Rural practices in decline

Editor’s note: This is the first of three stories on health care in Allen County.

By SUSAN LYNN
Register Editor

Register/Bob Johnson
Meeting with Register Reporter Susan Lynn are from left, Drs. Wes Stone, Frank Porter, Glen Singer, Brian Wolfe, Earl Walter and Dan Myers.

If the health care profession in Allen County stays on course, in 10 years’ time it will have one physician under the age of 60 practicing.
Dr. Rebecca Lohman, 31, gasped at the prediction.
“Just me?” she said, incredulously.
Of the county’s seven physicians, six are 50 and above; four expecting to retire in six-10 years. The area also has one surgeon, Dan Myers, 53, who forecasts another six-10 years on the job.
Although the doctor/patient ratio for primary care physicians is adequate for today, local doctors are anxious about the area’s future.
In a wide-ranging discussion about health care, five physicians, Frank Porter of the Osborn Clinic in Colony, Wesley Stone and Earl Walter of Iola’s Preferred Medical Associates, Tim Spears, Glen Singer and Brian Wolfe of The Family Physicians, and Myers, the on-staff surgeon at Allen County Hospital, met with this reporter recently. In a separate interview, Lohman weighed in. Drs. Porter, Stone and Walter are employees of Via Christi Health System of Wichita. Drs. Lohman, Spears, Singer and Wolfe are partners in The Family Physicians.

RECRUITING young doctors to Allen County is a daunting task, but not unique to southeast Kansas. Nationwide, the number of medical experts locating to rural areas is diminishing. About 20 percent of Americans live in rural areas such as Allen County. Only 10 percent of all physicians serve in rural areas.
The best thing Allen County has going for it is the state’s loan repayment program that lures doctors who attend the University of Kansas Medical School to practice in rural areas in exchange for paying their tuition and a monthly stipend for living expenses. Drs. Lohman, Wolfe and Myers took advantage of the program. Lohman and Wolfe chose Iola immediately out of medical school. Myers first worked in Concordia for 11 years, Parsons for nine years, and earlier this year moved to Iola.
In just her second year of practice, Lohman said she’s paid about half of her student loans for medical school that were incurred for tuition, textbooks and living expenses. “I’m way ahead of the game” because of the rural initiative, she said. “I have friends who will be paying off loans for the next 10 years or more. I feel very, very lucky.’
That Lohman, Wolfe and Myers chose to stay in small town America comes in large part because they, too, were raised in small- to mid-size communities.
Lohman, who grew up in Chanute, first considered staying in the Kansas City area where she had been offered a position at KU MedWest in Johnson County.
“I had to think long and hard,” about where she and her husband, Nicholas, and their children would be served best.
Weighing the advantages of an urban area against those of a rural, finally came down in favor of the latter.
“At the time, we didn’t want to pick up and move from where we were already settled,” in Kansas City where she had done her residency at KU Med. “But now I’m so glad we did. I always thought I would wind up in a rural community. All the pieces just fell together — a job for Nich with Iola Pharmacy, nearby family — that made coming to Iola the right decision.”
Myers grew up in the northeast Kansas town of Horton and Wolfe in relatively small towns in Indiana and Iowa.
“The best way to get doctors to locate in a small community is for them to come from a small community,” said Stone, a native of rural Paola. Likewise, Drs. Spears, Singer and Porter all were raised in southeast Kansas. Spears is originally from Parsons, Singer from Savonburg and Porter from Iola.
Earl Walter, 67, is the odd one out. “I come from the ‘city’ of New Jersey,” he said of the densely populated state. Of the physicians, Walter is the biggest fan of small-town life. “I think it’s a dream here,” he said of the ease with which he can conduct his life and career.
Selling that to new recruits, however, can be tough.
Rural hospitals and clinics compete to attract new graduates often with cash incentives to pay down outstanding loans. The practice has drawbacks.
Chanute’s Ashley Clinic sees an especially high turnover of physicians who “put in” their four years then leave for the more lucrative careers the cities can provide, the doctors said.
“That is not what small towns need,” said Myers.
Compounding the problem is that fewer medical school students choose primary care. The reason is twofold: As a profession, primary care doctors earn as much as half or less as specialists such as orthopedic surgeons; and medical schools sell the field short.
“Oh, that’s nothing new,” said Singer, 60, “It’s always been the case to undersell family practice. Even when I was in medical school that was being said. There’s always the allure to earn more money and have greater control over your life.”
For Lohman, those were reassuring words.
“The professors always made me feel that I was smarter than my decision to choose primary care,” she said. “Especially during the last couple of years when we did clinical rotations, experiencing all the various specialties. It got to a point where I didn’t want to tell anybody I wanted to do primary care because of the looks they would give me, as if saying ‘why would you want to that.’ The fact that they could make more money and not work as hard seemed a no-brainer. At the end, I’d hedge and say I wasn’t 100 percent sure just so I wouldn’t have to hear their judgments against family practice. You definitely feel at the bottom of the heap. You get a lot of flack. It was annoying,” she recalled.
In defense of their decision to choose family practice, Porter said, “We all think primary care is important, or we wouldn’t be doing it.”

Thursday: How the younger generation views the field of medicine.
Friday: What’s needed to recruit doctors to Allen County.