Nation, Topeka challenged to fill physician needs

The United States is facing a critical shortage of physicians, expected to escalate to a shortfall of more than 61,000 doctors by 2025.


The Topeka health care community could use more doctors to meet consumer needs, especially in particular specialties, according to leaders from Stormont Vail Health and The University of Kansas Health System.

A new patient appointment to see an endocrinologist can take three to five months, for instance, a situation that was exacerbated when a busy Topeka doctor recently moved out of state. Other specialties are also needed, said Robert S. Kenagy, a physician and Stormont senior vice president and chief medical officer.

“We’d like to add another cardiothoracic surgeon, rheumatology, neurology and urology,” Kenagy said. “We continue to recruit in general surgery, as well. We’ve really had good success in primary care. We continue to recruit in primary care.”

Stormont has been aggressively recruiting physicians and advanced practice providers, such as nurse practitioners, in recent years, raising its medical group providers from 335 in 2013 to 448 this year. Of that total, 265 are doctors and 183 are advanced practice providers.

Nationally and locally, the need for primary care physicians — often filled by family practice or internal medicine doctors and advanced practice providers — is concerning, said Jackie Hyland, a physician and chief medical officer at the University of Kansas Health System St. Francis Campus. She called internal medicine a “huge shortage” on the outpatient side of services.

“Nurse practitioners and PAs (physician assistants) are really helping with the primary care demand,” Hyland said.

Steven Stites, a physician who is vice chancellor for clinical affairs and senior vice president for clinical affairs for The University of Kansas Hospital Authority, said the primary care situation is not the only shortage nationally and locally, but the problem runs across the board in specialties.

“In Kansas, a high percentage of our physicians are over the age of 55,” Stites said. “We know the financial crisis of 2008 kept people in practice longer than what we may have otherwise seen. I think we’re all very concerned about what’s going to happen at a county level.

“In every area of medicine, you can find a projected shortage. Psychiatry, pulmonary, cardiology — everything. And part of that is because of the aging of the U.S. population, and part of it is an issue around distribution, and part of it is an issue that we haven’t really increased the number of graduate residents leaving training.”

Dan Partridge, director of the Lawrence-Douglas County Health Department, said primary care physician shortages affect his community, as well, but he’s also concerned about the lack of mental health providers and dental providers.

“Number one for me is dental access, especially for the Medicaid population and the uninsured,” Partridge said. “The demand far exceeds the availability to meet that.”

From a medical school perspective, class size has been increased to keep up with demand by 15 to 20 percent, Stites said.

“GMEs (Graduate Medical Education) medical slots have not kept up with that,” he said. “Some places dropped GME physicians because the government has not kept up with funding new positions.”

Stites was referring to a problem receiving attention as the physician crisis looms — there aren’t enough residency slots in Kansas for the medical students in school. Kansas leaders have been talking about adding an osteopathic medical school, but Stites said that won’t address the root problem created by having too few residency slots.

If medical students take residency positions in other states, it’s likely Kansas is simply training students to go to work elsewhere.

In a medical roundtable discussion conducted by The Topeka Capital-Journal, Hyland said she would like to see a former family medicine residency program in Topeka reopened. The program ran from 1992 to 2002, established by the Kansas Medical Education Foundation and supported by both Stormont and St. Francis.

Looking to the future as the University of Kansas Health System and Ardent settle into their new Topeka location at St. Francis, Stites said he’s hopeful resident training could be re-established in the capital city.

“We’ve got to get a lot of hoops done. We have to stabilize the clinical enterprise, we have to work closely and very tightly with Ardent to grow the number of physicians at St. Francis and if things are healthy there — we will consider the introduction of resident training,” he said.

Stites said KU and Ardent would have to agree to a residency program, and reiterated, “We’ve got a lot of work to do to get it there.”

Kenagy said Stormont has increased family medicine providers from 29 in 2013 to 36 physicians in late 2017. Growth overall in advanced practice providers has been high, and that’s reflected in primary care.

In that specialty, Stormont had 63 doctors and 39 advanced practice providers in 2015. This year, the numbers are up to 76 doctors and 62 advanced practice providers.

Stormont closely tracks access to its physicians, clinics and hospital services to help determine where to grow its provider network, Kenagy said.

“We track the number of days it takes for a patient calling with an acute need to be seen, how long it takes us to get them in, and how long it takes for a patient calling as a new patient to get established,” he said.

The recruitment of surgeons and advance practice providers is a necessary part of running a Level 2 trauma center, along with skilled nursing staff, Kenagy said. Within the hospital, Stormont has grown its hospitalist group from 16 physicians in 2013 to 23 this year.

Maintaining stability in hospitalists, who treat patients when they are in the hospital, helps with standardization of care, he said.

More than a year of uncertainty at St. Francis created challenges for Hyland, who said they are slowly rebuilding medical staff with the support of Ardent and KU Health. Primary care will be a strong initial focus in hiring. Pulmonology and urology are other areas she’d like to see additions.

“We have lots of different areas of opportunity to continue to grow and support the community,” she said.

“We’re hoping that what KU can bring to Topeka — you need a very strong, stable physician medical workforce in Topeka that’s going to be based in Topeka, living around Topeka, and take care of folks in Topeka,” Stites said, adding supplementing the Topeka market with specialists who are in the capital city two or three times a week can save Topekans the drive to Kansas City.

“We say this repeatedly at KU: We want to keep the folks who belong in the community in the community,” he said.

Manhattan struggles to recruit physicians, and Bob Copple, president of Via Christi Health in the university town, said he’s concerned about the future for other rural communities. Before joining the Manhattan health system, he worked in rural areas in Nebraska.

“It doesn’t matter where you are, the issues are all the same,” he said. “They’re even more challenging the farther west you go in our state. You lose the population density so it gets harder and harder to support physicians, especially specialties, and recruitment is hard because hiring new young physicians … if you don’t have a community that has some amenities and a good education sytem, they won’t go. It is surprisingly difficult to recruit physicians to Manhattan.”

Although Manhattan is experiencing significant economic growth, it just doesn’t have the amenities that Topeka has, Copple said. “You have more restaurants, you have more stores,” he said. “I wish we had a Lowe’s or a Kohl’s.”

Manhattan’s list of physicians needs “is actually very long,” Copple said, identifying need in primary care, cardiology, neurology, pulmonology, gastrointerology, and infectitious disease.

With his rural background, Copple worries a lot about meeting health-care needs in those communities.

”I think where people have to be very realistic is we’re going to have more advanced practice providers doing rural health care,” he said. “I think we will have to be more and more open to J-1 (Visa) physicians. They grew up overseas, they probably went to medical school overseas, but they do their residencies here in the United States. I think we’re just going to have to be open to that, where Kansas has not necessarily probably been the most welcoming.”

The J-1 Visa is available to physicians who are not U.S. citizens to do medical training in the United States.



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