Location: Hill City
Community Engagement Dept.: RHES
Program: Kansas Medical Student Loan
Dave Atkins, M.D., and family recently moved to the big city. He is now practicing family medicine at Graham County Hospital in Hill City, population 1,474, a 15-minute drive east from his boyhood home in Morland, Kan., population 154.
"Hill City was always the 'big city.' We would go for pizza or to rent a movie," says Atkins.
Hill City is a place Atkins already considers a second home, and is now able to enjoy a slice without the commute. He'll also be able to enjoy his new community without the burden of medical school debt, which today tops $150,000 for the average medical student, according to the American Medical Association.
Kansas Medical Student Loan and other incentives
Atkins, who graduated from the University of Kansas School of Medicine in 2010, is free of medical school loans as a participant in the Kansas Medical Student Loan (KMSL) program. KMSL distributes 120 loans annually to KU medical students who agree to practice in a rural Kansas community following their residency. The program is one of several financial incentive programs available to doctors and health care professionals that help fill a provider gap for large swaths of Kansas.
More than 363,000 Kansans live in a community with too few primary care practitioners, according to estimates by Health Resources and Services Administration (HRSA). The unequal distribution of health care providers mimics the unequal distribution of the state's population as 89 of Kansas' 105 counties are either partially or completely underserved.
The financial incentive programs available to doctors and health care professionals in Kansas include loan-repayment, bonuses and scholarships for health professionals in exchange for a prescribed time commitment - usually three to five years of service in a qualifying community. Many other states have similar financial incentive programs for doctors, nurses, dentists, mental health professionals, which have long been considered important and successful tools for recruitment and retention of qualified professionals in communities of need.
Several researchers have proven these programs effective to varying degrees. KU Medical Center alumnus, Erin Locke-Nilhas, MPH, M.D., is one of those researchers.
"My research demonstrated that the financial incentive programs are invaluable to both the health care providers in the programs and to the underserved communities who received the services," says Locke-Nilhas, who evaluated the effectiveness of three similar federally funded programs in Kansas for her master's thesis.
However, proof of the Kansas Medical Student Loan program's success isn't in research, but in the program's dwindling funds.
The Kansas Medical Student Loan program requires students to work in a rural community one year for every year of medical school paid for by the loan. Students who don't meet this obligation are required to pay back the loan at a hefty 15 percent interest. Until recently, interest and repayment by defaulting students was what funded the entire program. Now, however, roughly 70 percent - including students such as Atkins and Locke-Nilhas - are fulfilling their obligations by practicing in rural areas. As a result, the loan program is experiencing a budget shortfall.
Although this is creating a strain on the loan program's, that's a good problem to have, says Heidi Chumley, M.D., the KU School of Medicine's Senior Associate Dean for Medical Education. "We're actually thrilled that so many of our grads are choosing to repay their loans through service, by staying and practicing in Kansas, rather than by paying cash penalties for leaving and practicing in the big cities."
KMSL and additional financial incentives for Atkins to practice medicine at Graham County Hospital solidified his decision to practice in Hill City. He signed his agreement two years early, while still in residency.
"A lot of rural hospitals have some sort of loan repayment program. For me, they're going to provide those funds in the form of a stipend, which is why I signed early," says Atkins.
Rural Challenges & Opportunities
The financial incentive sealed the deal, but Atkins had a strong desire to practice rural medicine from the beginning. He just didn't believe it would be his fortune so soon after residency.
Atkins joined the National Guard as a combat medic to pay for his undergraduate studies at Kansas State University. To pay back those loans, Atkins owes 10 years of service to the National Guard, an obligation that will require his service away from Hill City for some weekends and lengthier deployments.
"That was always the limiting factor," says Atkins, who explains that small communities typically have only one or two physicians, which can make military service obligations, medical missions and even long vacations difficult.
Doug Newman, CEO of Graham County Hospital, didn't see Atkins' service commitment as a problem, however.
"We're going to make allowances for his military commitment. That's why he started six months after graduation - he got his required deployment out of the way before he got here," explains Newman. "We've tried to make it as easy on him as possible."
Newman's allowances are part goodwill gesture and part necessity because the hospital is in need of physicians who will establish life-long careers in Hill City. Currently, Graham County Hospital is staffed by two physicians who are both approaching retirement age. Atkins will provide relief for one of them.
"The benefit is knowing I have somebody coming," says Newman, who can use the security of Atkins' commitment to help recruit another physician.
Recruiting health care professionals can be tough business for Kansas' critical access hospitals, says Newman. "There are towns around us that are recruiting for three or four or five years and still haven't got anybody," he says.
The past few years have been good ones for Newman, who also signed a nurse practitioner. Newman's approach to provider recruitment centers on "compatibility," which means he keeps prospective employees and their families engaged in the recruiting process and in the Hill City way of life. The nurse practitioner's spouse and family appreciates rural life, which Newman describes as a more family-oriented lifestyle.
Locke-Nilhas' research and other studies have found that family support is a critical component to ensure that physicians who begin practicing in rural communities stay. One respondent in Locke-Nilhas' study changed practice sites because they wanted to be closer to family.
Atkins is also a devoted family man and the decision to practice at Graham County Hospital was a joint one for Atkins and his wife, Christine, who also grew up in Morland.
In fact, one study suggested that the spouse was the strongest influence on choice of practice location.
"We've come back home," says Atkins. Atkins and his wife know Hill City is the perfect place to raise their two young children. Their families still live in the area, with Christine's mother, Atkins' parents and one of his four brothers residing in Hill City.
If down the street wasn't close enough, most days, Atkins is down the hall from his mother, Melissa Atkins, who is the chief financial officer for Graham County Hospital.
"For us, this was really a 'Duh!?!' moment," says Atkins. "We got to come back home, and I have a dream job."