L ess than four years ago Caldwell Hospitalwas on a cash-only basis with its creditors

and the state had been notified that the hospitalwould almost certainly close within six months.

Things could not have looked gloomier forthe 27-bed facility located 60 miles southwestof Wichita near the Oklahoma line.

Then came a flood ofchange. Positive change.The board of directors ofCaldwell Hospital, officiallytitled Sumner CountyHospital District No. 1,seemed to grab the bull bythe horns – an appropriateanalogy for a communityrich in cow town history –as they banded together tothink outside the box andpull the hospital back fromthe edge of closure.

In 1996, the board’s firststrategic action was to transform10 hospital beds to private pay,long-term-care status – a movethat gives the hospital a signifi-cant source of revenue notaffected by Medicare.

The board then slammed the door on admin-istrators who treated Caldwell Hospital like ashort ride on a merry-go-round. After a trio ofadministrators had flown through the hospital,the board knew that its financially strappedhospital needed a good, if not perfect, adminis-

trator match. So, instead of rushing to fill thevacant position, they opted to operate withoutone for a few months. The decision provedwise as it allowed the board time to forge aunique agreement with South Central KansasRegional Medical Center in Arkansas City.

In short, Caldwell Hospital contracted with

its neighboring hospital 33 miles to the eastfor an administrator, including benefits.

The Arkansas City medical center chose oneof its own employees for the position. Theychose Virgil Watson, a man who had workedCONTINUED ON PAGE 4

What’s Inside . . .

Page 3Applications Availablefor Scholars Program

Pages 6Balanced Budget ActHits Rural Hospitals

Page 8Locum Tenens AllowsSmooth Operation ofJunction City ER

Pages 11Kansas Health CarePersonnel ShortagesConfirmed Businesses in downtown Caldwell helped save

their local hospital by taking part in a“Healthy Future Project” that allowed taxcredits on contributions to the Caldwell AreaHospital and Health Foundation.LEFT: Virgil Watson, Administrator

Caldwell Hospital:A Dramatic Turnaround

Volume 7

Number 4

Spring 2000 RURAL HEALTH EDUCATION AND SERVICES

2

Noteworthy TV newsStarting April 1, 2000, the Family

Health Channel in Wichita is running aseries of programs on rural medicinesponsored by the University of KansasSchool of Medicine-Wichita.

The series features Moundridgewhere Kathy Hayes, M.D.; JamesRatzlaff, M.D.; Marla Ullom-Minnich,M.D., and Paul Ullom-Minnich, M.D.were interviewed about the practice ofmedicine in a rural community.

Paul Ullom-Minnich and myself wereinterviewed about the Kansas BridgingPlan and the Kansas Locum Tenensprogram as well.

The film crew then visitedMcPherson where Greg Thomas, M.D.,discussed the rewards of teaching med-ical students. Third-year medical stu-dents Janelle Regier and CynthiaScheibe described their training ex-periences in a rural community.

The series closes with a segmenton the Kansas Practice Opportunitiesconference. Craig Hanson, administra-tor of St. Lukes Hospital in Marion,William A. Bartkoski, D.O., WesleyMedical Center family practice resident,and myself were interviewed for thisportion of the story.

Congressman honoredThe National Rural Health

Association recently honoredCongressman Jerry Moran with the1999 Legislative Award. The awardrecognized Moran’s work to ensurethat reforms in rural health care wereincluded in the Balanced BudgetRefinement Act of 1999. He was oneof six members of the U.S. House ofRepresentatives to be honored by

the NRHA.Moran also plays a leading role in

the Rural Health Care Coalition.

Quinter physicians recognizedQuinter Family Practice physicians

Dan Lichty, M.D., Michael Machen,M.D., and Victor Nemechek, M.D.,were selected as the 1999 Doug ParksRural Preceptors of the Year. The trioreceived the award last December atKU’s annual Family Practice Program.

In 1986, Machen and Nemechekestablished their rural practice inQuinter, a community of less than1,000 residents located 55 miles west ofHays. Lichty joined the group in 1992.All three physicians are graduates ofthe KU School of Medicine-KansasCity.

“This is an excellent program,according to the feedback we get fromour students,” said Rick Kellerman,M.D., professor and chair, Family andCommunity Medicine, KU School ofMedicine-Wichita. “They’re very active;our students see all kinds of situa-tions – surgery, trauma, maternal healthcare, etc. Above all, they’re also person-able. They seem to really enjoy havingstudents out there and they treat themvery well.”

Match DayTense faces. Sealed Envelopes.

Opened envelopes. Uplifting relief.That’s the way Match Day unfolds on

medical school campuses throughoutthe nation each year. On March 16,2000, it was no different on the KUSchool of Medicine campuses inKansas City and Wichita. A total of169 students now know where they will

spend the next two to five years oftheir lives.

This year, just shy of 50 percent ofKU’s fourth-year students chose toenter a primary care residency.

Seventy-two of KU’s medical schoolgraduates will be entering KU affiliatedresidency programs in Kansas, with fiveof them joining KU’s rural residencyprograms based in Salina and JunctionCity.

On the roadTrish Felt and Denise Rozof, Rural

Health coordinators of the KansasBridging Plan and Kansas PracticeOpportunities Program, respectively,have traveled to nearly 40 Kansastowns this spring to meet with hospitaland community representatives. Theyhave learned a great deal about thestate’s rural hospitals and communities,and said their experiences have alreadybeen helpful when promoting ruralpractice to residents and medical stu-dents.

Felt and Rozof will continue touringthe state as the year goes by. They planto visit community health-care repre-sentatives in the south central andsoutheast portion of the state soon.

Publication scheduleIf you would like to contribute a

news item to Kansas Connections orhave an idea for an article, we welcomeyour input. Please send information tothe KU School of Medicine-Wichita,1010 N. Kansas, Wichita, KS 67214-3199. Ideas are also welcomed by tele-phone at 316-293-2649; fax, 316-293-2671; or e-mail, lvalenti@kumc.edu.

Deadline for the next issue isJune 13, 2000.

If you know of someone who isnot receiving the newsletter but mightenjoy reading it, please let us know.

