical school loans are forgiven.

At the end of three of four years, depending on the contract, the doctors can evaluate whether to stay or go.

“At this point, we’re receiving more interest from medical providers than we can hire and we’ve had to tell them we don’t have room,” Anderson said.

The “brainchild” behind the concept, Anderson said, is Dr. Stephens, who began his career in Clark County and teaches at one of the most sought-after family medicine residencies in the country.

A native of Minneola whose father was a country doctor, Stephens is director of International Fellowship and associate director of the Via Christi Family Medicine Residency program. He started the missionary training program after serving six years as a medical missionary, in Kenya and Rwanda, and returning to his alma mater as faculty.

Stephens said a fellow student encouraged him to spend part of his last year in medical school practicing overseas.

“I did a two-month rotation in Rwanda that changed the trajectory of my life,” Stephens said. “I wasn’t expecting the impact, but I came back with a new set of glasses on. The world had completely changed for me.”

He later launched a one-year training program split between training in family practice and serving in resource-poor countries.

“It’s been an incredible adventure,” Stephens said. “We just graduated our seventh class. We have graduated 26 international family medical fellow physicians. Many are not serving abroad, however, but are serving in areas like western Kansas.

“Ben (Anderson) found to recruit doctors to western Kansas, you have to understand the heartbeat, to recognize some are motivated by something bigger than a paycheck and benefits. They really want to serve. This is an area with a lot of immigrants; a lot of Hispanics; a lot of people who are un- or under-insured; an area that can capture the heart of a missionary.”

By serving overseas as well, as part of their training, they come back as better doctors, Stephens said, because they have a different skill set and a gained confidence in their abilities they otherwise might not have.

They are also people, Stephens said, more likely to be willing to serve among the poor or in mobile clinics, and “to give their time more freely for charity clients.”

“It began when I was in Ashland,” Anderson said of tapping into the Via Christi program. “I was CEO there. We had one PA (physician’s assistant) working around the clock. We had a myriad of locums folks (medical providers working under temporary contract) working shift-by-shift. I went to Todd and asked, ‘What do I do to recruit?’ ”

His advice: recruit at least two doctors.

“Good ones don’t practice by themselves,” Anderson said he learned. “The days of working 24/7 as a solo family doctor are gone.”

Next, limit clinic days to four days a week and limit emergency room calls for the doctor to no more than one night a week and one weekend in five.

“You have to protect the quality of life,” Anderson explained.

You also have to pay at least the national average salary and give the doctors extended time off – at least eight weeks a year – for international mission work.

“I was in a town of 900 at the time,” Anderson said. “I said, ‘How can we sustain two doctors when we already have a PA? He said, ‘You’ve got to figure that out.’ I thought at the time, maybe I can share the doctor with another county.”

Another piece of advice from Stephens was for Anderson to travel with one of the doctors to Africa “to see what they’re about.”

He went to Zimbabwe and spent weeks building screens for houses to keep out snakes and mosquitoes with malaria.

That was six years ago, and Anderson has returned every year since.

“I saw the connection between rural Zimbabwe and rural Kansas in the same way they struggle with the difficult issue of access to care. For us, it’s a fixed-winged airplane getting to Wichita to save someone from a heart attack. For them, it’s a guy pushing someone in a wheelbarrow for three days to the nearest hospital to save a foot, or maybe even a life if it’s past that.”

Anderson said the program focused on the need instead of simply the benefits of small-town life. They are honest about the challenges, he said, but added it appeals to the doctors’ sense of mission.

Recruiting the physicians in teams of two or three is important to “have a life, to have colleagues and a shared calling,” Stephens said.

Building a regional network of doctors, Anderson said, will help sustain the doctors and let them support each other. He is looking to recruit six to eight physicians at one time, to work within 50 miles of each other.

“When a doctor from one town goes overseas, they can take another doctor from another town and travel together, and other family members, if not medical staff, as well.”

