It is well known that rural Kansas faces primary care provider shortages.1 The supply of rural doctors cannot meet the demand for patient care and the gap compared to urban areas is growing. Almost every rural county in Kansas faces a primary care shortage.2
This shortage of Kansas doctors has major impact on the health of its citizens. Rural Kansans face the prospect of more chronic disease, greater morbidity from their chronic conditions, and a higher mortality rate than their urban counterparts.3 The lack of primary care physicians compounds the impact this has on individuals and communities.4
In the late 1970’s the Kansas Legislature authorized the creation of a rurally located family medicine residency program for the purpose of training doctors for rural Kansas.5 Thus, Smoky Hill Family Medicine Residency Program was born in Salina, KS. Among Smoky Hill graduates over the last 30 years, placement has been overwhelmingly in Kansas (92%) and specifically in rural Kansas (83%). As of July 2024, 88 Smoky Hill graduates from the last 30 years currently practice in rural Kansas.
When Smoky Hill opened its doors in 1979, the idea to train rural background students in a rurally focused residency program was brand new. Since then, programs across the country have followed the Smoky Hill example and have had similar outcomes. Recent national studies of rural medical education demonstrate that the Smoky Hill experience is predictable.6 The formula is simple: rural background + rural residency = rural physicians.
The Vision:
A Health Professions Education Hub for Rural Kansas
Salina Family Healthcare Center’s mission of “serving our community at the crossroads of compassionate healthcare and professional education” comes from its long and successful history training family doctors for rural Kansas. Over the years, we have leaned into that mission and have trained more than just family doctors for needy communities.
Since 2013, Salina Family Healthcare Center has had an in-house pharmacy and clinical pharmacy services. Our pharmacists have trained many pharmacy students from the University of Kansas School of Pharmacy. Clinical pharmacy is a growing need in rural and underserved communities. Clinical pharmacists work alongside physicians and patients to advance high quality care, especially as it relates to maximizing the benefits of medication management and reducing medication errors and side effects. They are a vital component to a thriving medical community. Despite their value and growing role in the delivery of healthcare, Kansas has lacked sufficient training grounds for these types of pharmacists. Seeing this need, SFHC opened an ambulatory clinical pharmacy residency program in 2023 and graduated its first class of clinical pharmacist in June 2024. To accomplish this at our present location, the pharmacy residency program has had to double up offices and share educational space. SFHC has the clinical educational opportunities to grow the program to two residents per year but faces a severe lack of space that prevents this expansion. With an investment in SFHC to build a new clinical space with appropriate facilities, rural and underserved populations will gain access to highly trained clinical pharmacists partnering with their medical providers to maximize the benefit to their health and wellness.
Kansas also faces a severe shortage of dentists.7 With no Kansas-based dental school, Kansas students interested in dentistry must leave the state for their training. As the Smoky Hill Family Medicine Residency Program has demonstrated, the location of advanced healthcare training plays a significant role in eventual practice location. SFHC has a vision to increase the contact time dental students from regional dental schools have with Kansas. Over the years, our dental practice has served as a clinical rotation site for several area dental schools. We are currently working with those schools to increase the length of those rotations and attempting to link Kansas background students to our practice site. Unfortunately, the SFHC dental practice has no dedicated educational space for students and insufficient dental operatory exam rooms to accommodate a significant increase in students training in our dental practice. The SFHC expansion effort includes planning for dental student training with dedicated classroom space and an increase in the dental operatories to allow for the clinical time required of students.
The educational mission does not end there. Salina Family Healthcare Center serves as the training center for many other students, including nursing students, dental hygiene students, and behavioral health students. These areas of healthcare are important and will continue to be a significant part of our training for the next generation of healthcare leaders that Kansas needs.
Why Invest?
Our current location at the former YWCA building in Salina has served us well over the last 17 years. We already expanded our residency program once in 2014 and have no additional space to follow through on our current workforce training expansion. We have been preparing a plan, though. A new location has been selected and architectural work is in progress.
Unfortunately, recent inflation in the construction industry has created a funding gap for Salina Family Healthcare Center that must be filled through a capital fundraising campaign. Salina Family Healthcare Center is seeking funding partners who share our vision for the future of healthcare in Kansas. Salina Family’s future facility will come at a price tag at $60 million. The State of Kansas has generously provided $10 million to support our efforts.8 This money requires a match of support totaling $20 million. We must meet this $20 million dollar goal to access the state matching funds and cover the entire cost of the project to launch the construction of a new clinical education facility serving Kansas for decades to come.
Each new doctor Smoky Hill produces will bolster a local Kansas community to the tune of $2 million per year.9 Thus, a $20 million investment produces an economic return on investment in just 4 years! This is not even mentioning the patient care provided to those hard-working Kansans.
Fortunately, ready access to a family doctor helps mitigate the reality of worse health outcomes in rural communities.10 A well-trained family doctor provides prevention and early treatment of conditions that would otherwise lead to negative health outcomes. The challenge is to place family doctors in the rural communities that need them most.
References
1. Health Professional Underserved Areas Report: Kansas Primary Care and Rural Health. Kansas Department of Health and Environment; 2023. Accessed on May 30, 2024 at https://www.kdhe.ks.gov/DocumentCenter/View/36122/2022-Health-Professional-Underserved-Areas-Report-UAR-PDF.
2. Health Professional Shortage Areas: Primary Care, by County, 2023 – Kansas. Accessed on July 12, 2023 at www.ruralhealthinfo.org.
3. National Center for Health Statistics. About underlying cause of death, 1999–2019. CDC WONDER online database. 2021. Available from: https://wonder.cdc.gov/ucd-icd10.html.
4. Sharma A, Basu S. Does primary care availability mediate the relationship between rurality and lower life expectancy in the United States? Journal of Primary Care & Community Health. 2022; 13: 1-8.
5. KSA 76-366. L. 1977, ch. 309, § 1; July 1.
6. Patterson DG, Shipman SA, Pollack SW, Andrilla CHA, Schmitz D, Evans DV, Peterson LE, Longenecker R. Growing a rural family physician workforce: The contributions of rural background and rural place of residency training. Health Serv Res. 2024 Feb;59(1):e14168. doi: 10.1111/1475-6773.14168. Epub 2023 May 9. PMID: 37161614; PMCID: PMC10771894.
7. Doescher MP, Keppel GA, Skillman SM, Rosenblatt RA, MFR. (2009). The Crisis in Rural Dentistry (Issue brief).
8. State Sen. Claeys secures $10 million for new Salina healthcare facility. Salina Post. May 3, 2024. Accessed on May 31, 2024 at https://salinapost.com/posts/61c2b156-06d2-4ef1-8272-99dea5061f04.
9. Caritt N. Health care’s role in rural economic development: Addressing health workforce needs. National Rural Health Association Policy Brief. 2023.
10. Sharma A, Basu S. Does primary care availability mediate the relationship between rurality and lower life expectancy in the United States? Journal of Primary Care & Community Health. 2022; 13: 1-8.
Learn More:
Our capital campaign seeks to address these needs by adding dedicated classrooms and more operatory rooms, enriching the training experience for dental students. Additionally, SFHC is a key training site for nursing, dental hygiene, and behavioral health students. By supporting our campaign, you invest in the future of healthcare in Kansas, nurturing the next generation of skilled professionals for rural communities.
Below, you will find resources to learn more about various topics related to the Rural Kansas Workforce challenges and the impact of Rural Family Medicine, providing insight into how our expansion efforts align with broader healthcare goals.