From The Director . . .Lorene R. Valentine

3

Kansas Connectionsis published four times a

year by the University of

Kansas Medical Center,

Rural Health Education

and Services, Kansas City

and Wichita.

316-293-2649

DIRECTOR

Lorene R. ValentineEDITOR

Jackie Cleary

http://ruralhealth.kumc.edu

Applications Available For Scholars ProgramPremedical students encouraged to apply for programthat assures admission to the KU School of Medicine

APPLICANT ELIGIBILITYApplicants to the Scholars in Primary Care Program must meet the following criteria:1 Graduated from high school in a Kansas rural community with a population of less

than 30,000;2 Demonstrated intellectual promise;3 Attained sophomore standing (as of Jan. 1, 2000) in a Kansas university college or

community college; or have two years of undergraduate course work remaining;4 Completed one academic year of college undergraduate study in general biology and one

academic year in general inorganic chemistry (Note: this requirement may be modified bya substitution of other required premedical science courses.);

5 Demonstrated commitment to practicing primary care medicine in rural Kansas;6 Demonstrated commitment to service by having displayed the dedication and compassion

necessary to become a competent and caring primary care physician.

C ollege sophomores with an interest inrural primary care medicine may now apply

for the Scholars in Primary Care Program 2000,an assured admission program to the KUSchool of Medicine. Applications must becompleted by June 9.

The Scholars in Primary Care Program is forpremedical students with rural backgroundswho plan to practice primary care medicine inunderserved areas in Kansas.

Program activitiesThe two-year program involves undergradu-

ate primary care experiences with physicianmentors and specific learning activities.

Each scholar will spend a minimum of 40hours with an assigned primary-care physicianand will be exposed to the full spectrum ofhealth care services including hospital, primarycare practice, public health and mental-healthservices. Scholars will also be required to com-plete a patient case report each semester, andduring the senior year, complete an assessmentof a community health problem.

Many primary care physicians say that a pri-mary care mentor and/or experiences early intheir premedical education influenced theirdecisions to study primary care medicine. Forthis reason, primary care experiences in schol-

ars’ hometowns are an integral part of the pro-gram.

Selection processEligible applicants (see eligibility list) may

receive application materials by contacting theirpremedical advisor or by calling 316-293-2603or 913-588-5245.

A two-step admission process is used toselect the scholars. First, each of KU’s sixregional medical education sites establishes acommittee to interview applicants and recom-mend up to two applicants to the medicalschool’s Scholars in Primary Care SelectionCommittee. The selection committee conductsfinal applicant interviews and selects a maxi-mum of six students for the program.

Assured admissionIn order to earn assured admission to the KU

School of Medicine, scholars must complete allprogram requirements as well as demonstrateacademic achievements and a significant andinformed interest in primary care.

For more information, contact Ken Kallail,Ph.D., director of medical education outreach,at 316-293-2603, or access the Web atwww.kumc.edu/som/scholars.html.

his way up the ranks in his hometownhospital from laundry and housekeep-ing duties to Human Resources.

When Watson entered CaldwellHospital in May 1996, it was like a newmarshal had come to town – a marshalwho got things done, but never with aheavy hand.

“I credit an awful lot of the turn-around to Virgil,” said Colleen Teeter,board member and retired CaldwellHospital employee. “He is very proac-tive. He is always looking down the roada little bit and not just paying the bills.”

Watson credits the teamwork of theboard and employees, as well as a focuson frugality and service for sendingCaldwell Hospital out of the red andinto the black financially.

Upon his arrival, Watson said hemade it his first priority to ensure thatthe hospital was paying the absolutelowest price for everything from med-ical items to toilet paper. He tookadvantage of Arkansas City medicalcenter’s supply contracts to quicklyreduce the hospital’s operating expens-es.

Penny pinching, said Watson, isengrained in him – part of his trainingunder Webster Russell, the CEO ofArkansas City’s medical center.

Watson’s thriftiness paid off prompt-ly. After just five months in the posi-tion, the hospital was able to pay all itscreditors for the first time in manymonths. By January 1997, employeesreceived their first raise in more thanthree years.

But the money didn’t come just frompenny pinching. Everyone focused onbuilding services back up, and it soonmade a difference in the bottom line.

The improvement of one service inparticular stands out in Watson’s memo-ry. When he came to Caldwell, the hospi-tal had one IV pump, and it didn’t evenwork. Watson knew that had to change,so he collaborated with his Arkansas City

friends and was able to get six IV pumpsjust by purchasing the tubing.

“Six pumps really turned our revenuearound. It made a dramatic differencein Dr. [Jim] Blunk’s ability to keeppatients here in Caldwell,” said Watson.

The small hospital also increased itsuse of mobile health-care services.Currently, mobile services that come toCaldwell by van or bus include mam-mography, prostate and bone densityscreenings. A cardiologist also comes tothe hospital monthly.

In 1999, when Watson learned how

many patients were being referred toWichita or other places for a sleep clin-ic, he arranged to have the serviceoffered monthly in Caldwell.

Surgery, performed an average oftwice a month, is not a new service, butit has been enhanced. When Watsonsaw that the surgeon who travels fromMedicine Lodge had to bring his ownsurgical tools, he focused on improvingthe quality and number of hospital-owned instruments. He did it throughan Oklahoma hospital auction. Theboard approved an expenditure of upto $15,000, but following the sale, hehad spent only $1,000 and had in hispossession $10,000 worth of surgicalinstruments.

“It has made our surgical instrumen-

tation second to none,” said Watson. A full-time physical therapist is

another asset the hospital possesses.“We lucked into that,” said Teeter. “Hemarried a local girl, and we seized theopportunity.”

Similarly, Watson made a hometownconnection to employ a pharmacist.The son of a retired hospital employeesets up shop in the hospital once amonth to do chart reviews and fillsemployee prescriptions at cost. Theprescription benefit is quite a bonus forstaff who had been stripped of nearly

every benefit including sick leave andvacation before Watson arrived.

Teeter said the board is trying togradually reward employees, and shepraised Watson for his leadership withemployees. “He has really improved themorale. I think Virgil has been so suc-cessful because he doesn’t use a dictato-rial leadership style,” she said.