“It doesn’t work everywhere,” Anderson said of targeting missionary doctors. “There are communities where it’s toxic for these doctors to work in. We’ll not go there.”

The need to provide a network or community of like-minded doctors, however, has Anderson working with other area facilities and organizations to recruit as well.

“We’re not having a hard time recruiting, but our neighbors are,” Anderson said. “We need to look at a statewide approach to recruiting the mission-minded. We are losing these doctors to overseas because they are not aware of the need here. We need to structure an organization in such a way to employ them.”

His hospital, for example, partnered with two other organizations in the region – United Methodist Mexican-American Ministries and Scott County Hospital. Individually, he said, each would struggle to employ the needed doctors, but among the three, they can.

Dr. John Birky, who was chief medical officer for United Methodist Mexican-American Ministries in Garden City until last week, was one of the first doctors Anderson tried to recruit to western Kansas through the Via Christi International Fellowship program. Anderson was CEO of Ashland Health Center at the time and Birky wanted to work in rural Kansas.

Ironically, Birky declined the job offer and went to work with a friend in Lakin at Kearny County Hospital instead. A couple of years later, Anderson joined Birky in Lakin as that hospital’s CEO.

About six months ago, Birky, 35, and originally from Goessel, moved into the job at Mexican-American Ministries in Garden City, a federally qualified health center that operates clinics in Garden City, Dodge City, Liberal and Ulysses. Birky believes the same program can help to recruit doctors to serve its clinics.

“Currently we’re looking to recruit physicians into those four cities where clinics are located,” Birky said recently, before he left the organization. “There’s a huge need for physicians out here.”

The diverse immigrant population drawn to the area by meatpacking plants has its own special health needs, Birky said, thus offering the same challenges to physicians who would serve these populations overseas.

He never expected he would move to southwest Kansas, Birky said, but the job offered those two key factors: time off for missionary work and an opportunity to use all his skills.

“After I got to southwest Kansas I realized the incredible diversity,” he said. “I realized the stuff I went to Africa for, the same needs, the cross cultures and cultural barriers to health care all exist in Kansas.”

“There are several types of doctors who come to southwest Kansas,” Birky said. “The ideal type is somebody who is local, meaning they grew up here and want to come back home. They’re wonderful because they understand the community and the region. They’re likely to stay, to build relationships and raise a family. But I think everyone recognizes the supply of homegrown doctors is limited and inadequate.”

Another type who comes to the region, he said, are doctors who cannot get a job elsewhere.

“They’re sort of a problem doctor, who has bad relationships with patients or with staff,” Birky said. “Of course, they’re ones we’d rather not hire. There’s some who come solely for the loan repayment, who come for maybe four years and then they’re done and off to the east or west coast. The other type is the one we’re talking about here, who are mission-minded.”

Giving the doctors so many weeks off “comes at a bit of price to us,” Birky said.

“But we recognize the positive benefit because that provider comes with a sense of mission. They not only carry that overseas, but will bring that passion to southwest Kansas, to give quality care to our patients, to our mothers and grandmothers. The kind of physician we want in southwest Kansas has that type of compassion.”

“I love this concept,” Stephens said of the current recruitment effort. “There are multiple small communities out there within 20 or 30 miles of each other and all are having difficulty recruiting doctors. It was a brilliant vision to recruit as a group, to serve maybe one of two days here, one day here, to spread medical services around the region, but live in the community.”

Recognizing that the doctors will likely move on after getting some experience and may need to be replaced after a relatively short time is really the only caveat to recruiting missionary doctors, Stephens said.

Something else they’ve discovered among their graduates, however, Stephens said, is that when the doctors want to move on after eight or 12 years, “they tend to recruit people to fill their place as senders.”

“These are great doctors, really at the top of their game,” he said. “They are fresh out of residency and highly trained. They’re a really amazing gift to the community.”

 

Copyright 2015 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

 

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