October 09, 2013
By Denice Bruce and David Martin
If asked to name the top 10 medical schools in the country, it's unlikely many people would include the KU School of Medicine–Wichita (KUSM–W).
But they'd be wrong.
A recent study named the school as sixth in the nation for producing primary care physicians. That's particularly significant at a time when Kansas and the rest of the nation face a critical physician shortage.
The study, conducted by researchers at George Washington University and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, ranked KUSM–W sixth nationwide for the number of graduates who practice primary care.
Researchers looked at 159 institutions with more than 150 graduates, between the years 2006 and 2008.
|Family physicians Doug and Shelly Gruenbacher practice in rural Quinter, Kan.|
Recent figures compiled by the American Association of Medical Colleges reveal that nearly 60 percent of primary care physicians in Kansas are over 45, and a third are over 50. This coincides with the aging of the general population, which means ever-increasing demand for medical services and ever-declining numbers of providers. Nationally, an estimated 52,000 additional primary care physicians will be needed by 2025.
"Everybody agrees we have to do something about the production of family doctors in this society," says Rick Kellerman, M.D., chair of KUSM–W's Department of Family and Community Medicine. "We know that health care systems work better if there's a broad base of primary care physicians."
Primary care is frontline medicine. They're the family doctors, general internists and pediatricians who treat new illnesses, manage chronic diseases, and prevent new ones from developing. Studies indicate that access to primary care leads to better health and lower cost.
Part of the difficulty in meeting primary care needs results from incentives that steer young doctors into subspecialties. Primary care physicians, on average, earn half that of their peers who specialize. And primary care doctors tend to work longer hours.
Residency (also called graduate medical education or GME) plays a huge role in shaping the physician workforce. Approximately 112,000 residents and fellows train in 150 sites across the country. Medicare, Medicaid and other sources provide $13 billion in public funding for this training each year.
Given the size of taxpayer investment, many experts believe the system needs to do a better job of addressing the public's health needs. Specifically in producing more primary care providers.
In fact, the bulk of federal funding for GME is directed to those institutions that produce the fewest primary care doctors. Between 2006 and 2008, the top-20 producing medical schools received $292 million in GME funding, while the 20 schools with the fewest primary care graduates received $842 million.
Researchers at George Washington University and the Robert Graham Center used the American Medical Association's master file to identify the specialties and locations of physicians who completed their residency between 2006 and 2008.
Nationally, only 25 percent of the doctors went into primary care, and less than five percent located in rural, underserved areas.
The Wichita campus far exceeded those national averages. Nearly half its residents went into primary care, and nearly 20 percent established practice in a rural area.
And it gets better. More of the school's residents went into underserved areas designated as "health professional shortage areas" than any other institution. For producing doctors in those areas that are most in need, KUSM–W is a standout.
"It's not only that we produce primary care docs for the state," says Kellerman, who oversees the family medicine residency programs at Via Christi, Wesley Medical Center, and the Smoky Hill program in Salina, Kan. "It's that we produce physicians who are going to the rural areas in desperate need of a local doctor."
School officials have worked with communities to place graduates in less populated areas of Kansas. "We still have work to do, " Kellerman says. "We get calls all the time from hospital administrators, from physicians looking for partners, and from community recruiters looking for family docs."
"The other part of this is the quality of the people we're training," Kellerman adds, noting that residents in all three family medicine programs score well above average on their in-service exams.
Kellerman says the medical communities in Wichita, and in Salina, Kan., deserve much of the credit for the quality and quantity of the primary care doctors who learn and train at KUSM–W. "It's a real community-wide effort and partnership," he says.
And while residency training is funded primarily through the federal government, Kellerman says state policymakers can also make a difference. "There is a correlation between the amount of debt our students have and the specialties they pick," he explains. Controlling the growth of medical school tuition and supporting the Medical Student Loan program, which is offered to graduates who practice outside the state's larger cities, are important to keeping the pipeline of primary care providers flowing.
Kellerman also credits the Smoky Hill residency program in Salina, created by the state legislature in 1977, as instrumental to supplying doctors for rural Kansas.
Though KUSM–W's number six national rank is a nice affirmation for all those who make it possible, it came as no surprise. "It confirms what we already knew," Kellerman concludes. "This school is succeeding in its mission to provide for the medical needs of Kansas."KU School of Medicine