Even things that seem insignificanthave made a big difference to CaldwellHospital employees. Electric hospitalbeds are an example. Watson had theopportunity to replace the hospital’scrank style positional beds with electricones – “for pennies on the dollar,” ofcourse – and it turned out to be a majorimprovement for staff and patients.

“We didn’t realize how much time

Caldwell Hospital CONTINUED FROM PAGE 1

4

Caldwell Hospital board member Colleen Teeter said the entire community, not just the local hos-pital, is focused on improvement. In recent years, Caldwell has worked hard to highlight its histo-ry. The marker with this mural says that Caldwell, founded in 1871, was one of the original cowtowns in Kansas. Violence and politics claimed 18 city marshals between 1879 and 1885 and led aWichita editor to write, “As we go to press hell is again in session in Caldwell.”

and stress we would save just by havingelectric beds. I was thanked a thousandtimes by the staff,” he said.

Watson is a savvy administrator, buthe is quick to give the hospital board,physician Jim Blunk, D.O., and the localcommunity credit. The community, atthe urging of Blunk, pulled together to

establish a foundation to help supportthe hospital.

The foundation, said Watson, sets hishospital apart. The Caldwell AreaHospital and Health Foundation,chaired by community member ColinWood, has been instrumental in helpingthe hospital make improvements. Mostsignificantly, the foundation conducted a“Healthy Future Project” that allowedbusinesses and self-employed farmersup to a 70 percent tax credit on contri-butions to the foundation.

Because of the tax credit, “We collect-ed $117,000 in 18 months in a commu-nity of 2,500 people and about twodozen businesses and farm families,”said Watson.

The goal of the Healthy FutureProject was to raise enough money toreplace the Radiology Department’soutdated X-ray equipment, whichWatson described as looking as if it hadcome over on the Mayflower. As a resultof the foundation’s success, the hospitalpurchased a state-of-the-art X-raymachine, processor and portable X-ray.

“It’s the best equipment in SouthCentral Kansas right now – in any big,small or medium hospital,” said Watson.

Perhaps most amazing is the fact thateverything, including major remodelingto enlarge the room that houses the X-ray machine, is paid for free and clear.

The goal of improving the X-raycapabilities of the hospital had rewardsfor other departments as well. “Whilewe were making a mess,” said Watson,“we remodeled the ER, surgery andphysical therapy area.”

Though the remodeling and new equip-ment purchases were big news, Watsonsaid the most exciting development at thehospital is the addition of telemedicine.In early 1999, Watson began to investi-gate telemedicine, not because it was partof an overall plan, but because it was thesolution to a problem.

“In the middle of remodeling and try-ing to get the new X-ray machine, Dr.Blunk lost his back-up coverage,”explained Watson. “The more we lookedinto it, telemedicine looked like a viablesolution to our coverage problem.”

Caldwell Hospital, which received a$25,000 telemedicine grant from KUMedical Center in June 1999, now usestelemedicine to visually link its emer-gency room to the one in Arkansas City.The arrangement allows Blunk, thecommunity’s only physician, time off onevenings and weekends.

The telemedicine equipment whichCaldwell and Arkansas City installed is adirect dial system that works just like atelephone. “KanOkla [the local phonecompany] went out of its way to get thesystem up and running,” said Watson.He noted that KU officials commentedthat Caldwell Hospital purchased andinstalled its telemedicine equipment insix months – faster than any previousgrant recipient.

Though ER coverage was the thoughtbehind telemedicine, Caldwell Hospitalhas quickly put it to use in other wayssince it was installed last December.

Two oncology patients use interactivetelevision to see cancer specialists at KUMedical Center. Watson said the special-

ists in Kansas City oversee thesepatients’ care, and Caldwell nursesadminister the prescribed therapy. Theuse of technology to administer care toone patient is especially helpful sinceshe has no transportation, said Watson.“This situation is what makes healthcareworthwhile,” he said.

The use of interactive television isalways expanding. KU has includedCaldwell in a grant program that willincrease access to specialists, and in-ser-vice education took place through thesystem for the first time in March. Teeternoted that the board has used it to holdjoint meetings with the governing boardof Arkansas City’s medical center.

With so many major improvementsbehind it, now Caldwell Hospital is onthe road to becoming a Critical AccessHospital. With at least 85 percent oftheir patients being Medicare patients,Teeter and Watson say the CAH determi-nation will move the hospital to a per-spective payment system and free it frommuch of the negative impact imposed byBalanced Budget Act legislation.

Through all the changes, it’s evidentthat Watson, the board, hospitalemployees and community members areworking as a team. “The bottom line isthat the community supports the hospi-tal and the board of trustees is veryconscientious. They want to do every-thing they can to make sure the hospitalsurvives.

“The reputation of this hospital hasalways been positive, but it has beenenhanced by improvements. Peoplefrom the community are continuallystopping by to compliment the hospitalon the progress we have made in the lastfew years,” said Watson.

Thinking back, Watson chucklesabout his early days in Caldwell. “WhenI first came, I was bored to tears.Needless to say, now I wish it wouldslow down just a little bit. We have beenbusy.”

5

“The bottom line is that thecommunity supports the

hospital and the board oftrustees is very conscientious.They want to do everythingthey can to make sure the

hospital survives.” Virgil Watson

6

BBA Hits Rural Hospitals Hard

H ospitals across the country havebeen hit hard by the first two

years of the Balanced Budget Act of1997. Rural hospitals, however, areamong those taking the biggest punchbecause 60 to 80 percent of their oper-ating revenues come from Medicare.

The BBA was calculated to reduceMedicare payments to healthcare orga-nizations by $115 billion dollars overfive years, but the knife went deeperthan intended and experts expect thetotal to be closer to $190 billion.

The total cut is not unimportant, butright now, health care providers arefocused on the here and now. They arefocused on BBA relief. Rural hospitalsare especially in tune with BBA relief.

The plight of rural hospitals has notgone unnoticed by Congressman JerryMoran (R-Hays). He sponsored theBalanced Budget Refinement Act,passed by Congress, Nov. 18, 1999, thatrestored $11.5 billion originally cutfrom Medicare.

But hospital administrators andorganizations like the Kansas HospitalAssociation said last year’s BBA reliefwas just a first step. They are trying hardat every turn to convincingly demon-strate the need for further BBA relief.

