Sinking Sand - Small town healthcare

Sinking Sand

Time and economic factors have drained small town Kansas of much of its healthcare resources.

Some of us are old enough to remember when Kansas was mostly a rural state. Wait a minute, you say. It still is. And geographically speaking you are absolutely right. In fact, you could argue that there are really only three Kansas towns big enough to qualify as what other states might regard as cities, Wichita, Topeka and the Kansas portion of Kansas City.

Some of us are also old enough to remember the mythical Doc of Gunsmoke fame who was forever making house calls in the Kansas deep of yesteryear and presumably taking chickens for his fee.  Ok, so maybe some of us aren’t that old. But suffice it to say that the country doctor is a treasured icon of our small town heritage.  Unfortunately, it’s an icon that is rapidly becoming a distant memory.  And there’s the rub: Country life is still very much a part of the Kansas landscape.  But country healthcare? Not so much.

Valerie Anderson, APRN“It’s understandable, but it’s also a shame,” said Valerie Anderson, APRN at GraceMed’s Clearwater Clinic.  “Between the advanced resources and plentiful supply of patients offered by practices in larger markets, generations of family practitioners have been steadily migrating to the cities.  To me, what they miss out on is the quality of life in a practice where you become a part of the family for all your patients.  You end up feeling like they care about you as much as you do about them.”

Of course, the problem is not one-dimensional.  It’s not just that healthcare providers aren’t coming to rural communities. Many of the would-be patients have been leaving their hometowns for metropolitan America as well.  The smaller towns get smaller still when businesses  pull up stakes, taking with them the health insurance benefits their employees once had.  In some of these towns, the hospital is a major employer, and we are starting to lose an alarming number of those businesses as well, resulting in a triple threat: the loss of vital healthcare resource, jobs and the employer based insurance that comes with them.

There’s a phrase the government uses to describe the medical deserts that are left behind.  They call them Health Professional Shortage Areas (HPSA) and about 90% of Kansas counties have been given that designation. What they have in common with urban areas in the heart of our cities is the relatively high rate of poverty among the people who live there — and the poor health generally associated with it.   The highest death rates among children and young adults are in rural counties. Chronic illnesses such as cardiovascular disease and diabetes are more prevalent, too as are injury-related deaths. Stroke-related deaths have also been found to be on the rise, even though the same rate has either stabilized or declined in metro environments.

Community health centers provide outposts of hope, but here in Kansas, only in roughly 30% of our counties.  GraceMed had long been rooted in the heart of Wichita, but we first heard the call of rural Kansas in 2015.  That was when McPherson leaders approached us about the limited capacity for primary care in their community. “At the time, the town was growing, but the existing practices were not able to take new patients,” said Jason Ybarra, Chief Operating Officer of GraceMed.  “A lot of residents were having to go to Hutchinson for care.  It was our first opportunity to expand our definition of the underserved to include rural patients.”

Then, in 2017, GraceMed was approached by David Papish, the only doctor in Clearwater, KS.  Dr. Papish was ready to retire, but didn’t want to leave his patients without access to local healthcare. So Clearwater became our second venture into rural Kansas as Valerie Anderson, who happened to be from the area, took on the challenge of stepping into patient relationships that had been built through generations of small town life.

“Trust is something you really do have to earn in a rural practice,” Valerie readily admits. “Generally speaking, people are used to living very private lives out here, but it’s a privacy that can sometimes be hard to keep in a small town where everyone knows each other.  I think it’s important to become a neighbor they know, while still being a professional they can trust.”

Connie Andrews, DDSFor Dr. Connie Andrews, GraceMed’s dentist in McPherson, rural Kansas dentistry is not struggling with a lack of dentists as much as it is with the cost to provide care. “We’ve been seeing a lot of patients from small towns many miles away from McPherson,” Dr. Andrews explained. “For a lot of general dentist practices out here, Medicaid and other insurance plans’ reimbursements rates just aren’t sufficient to cover the cost of care.  Community health centers such as GraceMed can be in a position to provide care to those patients because we are able to offer a sliding-scale of fees based on income.”

She went on to point out that “It can be very difficult to refer patients that need sedation or specialized dental care that we can’t provide, because there aren’ta  lot of nearby specialists that accept Medicaid.  It’s unfortunate but, for some situations, the only option might be as far away as Kansas City.  We can’t forget about Kansans in small, rural areas.  They are also important.”

Another issue that is increasing in significance is the lack of access to behavioral health services, and in particular addiction therapy. “There was a time when addiction was just unheard of as an issue in a small-town setting,” said Jeff Hubbell, GraceMed Director of Behavioral Health. “But the proliferation of opioids, methamphetamine and other drugs has had a devastating effect on far too many households and communities and really underscored the deficit in behavioral health professionals. I think telehealth is going to be an important asset as we try to make the most of limited resources to serve rural Kansans in the future.”

One solution currently being pursued is to raise our own crop of next generation professionals.  On the medical side, accreditation is currently being sought for a school of osteopathic medicine.  Dr. Julie Elder, Chief Medical Officer for GraceMed, and an osteopathic doctor herself, explained that “the school is going to be called the Kansas Health Science Center and its Osteopathic College is being founded with a vision to specifically address the inequities in access to professional care across the state.”

There’s also been an effort to open a dental school which, surprisingly, has never existed in Kansas. “That idea is competing right now with another one at the state capitol,” said Eric DeShazer, Chief Dental Officer at GraceMed. “The other approach is to develop a workforce of mid-level professionals called Dental Therapists who would work under the supervision of dentists, a lot like APRNs are supervised by physicians.  I think the need is such that we could benefit enormously from either or both solutions.”

For GraceMed, the question that begs to be answered in all of this is what our role might be in helping to serve more of the underserved in HPSA land. “It’s a difficult question to answer,” Venus admitted. “For the time being I would say that we remain open to whatever possibilities we feel led to pursue. We have been expanding rapidly for many years now, and it’s been exciting to see what God has in store for our ministry. If we can deliver the level and quality of care in a given community that the residents there want and need, and we feel we can sustain it operationally, then I can certainly see that happening. We want to serve where there are underserved patients. It’s our mission and calling.  As long as we can be good stewards of the ministry we’ve been given, the future is always an open possibility.”

This post originated in our State of Grace quarterly news magazine. If you would like to receive the magazine, please visit this link and give us your information. Thanks!