For patients in Kearny County and the surrounding area in western Kansas, the road their doctors traveled to serve at the clinic and hospital in Lakin leads through Ecuador, Egypt, Zimbabwe, Ghana, Paraguay, Haiti, and other far-off places.

Kearny County Hospital has successfully done something difficult for many rural communities - recruit doctors likely to stay and make a career - with a policy that not only encourages mission work but also provides the time off to do it.

The approach is one Benjamin Anderson, hospital CEO, used previously at Ashland Health Center in Clark County about 50 miles south of Dodge City. The strategy was suggested to Anderson by Todd Stephens, director of Via Christi's International Family Medicine Fellowship. Anderson was also encouraged to hunt  for two doctors - "the good ones don't want to practice alone," he heard - and to take a mission trip himself. Since going to Zimbabwe that first time, Anderson has returned every year.

Time off for mission work

Anderson became Kearny County's CEO in 2013 and has built upon the hospital's existing policy and inclination to allow paid time off - up to eight weeks of vacation and sick time - by recently expanding it to all staff, from doctors to nurses to physician assistants to housekeepers. And he's recruited two more doctors to join Drew Miller, John Birky, and Arlo Reimer, all graduates of the KU School of Medicine-Wichita and the Via Christi Family Practice residency program.

"When we came here, we asked to be able to have up to eight weeks off so we could do mission work," said Birky, who joined Miller, his classmate and friend, before Anderson came aboard. "The board chairman at the time, Jon Wheat, said, 'Well, we give seven weeks off right now, we might as well have another one.' That was really different from what I'd heard in other places."

Miller joined the hospital in 2010 and Birky in 2011, after a year as a Via Christi International Family Medicine fellow. The doctors, who knew Anderson from his time in Ashland, helped recruit him to Lakin.

"What they said is they had mission-focused doctors and a mission-focused board, what they needed was a mission-focused CEO to be part of a team," Anderson recalled.

Anderson said the time-off policy makes financial sense when weighed against the cost of staffing an ER with locum tenens doctors (a substitute who can fill in temporarily during a regular doctor's absence). It's an approach he and the doctors believe could be replicated elsewhere, as long as it's embedded in an institution's fabric.

"You must understand your organization's mission, core values and goals, and be able to clearly articulate those to physician candidates. Recruitment is not a sales pitch. It's about mission alignment. An organization has to be mission-focused to recruit mission-focused doctors," Anderson said.

Cornucopia of cultures in rural Kansas

Lakin, home to 2,200, is about 25 miles west of Garden City and about 40 miles from the Colorado border. The medical complex on the town's east edge contains 25 beds, a 70-bed nursing home and a busy hospital-owned clinic. About 200 babies are delivered in its four birthing rooms annually.

Medical staff may venture to Zimbabwe, India, Haiti, and other distant points, but there's plenty of mission back home as well. Lakin's proximity to Garden City and the Tyson beef plant in Holcomb deliver diversity aplenty. "We serve people from at least 22 countries speaking nine languages, and that is because Tyson Meat is 15 to 20 miles east of us," Anderson said.

"My primary mission field is Lakin, Kansas, and I think you'll find that many of the medical providers agree," Anderson said. "There is a direct tie between service here and service overseas. Our doctors are choosing to spend their time in the countries where some of our patients are from. By serving in Mexico, we learn the culture and the intangible things that determine medical outcomes. It better equips us to serve people from Mexico who live in Lakin." The same is true for Burmese and Ethiopians. "All those nationalities exist here," he said.

The hospital recently began staffing the United Methodist Mexican American Ministries Clinic in Garden City and added another doctor, Lisa Gilbert, who splits time between that clinic and Lakin. Anderson said such service was an attraction for Gilbert, the daughter of missionaries. Both she and Lane Olson, who will join the hospital next year, went through Via Christi's international program.

Variety is the spice of ... medical practice

The opportunity for full-spectrum family practice is a selling point. "You can do as much OB as you want; you can do scopes," said Reimer, who went to Lakin in 2000. "When you come out of training, you want to continue to build your skill set and keep your skill set and not just drop off and be isolated to one aspect of the care. That's a huge draw."

"I can do their colonoscopy or deliver their baby, whereas in Wichita very few family docs do that," said Birky, who grew up near Newton. "Out here, there aren't enough specialists. If you think about people out in Tribune, it's an hour and a half drive to Garden City. So if they can come to Lakin and get the same thing done, it's a half hour closer to home."

"I have always been drawn to a small town, the idea of being one of however many doctors and serving that community," said Reimer, who grew up in Satanta. "That's part of why I went into medicine."

"What drew me to rural medicine was the unique relationships you develop with your patients," said Miller, a native of Leoti, about 40 miles north of Lakin. "You never know what's going to walk through the door, and that's what makes it challenging and fun."

Miller went to Ghana during medical school and will venture to India next year. "Todd Stephens always said international medicine is extreme rural medicine. Ghana was rural medicine with less resources and support. It was a huge aid to my training and made me a better doctor because you have to function with less."

Shared sense of mission aids in retention

With four doctors on staff and a fifth coming, the hospital keeps recruiting.

"We see our responsibility as a regional one to support surrounding communities," Anderson said. "The challenge is that we can only support as many doctors as we can sustain here at home base. But for now, we will continue to recruit until the need is met."

With the demands of medical practice far and near, one area that remains a work in progress is providing doctors time with their families, to create the margin of time for them to succeed personally as well as professionally and to avoid burnout.

"If you've got somebody who's financially compensated at least at the average, and they have a strong sense of mission and they've got margin, a reason for them to leave would have to be significant or compelling," Birky said.