In February, four Kansas hospitaladministrators had that chance whenMoran toured their Northwest Kansashospitals to monitor the impact ofhealth care legislation. Moran’s tourincluded Graham County Hospital, HillCity; Edwards County Hospital,Kinsley; Rush County MemorialHospital, La Crosse; and RussellRegional Hospital, Russell.

After touring, Moran said, “It is clearthat we have made some progress...inredirecting Medicare funding back torural areas, but it is equally evident thatour hospitals are still hurting.”

Fred Meis, administrator and CEO,Graham County Hospital, said he had

invited Moran to visit his rural hospitalafter making a trip to Washington D.C.Meis took advantage of Moran’sFebruary visit to reiterate the facts andput a community face on BBA numbers.

For example, like many hospitals,Graham County Hospital runs a homehealth service. The home health opera-tions of the hospital took a big loss in1998, the first year of the BBA cuts.Meis explained to Moran that withoutthe BBA, his home health operationcould have produced $160,000 in rev-enue, rather than a $60,000 shortfall.

Meis said he believes Moran is

informed about health care issues, buthe also wants Congress to know thatthe relief act only delayed some things.“They really have not restored dollars,”said Meis. “We know we are not goingto get relief from the county. For us togo to our county and ask for help withthe hospital – it’s not going to happen.It has to come from Medicare to keepour hospital viable.”

The tour stop at the Edwards CountyHospital was Moran’s only visit to aCritical Access Hospital. “We wanted tomake it real clear that we don’t want tosee it [the CAH program] go away,”said Kim Alderfer, administrator. “Ithas helped us out tremendously.”

Edwards County Hospital was thefirst hospital in Kansas to become aCAH. The CAH determination, as ofFebruary 1999, allows the hospital to bereimbursed by Medicare for the actualcare administered, rather than getting apredetermined amount of money. Asan example, Alderfer said the hospitallab is now reimbursed at a rate of 80

percent, rather than 30 percent.Alderfer echoed concerns brought

forth by Meis regarding home healthcare. Edwards County Hospital is nowthe only home health service in thecounty because two agencies closedtheir doors. Many rural hospitals contin-ue to operate home health services outof an obligation to the community, notbecause it’s a sound business operation.

Teresa Deuel, administrator, RushCounty Memorial, said, “I thought itwas important for Congressman Moranto see how important rural hospitals arein saving lives.”

She also expressed her appreciationfor all Moran has done thus far tosponsor BBA relief efforts. She wasencouraged to see him tour rural hospi-tals, especially since “what WashingtonD.C. considers rural is a little bit differ-ent than what we consider rural.”

At Russell Regional Hospital, thelast hospital visit made by Moran, heheard more about the dependency ofrural hospitals on Medicare. BruceGarrett, administrator, said 80 percentof his hospital’s income is derivedfrom Medicare.

“The message from each hospitalwas clear: progress made, but problemsremain,” said Moran. “As a directorof the Rural Health Care Coalition,I intend to take this message back toWashington and fight for access toadequate health care all across ruralAmerica.”

“It is clear that we have made some progress . . . in redirectingMedicare funding back to rural areas, but it is equally evident

that our hospitals are still hurting.” Congressman Jerry Moran (R-Hays)

7

O ver the next three years, the KUCenter on Aging plans to develop

a variety of interdisciplinary trainingactivities with a rural focus.

This new Rural Health Interdiscip-linary Program is designed to enhancethe knowledge of health professionalstudents and practitioners regardingrural health care. The program is grantfunded from the Bureau of HealthProfessions, Health Resources andServices Administration, and is directedby Linda Redford, R.N., Ph.D.,statewide interdisciplinary educationdirector, KU Center on Aging.

The primary purpose of the programis to train people in innovative interdis-ciplinary care for rural communities.

“Certainly part of our aim is to getmore health professionals to practice inrural areas,” said Redford.

Since the program is based in theCenter on Aging, the program will havesome geriatric emphasis.

“The demographic profile of Kansasadds urgency to the need for morehealth professionals trained in geri-atrics,” said Redford. “Kansas has anolder population than most states.”

In addition to the Center on Aging,the grant program is a joint effortwith the KU Southeast Area HealthEducation Center (AHEC), Pittsburg,and the Norteast Kansas Center forHealth and Wellness, Horton.

Interdisciplinary training will be“taught” in three ways: community-focused team projects, facilitated inter-disciplinary student groups, and didac-tic courses.

This summer, team projects will bepiloted in Horton and Pittsburg. Each cityhas defined a project that a team of fouror more people from different disciplineswill work on. Horton’s project asks stu-dents to assess health-education needs inBrown County, and the Pittsburg projectwill study how the community cares forthe needs of the dying and their families.

“Our program is modeled after a

program that K-State has used foryears,” said Redford, noting that someKU students might participate on aKansas State University team.

In the future, Redford would like toincrease the number of teams tacklinghealth-care projects and ask communi-ties state wide to apply for the program.“Communities will have to ensurehousing, and, in the future, to involvemore students we wouldlike to ask them to providesome stipend money,” shesaid.

For the second part ofthe program, interdiscipli-nary student groups willmeet for case-based learn-ing. The groups, saidRedford, will expose stu-dents to the “reality” ofrural communities, such assparse resources and limit-ed access to additional care. To counterthis harsh reality, interdisciplinary train-ing will show health professionals thatthey can maximize their strengths byworking as a team.

The program is not limited to KUstudents. Redford said the Wichita StateUniversity Physician Assistant Programis already involved and hopefully othercolleges and universities across the statewill join in the process.

Ken Davis, P.T., M.P.H., outreachdirector, School of Allied Health andproject manager for the grant program,explained that, all too often, studentslearn in isolation. “We want students tothink about their role in a rural commu-nity and in interdisciplinary teams,” saidDavis. “We want them to learn how dif-ferent disciplines can help each other.”

To facilitate the groups, KU trainedseveral faculty, staff and preceptors tobe interdisciplinary “tutors.” Mary BethWarren, Southeast Kansas AHEC direc-tor, said, “The tutor is there to makesure the group process is going well.He or she is very much out of the tradi-

tional teaching role because it is a self-directed type of learning.”

