March 09, 2017
By Joe Stumpe
Jayhawks - the University of Kansas variety, that is - are used to high national rankings. The latest No. 2 ranking comes not for the school's basketball team, but for the medical school for the percentage of students it is sending into the crucial specialty of family medicine.
In 2015, 17.8 percent of the KU School of Medicine's graduates entered a family medicine residency program. The percentage at KU's Wichita campus was even higher: 25 percent.
KU's overall rate trailed only the 19 percent posted by the University of Minnesota Medical School. Nationally the rate is about 8.5 percent.
Family medicine advocates say KU's performance is no accident; it's consistently placed in the top 10 in this category in previous years. The reasons cited are a clear sense of mission, strategic admissions and plenty of exposure to the specialty in the form of full-time faculty and other role models.
And something that might be called "the Kansas way."
The school's ranking was part of a study conducted by the American Academy of Family Physicians.
"If you look nationally, there's quite a variation, from schools that have practically no students that choose to go (into family medicine) and some that do quite well," said Dr. Clif Knight, the AAFP's senior vice president for education. "There are multiple aspects that are involved."
"Part of it starts with what the medical school sees as its mission," Knight continued. "If a medical school has a priority of providing a strong primary care workforce, that's a predictor of how they'll do from a standpoint of performance."
"The next step is at the admission level. If they see it as part of their responsibility to make sure students are admitted who have an interest in family medicine, and have local connections, those are other predictors. If you want to provide primary care to rural areas, you know that students who grew up in rural areas are much more likely to go practice in rural areas than students who grew up in urban areas."
"And then once they actually start, they need to be exposed to role models. They need to understand the importance of family medicine and get reinforcement during their first couple of years in medicine school, and then in the transition to their clinical years, they need to be exposed to real-life opportunities, see how primary care is practiced and have mentoring from within and without the medical school."
As an example of his last point, Knight said KU has "such a great summer program" that matches students with a practicing physician between their first and second year of school. "I think that is such a powerful tool to help students to get a sense of what the specialty involves."
Dr. Rick Kellerman, chair of the Department of Family and Community Medicine at KUSM-Wichita, said Knight's analysis is accurate.
The quality of the school's faculty - full-time, part-time and volunteer - and residents play a role, as does the motivation of the students, he added.
"The medical students tend to think in terms of community," Kellerman said. "They're altruistic. They want to help people who aren't as fortunate as they are. It's the Kansas way."
And not an easy way, he added.
"There are many things that work against students going into family medicine: the practice environment, the hard work versus the differential in payment, the implicit pressures to subspecialize."
"I think we tend to attract these students who are really dedicated to community in ways that are more important than what they might earn in another specialty."
Asked what it would take for KU to produce even more family physicians, Kellerman said an expansion of the school and family medicine residency program would be needed.
Overall, the AAFP says the country is still underserved by primary care physicians.
"When you look at other countries around the world that have better health outcomes and spend less money, they are systems built on primary care," Knight said.
Ashley Bentley, AAFP student interest strategist, says the consensus of thought leaders in the field is that 40 percent of the medical workforce should be engaged in primary care "to keep people from using the emergency room for what should be a primary care visit, to keep people from getting super sick and to provide coordinated care."
"A patient may need multiple doctors and other sources of support, but the care needs to be coordinated. There needs to be someone taking care of them as a person, not just taking care of one of their body parts or one of their conditions. Continuous, coordinated care is at the foundation of primary care and family medicine."
While there's been a "slight uptick" in the production of family physicians in recent years, Bentley said, "It's still not where it needs to be."KU School of Medicine-Wichita