The case-based learning processshould give students an appreciation forthe expertise that each discipline bringsto solving health problems. “Everyonegets a voice and you deal with commu-nication issues,” said Redford.

For the group studies, Robert Haskins,M.D., director, KU Southeast Kansas

Medical EducationNetwork, put togetherhypothetical patient casesthat are similar to what heand other rural health pro-fessionals see in small com-munities.

Horton and Pittsburgare slated to pilot case-based interdisciplinarytraining this summer.Students will ideally meetonce a week for four to six

weeks to discuss the cases, spending atleast two class sessions per case.

To gather students from several disci-plines and multiple institutions is alogistic nightmare, but Davis said heis confident that “the value it will bringto students is going to be worth theeffort. The university is really tryingto strengthen interdisciplinary trainingand this is a way it can be done withoutchanging curriculum.”

The final part of the program is didac-tic course work. Faculty are developingtwo courses that will help prepare stu-dents to be members of a rural interdis-ciplinary team. Much of the course workwill be online and some will be presentedthrough interactive television.

If you want to become part of theRural Health Interdisciplinary Program,contact Redford at 913-588-1636. Sheis interested in students, faculty andpractitioners in such health fields asmedicine, nursing, social work, alliedhealth and dentistry.

Interdisciplinary Training Targets Rural Health Care

Linda Redford, R.N., Ph.D.

8

Locum Tenens Allows Smooth OperationOf Junction City Emergency Room

Geary Community Hospital employee JudyWerner sleeps a little easier at night and

worries a little less by day.The reason for her sound slumber and less

stressful days is KU Medical Center’s KansasLocum Tenens Program, coordinated by RuralHealth Education and Services. Werner onlywishes the program had been developed soon-

er.For the past 14 years, Werner,

administrative assistant to GearyCommunity Hospital’s CEO, has beenresponsible for scheduling emergencyroom staff. “It’s my duty to take careof the ER and the ER docs,” sheproudly said.

There are three full-time emer-gency medicine doctors who providearound-the-clock care in JunctionCity’s ER, and these days, it’s nearly acinch to find coverage for scheduledtime off and vacations, especiallywhen she compares the present situa-tion to the past. “It used to beextremely hard to find coverage forevery night of the week. I used to beable to schedule a doctor for 60 hoursof emergency room call, but now themaximum is 24 hours,” she said.

Changes in acceptable call scheduling makeWerner happy to have the Kansas LocumTenens Program to fall back on. “I don’t knowwhat we would do with out it,” she said.

In fall 1996, physicians who were part of theFamily Practice Residency Program in JunctionCity began to provide locum tenens ER cover-age through the Rural Health program. Whenone of the residents completed his training, andWerner found herself needing more frequentlocum tenens coverage because of staffchanges, she began to call upon the fullresources of the program, which utilizes bothresident physicians and KU faculty.

From August 1997 through December 1999,Werner sent approximately 70 requests to KUfor ER coverage. That has resulted in locumtenens service of approximately 1,300 hours.

The convenient, reliable and friendly assis-tance provided through the Kansas LocumTenens Program means a lot to Werner. “Onlyone time have we had to use a national service,”she said. “It was twice as expensive and itseemed that we had to jump through a lot ofhoops” to get the coverage.

Just over a year ago, Werner called upon KU’slocum tenens service to cover the practice of adoctor who was out for six weeks straight. Thattype of assignment is rare, but KU was able tocover nearly every day requested.

“It’s amazing how those residents are able toadjust their time. It works wonderful for us,”said Werner.

The relatively close distance between KUMedical Center in Kansas City and JunctionCity, just a two-hour drive, makes GearyCommunity Hospital assignments attractive toresidents and faculty. The distance is evenshorter, about one hour, for KU residents inthe Family Practice Residency Program atSmoky Hill in Salina.

As an example of the popularity of providingcoverage in the Junction City ER, Joan Hughes,locum tenens coordinator, said, “I recentlyreceived a request for 12 dates in May and Junewhen they needed coverage. I put a notice outon e-mail on Thursday at 4 p.m., and by Fridayat noon, nine of the dates had been snatchedup.”

Scott Ceule, M.D., fourth year InternalMedicine/Pediatrics chief resident, KU MedicalCenter, said, “The people out there are so niceto us. The whole system is appreciative of hav-ing us out there.”

He cites the cafeteria staff for example; theyremember the doctors by name and ask themspecifically what they would like to have forbreakfast, lunch and dinner.

Ceule said residents like Junction Citybecause it is a “regular” locum tenens opportu-nity. “We like to repeat at the same places.There are so many potential opportunitiesthere, it’s hard not to go down there.”

In addition to the medical experience,CONTINUED ON PAGE 9

Michael Malin, M.D., 2nd year resi-dent, KU Family Practice Residency atSmoky Hill, Salina, recently providedlocum tenens coverage in the GearyCommunity Hospital ER.

9

CONTINUED FROM PAGE 8

residents love the fact that locumtenens is a chance to make some extramoney. Ceule commented that one 24-hour shift of locum tenens work willpay about equal to two weeks of workat the medical center.

If this seems like easy money, it isn’t.There aren’t too many slow shifts inJunction City. Residents say the ER isconsistently busy with everything fromkids with ear infections to full-blowntrauma cases.

Ceule has been on duty when therewere two simultaneous rollover caraccidents in which every patient was a

teenager. “I got four patients withinfive minutes in full-trauma,” he said.

The range of patients and fast pacehas been apparent to Ed Zimmerman,M.D., second-year resident, KU FamilyPractice Residency at Smoky Hill,Salina, as well. “You can see 30 to 40people in 24-hours,” he said. “It cer-tainly builds your confidence when youknow there is no back-up. I plan ongoing to a rural area where I won’t havemuch back-up.”

Zimmerman’s coverage time at GearyCommunity Hospital has helped himfocus in on what he wants in the future.He said he plans to settle his practice

and his family in a rural town smallerthan Junction City, perhaps a communi-ty of 10-to-15,000.

The hospital remodeled the ER abouttwo years ago, and Werner said, “Thereare not too many large hospitals thathave a nicer ER.”

Residents have a tendency to agree.They said they like the facility and tech-nologies available to them in JunctionCity. “There is a lot of support there,so you feel you can do a really goodjob,” said Ceule.

Coffeyville Education Program Rebounds

I f you would like to eat dinner with adoctor in Coffeyville, you had better

make a reservation.Capacity crowds of nearly 70 people

have been filling Coffeyville RegionalMedical Center’s cafeteria for itsmonthly “Dinner with the Doctor”education programs. The programs paira free dinner with a health topic pre-sented by a physician or other healthprofessional.

“Almost every month, we have tostop taking reservations,” said ChrisHunt, community relations specialist,Coffeyville Regional Medical Center.

An overabundance of participants isa problem the hospital is happy have.Little more than six months ago,Dinner with the Doctor was known asCHIP, Community Health InformationProgram. That program, which beganin 1997, was as good as dead.

Usually, less than a dozen citizensfrom the community of 13,000 attendedthe monthly presentations. Hunt saiddoctors were no longer interested inspeaking and employees were begged toattend just to have people in the room.

Now, physicians are knocking at thedoor of the Education Departmentasking to speak at the outreach pro-

grams. Out of 27 physicians on themedical staff, Hunt estimated that atleast half are willing to be Dinner withthe Doctor presenters.

The transformation is contributed tothe catchy new name that sticks in themind of the public, creative advertising,a new logo and a change of the meet-ing time from noon to evening.

The new format begins with dinnerat 5 p.m. and the doctor, or otherhealth professional, such as an ARNP,

speaks from 5:30 to 6:30 p.m. “Atlunch, you really limit your audienceand you’re limited on time,” said Hunt.

The evening programs have openedthe door to bigger audiences, as well asa wider audience. For example, Huntsaid the audience was traditionallyelderly women, but now more men areattending as well.

The monthly crowd also varies bytopic. Doctors have spoken about hor-mone replacement therapy and dia-betes. An ARNP, from one ofCoffeyville’s rural clinics, presented“Teaching Your Daughter the Facts ofLife . . . Before Someone Else Does.”For that program, mothers, daughtersand single dads were invited.

Since the program has moved toevening, the menu has also changed.The hospital used to serve a sandwich

lunch with a drink for $3,but now it serves a buffetdinner at no charge.

“We thought peoplemight come just for thefood, but it was clear theywere there for the informa-tion,” said Hunt.

“The hospital is verymuch community and

health minded,” she said. “This followsthe mission of the hospital to do notjust health care but prevention also.”

For more information aboutCoffeyville Regional Medical Center’shealth outreach program, please callHunt at 316-252-1616.

10

Life Before Medical SchoolPremed conference advises medical school hopefuls

P repare now. That was the recurringmessage given to a record number

of 245 students and advisors whoattended a Premedical StudentConference in late February.

The annual conference, hosted by theKU School of Medicine on EmporiaState University’s campus, allowedundergraduates from 30 colleges anduniversities from Kansas and Missourito meet with faculty members, medicalstudents and residents. Each group lentits own expertise on preparing for med-ical school and beyond.

Paul Crosby, medical professionsadvisor, University of Kansas,Lawrence, led a session entitled“Beyond Grades and MCAT Scores.”He emphasized that students canstrengthen their medical school candi-dacy through volunteer and work activi-

ties. When looking for volunteer or paidexperiences, Crosby said it is valuableto look beyond the local hospital or inaddition to that institution. “There aresome limitations to working withpatients in hospitals. There are moreopportunities to engage with patientsoutside the hospital setting,” he said.

A show of audience hands indicatedthat many students do work outsidehospital walls. Some people were learn-ing lessons – and earning money – asa pharmacy technician, lab assistant,nursing home ward clerk, medicaloffice receptionist and CNA.

Exposure to patients, physicians

and other health care professionals canalso be found in Hospice programsand public-health departments, saidCrosby.

Physician shadowing was recom-mended as one component of medicalschool preparation. “Personal physi-cians are great to talk with, but manywon’t let you shadow them because ofconfidentiality issues,” he said. “Theycan however, give you a referral toother physicians, so it’s certainly worthknocking on some doors.”

Crosby recommended the KUPrimary Care Summer Mentor Programto students. The program exposes par-ticipants to a primary care physician’sday-to-day clinical activities by havingthem volunteer 100 hours over six toeight weeks. Although participants forthe summer 2000 Mentor Program have

been chosen, Crosby said the programis worth checking into for next year.“Even if you don’t get accepted, itexposes you to the interview process,”he said.

Applications for the 2001 KUSummer Mentor Program may beobtained from premedical advisors atKansas colleges and universities in lateNovember or early December of 2000.

Beyond health-care activities,Crosby said students should engagein activities that demonstrate that theycare about people. Audience membersshared examples of involvement withBig Brothers/Big Sisters and missiontrips. One student said she is involved

in pet therapy for people in a mentalinstitution.

Crosby suggested a call to UnitedWay or a search of the World WideWeb for a wealth of possible activities.One online site, Impact Online, he said,has a volunteer match program. Theaddress is http://www.impactonline.org.

Research projects are also good ex-perience for premedical students andthese experiences are easily found bytalking with faculty members. Headvised, “It doesn’t have to be medicalto be good experience.”

Crosby recommended that studentsuse their undergraduate years as anopportunity to hone qualities that willbe valuable to them as physicians, butalso pleasing to admissions interview-ers. For example, students might wantto strengthen leadership and manage-ment skills by getting involved in stu-dent government or campus clubs.Teaching and counseling skills are alsoimportant and can be developedthrough tutoring.

Today’s global community also putsemphasis on working with people fromdifferent cultural backgrounds. Crosbysuggested the Web sites of Americorps(http://www.americorps.org/home)and Studyabroad.com (http://www.studyabroad.com) as places to browsefor information and activities.

“Remember,” said Crosby, “Eachstudent can’t do all of this. This is notinstead of MCATS and grades.”

Crosby’s final suggestion was thatpeople keep track of volunteer hoursand record or journal their activities.By doing this, it will be easier to recallexperiences and present it to medicalschool admission committees.

Crosby recommended that students use their under-graduate years as an opportunity to hone qualities that

will be valuable to them as physicians, but alsopleasing to admissions interviewers.

11

Kansas Health Care PersonnelShortages ConfirmedH ealth care personnel shortages are a real

problem in Kansas and in the nation,according to information presented at theannual Kansas Hospital Association RuralHealth Symposium in Manhattan this spring byLorene Valentine, director, Rural HealthEducation and Services, KU Medical Center.

In 1999, at the national level, the SenateHealth and Family Security Committeeexplored the shortage of health care workers inAmerica. It concluded that the health care jobvacancy rate was about six percent, turnoverrates were as high as 50 percent and workershortages were more acute in lower payinghealth care jobs.

Nurses, the largest sector of the health carework force, are especially challenged by today’shealth care environment. For several years,managed care has dominated the health arena,and its moves to streamline health care haveresulted in fewer admissions for inpatient stays.As a consequence, hospital staffs have beendownsized at the same time that the concentra-tion of “needy” patients requiring highly skillednurses has risen.

In addition, “Nurses in particular have seenlittle or no salary increases,” said Valentine.

Hospitals and other care facilities nationwidereport shortages of experienced, highly skilledRNs. That shortage, said Valentine, is complex.

“At first glance, the supply may potentiallymeet demand, but the shortfall is in skill. Manynurses do not have strong science and technol-ogy backgrounds,” she said.

Nurses report that their jobs are increasinglystressful. Faced daily with the pressures ofincreased paperwork, undesirable shifts andhigher patient acuity, Valentine said, “RN dis-satisfaction may be driving the shortage we areseeing in hospitals.”

Employers, however, feel the stress also.“Increased costs and decreased revenues con-flict with efforts to improve working conditionsfor RNs in hospitals,” said Valentine.

The market place, however, is going to

demand changes in the near future. For exam-ple, the average age of RNs in the U.S. is nearage 50. At the same time, enrollment in nursingeducation programs is declining. “It is predictedthat there will be a shortage of nearly 300,000RNs by the year 2020,” said Valentine.

National health care personnel shortages zeroin on nurses, but in Kansas, doctors are also inshort supply. Major studies have concluded thatthe United States faces a physician surplus, but,“The problem is not the number of physi-cians,” said Valentine. “The problem lies in thegeographic distribution of physicians.”

In 1996, the Kansas Health Institute studiedphysician workforce projections. They conclud-ed that through the year 2030, Kansas metro-politan areas should have an adequate supply ofprimary care physicians. Meanwhile, ruralKansas will experience a shortage of 175 pri-mary care physicians.

In the nursing field, according to the KansasHospital Association 1999 STAT report,Kansas employs approximately 32,000 RNs, ofwhich only 12 percent are 30 years of age oryounger. There are about 8,000 LPNs inKansas, of which 17 percent are 30 or younger.CONTINUED ON PAGE 12

Rural vs.Urban Nurse Shortage

OR/Peri-Operative

Critical Care

Experienced RNs

New Graduates

0 20 40 60 80 100

Median number of days to fill vacant RN positionsin urban and rural areas nationally.

Source: TrendWatch, Vol. 1, No. 2, March 1999 Urban Rural

“By the year 2020, over 60 percent ofKansas’ nurses will be at or beyond retire-ment,” said Valentine. “With the supply pooldecreasing, challenges increase in recruitingand retaining qualified nursing personnel, espe-cially in rural Kansas.”

Right now, chronic personnel shortages per-sist among other key hospital occupations too,most notably the field of radiology. The KHASTAT report showed eight allied health occupa-tions had a vacancy rate of 7 percent.

The Kansas Occupational Outlook for 2006,according to Kansas Labor Market InformationServices, assesses that 12 out of the state’s 30fastest growing occupations are in health care.Hospitals, skilled nursing homes and doctorsoffices are predicted to be the primary areas ofjob growth. In every region of the state, RNsand nursing assistants are forecasted to beamong the top 10 occupations adding the mostjobs, said Valentine.

Valentine concluded by asking the audience ifthe predictions of analysts matched their owninsights. A show of hands confirmed that manyare already experiencing shortages of physi-cians, nurses and other health professionals.

“It is clear that the health care workforce isan issue not only for health care facilities, butalso for educational institutions,” said Valentine.“Shortages of health care workers will and areimpacting health care in Kansas.”

Personnel Shortages CONTINUED FROM PAGE 11

“It is clear that the health care workforce is an issuenot only for health care facilities, but also for

educational institutions. Shortages of health careworkers will and are impacting health care in Kansas.”

Lorene Valentine, director, Rural Health Education and Services

NORTHWESTCITY: AtwoodPOSITION(S): Medical Records Tech orMedical TranscriptionistCONTACT: Don Kessen/Delma Jenick,785-626-3211

CITY: HaysPOSITION(S): Orthopedic Physician(spine), Pathologist, Pediatrician,Physical Medicine and RehabilitationPhysician, Internal Medicine CONTACT: Myron Applequist, 785-623-5753

CITY: HaysPOSITION(S): Step-Down ICURegistered Nurses, ICU Nurses,Medical/Surgical NursesCONTACT: Julie Huelsman, 800-690-1560

CITY: HoxiePOSITION(S): Family PhysicianCONTACT: Brian Kirk, 785-675-3281

CITY: PhillipsburgPOSITION(S): Family Physician,Internist, Pediatrician, GeneralSurgeon, Anesthesiologist/PainManagement CONTACT: C.D. Knackstedt, D.O., 785-543-5800

CITY: PhillipsburgPOSITION(S): Family Physician w/OB,Internist CONTACT: Rhonda Kellerman, 785-543-5211

CITY: PhillipsburgPOSITION(S): Family Physician CONTACT: Mark Bieberle, 316-291-4378

CITY: RussellPOSITION(S): Family Physician w/OBand GynecologyCONTACT: Earl D. Merkel, M.D.,785-483-2178

CITY: RussellPOSITION(S): Family Physician w/OB,General Surgeon, Plastic SurgeonCONTACT: Bruce Garrett, 785-483-2323

NORTHEASTCITY: Blue RapidsPOSITION(S): Family PhysicianCONTACT: Kenneth Duensing, D.O., orWilliam Buck, M.D., 785-363-7292

CITY: ConcordiaPOSITION(S): Family Physician w/OBCONTACT: Dalrona Harrison, 785-243-4272

CITY: EmporiaPOSITION(S): Family Physician,Orthopedic Surgeon, PsychiatristCONTACT: Terry Lambert, 316-343-6800, ext. 601

CITY: HortonPOSITION(S): Family Physician w/OBCONTACT: Ty Compton, 785-486-2642

CITY: LawrencePOSITION(S):Obstetrician/Gynecologist, OncologistCONTACT: Charlene Droste, 785-840-3155

CITY: ManhattanPOSITION(S): InternistCONTACT: Scott Coonrod, M.D.785-537-2651

CITY: OttawaPOSITION(S):

Obstetrician/Gynecologist, EmergencyMedicine (full and part-time)CONTACT: Larry Felix, 785-229-8308

SOUTH CENTRAL

CITY: AnthonyPOSITION(S): Family PhysicianCONTACT: Cindy McCray, 316-842-5111

CITY: Conway SpringsPOSITION(S): Dentist, OptometristCONTACT: Ruth Busch, A.R.N.P., 316-456-2411

CITY: El DoradoPOSITION(S): General Surgeon,Pediatrician, OtolaryngologistCONTACT: Jim Wilson 316-322-4557

CITY: El DoradoPOSITION(S): Social Worker (Part-time)CONTACT: Gay Kimble, 316-322-4568

CITY: EllinwoodPOSITION(S): PharmacistCONTACT: Marge Conell, 316-564-2548

CITY: HalsteadPOSITION(S): PharmacistCONTACT: Mary Heaton, 316-835-4606

CITY: HalsteadPOSITION(S): Family Physician,Cardiologist, Internist,Pulmonologist/Critical CareCONTACT: Ron Lawson, 800-475-1042

CONTINUED ON REVERSE

April 2000 HEALTH CARE: THE HEARTBEAT OF THE COMMUNITY

CITY: HutchinsonPOSITION(S): Nuclear MedicalTechnologist, Registered VascularTechnologist, Clinical Pharmacist,Echo Technologist, MedicalTechnologist, Registered Nurse(Cath Lab), Cath Lab TechnicianCONTACT: Loretta Fletchall, 316-665-2032

CITY: HutchinsonPOSITION(S): Family Physician w/o OBCONTACT: Sally Tesluk, 316-663-8484

CITY: HutchinsonPOSITION(S): Cardiologist,Rheumatologist, UrologistCONTACT: Lynn Harris, R.N., 316- 669-2579

CITY: MarionPOSITION(S): Family Physician w/OB,Part-time RNsCONTACT: Craig Hanson, 316-382-2177

CITY: PrattPOSITION(S): General SurgeonCONTACT: Susan Page, 316-672-6476

CITY: SalinaPOSITION(S): PediatricianCONTACT: Dirk Hutchinson, M.D., 785-827-9631

CITY: SalinaPOSITION(S): Internal MedicineCONTACT: Darrell Wilson, 785-822-0251

CITY: South HavenPOSITION(S): Family PhysicianCONTACT: Roger Cox or MarilynFlanders, 316-892-5513

CITY: StaffordPOSITION(S): Family PhysicianCONTACT: Douglas Newman, 316-234-5221

SOUTHWESTCITY: DightonPOSITION(S): Family PhysicianCONTACT: Marcia Snodgrass, 316-285-6424

CITY: Dodge CityPOSITION(S): Family Physician,Internist, Pulmonologist,OtolaryngologistCONTACT: Howell Johnson, M.D., 316-227-1371

CITY: Garden CityPOSITION(S): Internist, OrthopedicSurgeon, Neurologist,Otolaryngologist, Psychiatrist,Oncologist, Pediatrician,Dermatologist, AnesthesiologistCONTACT: Jeff Forrest, 316-272-2422

CITY: KinsleyPOSITION(S): Nurse Practitioners,Physician AssistantsCONTACT: Kim Alderfer, 316-659-3621

CITY: La CrossePOSITION(S): FamilyPhysician/Internist, Physician AssistantCONTACT: Ashok Bhargava, M.D., 785-222-2564

CITY: LarnedPOSITION(S): Family PhysicianCONTACT: Scott Chapman, 800-657-5733

CITY: LarnedPOSITION(S): Family PhysicianCONTACT: Marcia Snodgrass, 316-285-6424

CITY: LeotiPOSITION(S): Family Physician w/OBCONTACT: Ed Finley, 316-375-2233

CITY: LiberalPOSITION(S): OtorhinolaryngologistCONTACT: Kim Harris or Sally Fuller,316-629-6335 or 629-6437

CITY: MinneolaPOSITION(S): Family Physician CONTACT: Ron Baker, 316-885-4264

CITY: UlyssesPOSITION(S): Family Physician w/OB,Nurse Practitioner, Physician Assistant CONTACT: Steven Daniel, 316-356-1266

CITY: UlyssesPOSITION(S): Family Physician w/OBCONTACT: Tayna J. Pittman-Parks, M.D.,316-356-5867

SOUTHEASTCITY: EurekaPOSITION(S): CFO, Materials ManagerCONTACT: Melisa Campbell, 316-583-7451

CITY: EurekaPOSITION(S): General SurgeonCONTACT: Emmett C. Schuster, 316-583-7451

CITY: Fredonia POSITION(S): Family Physician CONTACT: Mark Bieberle, 316-291-4278

CITY: GirardPOSITION(S): Family PhysicianCONTACT: Jerry Hanson, 316-724-8291

CITY: IndependencePOSITION(S): Family Physician w/OBCONTACT: Darren Allison, 316-331-8855

CITY: ParsonsPOSITION(S): Family PhysicianCONTACT: Doris Griffin, 316-421-4881,ext. 262

CITY: PittsburgPOSITION(S): Psychiatrist,Orthopedic SurgeonCONTACT: Lisa Deines, 316-235-3527

CITY: PittsburgPOSITION(S): PharmacistCONTACT: Jody Henderson, 316-232-0147

NOTE: To list practice opportunities in Kansas Connections, please mail or fax a Kansas Practice

Opportunities form to the Office of Rural Health Education and Services, 316-293-2671. Forms are accessible

through the Rural Health Web site, http://ruralhealth.kumc.edu, or by calling at 316-293-2649.