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Kansas Physician Workforce Report University of Kansas Medical School

March12, 2007


IntroductionIn early 2005, the University of Kansas School of Medicine

(KUSOM) was approached by representatives of the Kansas Academy of Family Physicians (KAFP) to discuss Kansas’ fu-ture primary care physician workforce. The School had been considering studies by the American Association of Medical Colleges (AAMC) and the Council on Graduate Medical Education (COGME) calling for increases in medical school class size and graduate medical education (residencies and fellowships). Representatives of the Kansas Department of Health and Environment (KDHE) had also been in contact with the School concerning the availability of physicians and access to health care across the state. In response to these common concerns, KUSOM, KAFP, and KDHE jointly con-vened a group of researchers and policymakers to:

With funding from the KDHE Office of Local and Rural Health, Office of Primary Care, the initial meeting of the Workforce Advisory Board was held in the Fall of 2005. Over a twelve month period, a statewide team with representatives from public institutions, professional organizations, and pri-vate industry met to determine the best approach for address-ing this complex goal. This report captures these efforts.

Overview of Physician Workforce Shortage Challenges

The growing aging U.S. population as well as the expan-sion of demand for physician services in recent years has led several major organizations, including the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME) to call for expansions in U.S. medical education programs over the next two decades. The AAMC has issued recommendations

on the primary items to be considered in regional workforce analyses, including: A profile of the state’s physician workforce A profile of medical education and training in the state A demographic analysis of the state’s population Forecasts of future physician supply and demand in the state The results from these analyses help state policy makers

to identify and understand the issues surrounding the state’s physician supply and demand, assess the magnitude of prob-lems and timeframe within which they need to be addressed, and prescribe effective policy measures to address them.

This report describes efforts within the State of Kansas to follow the recommendations and guidance of the AAMC and evaluate the state’s physician workforce by organizing a group of stakeholders to track and assist in the analysis effort.

Primary Study Findings Taken as a whole, the state of Kansas is currently below

the National Average for physicians per 100,000 population. In addition, Kansas has a mal-distribution of physicians

reflected by low physician-per-100,000 ratios in five of its six major geographic regions, with under service prominent in rural regions, especially the Southeastern and Southwestern regions. This mal-distribution cannot be addressed without

attention to Primary Care workforce development. The most underserved rural and urban areas require and are likely to be best served by Primary Care physicians (Family Medicine, General Internal Medicine, and Pediatrics). While the state’s physician supply will increase over the

next two decades, Kansas will likely remain behind most other states due to physician demand trends and increased rates of out-migration of medical school graduates, interns, and residents as a result of expansion of practice opportunities and educational programs in geographically contiguous states and nationwide.

Executive Summary

1

“Improve understanding of current and future health professions workforce needs in the state of Kansas and to identify the determinants of professional practice patterns in an effort to enhance strategic planning and advance population health.”


Limitations of the StudyWhile the Workforce Advisory Board and the Analysis

Group made every attempt to be comprehensive in the analyses described in this report, there are several significant limitations to findings and recommendations. The existing physician practice demographics data

obtained during the annual re-licensure of Kansas’ physicians and the practitioner databases maintained by various state agencies, primarily the Kansas Board of Healing Arts, are for the purposes of this work incomplete. The current study does not take into account the impact

on the future of the Kansas physician workforce that may be seen as a result of changes in the educational programs and the physician practice patterns in contiguous states and the region as a whole. The current study focuses only on the “supply side”

of the physician workforce equation -- while models that attempt to predict future demand for physicians are being developed, these models have not as yet been validated for the state of Kansas and they have not been considered in the preparation of this report. Lacking consensus on the appropriate physician-

per-100,000-population ratios for primary care and specialist physicians, the study assumes that policies should aim to provide ratios for the state as a whole that are no less than the national ratios.

Primary Advisory Board Recommendations The State of Kansas should: Increase the number of Graduate Medical Education

(GME) opportunities, i.e. residency or fellowship positions, available in the state Create a Primary Care Education Enhancement Task

Force to make recommendations to maintain and enhance the school’s tradition of education for primary care careers Locate GME programs and positions in underserved

and rural geographic regions to enhance recruitment to and retention in practice Increase the size of the Undergraduate Medical

Education (medical student) program and explore methods to allow students to spend significant amounts of time in underserved and rural areas Improve the stipend and benefits available to GME

trainees Increase GME stipends (salaries) to the mean value

for the region as determined by from the AAMC

survey of GME programs Create a system of supplemental payments or

premiums for certain programs, particularly primary care to assure that these programs fill Engage state policy making bodies such as the

Kansas Health Policy Authority Board to review/ recommend improvements in GME support in Wichita, Kansas City, and throughout the state Increase incentives and stipends for UME and GME

trainees, J-1 participants and other physicians to maximize retention of those who desire to practice in rural and underserved regions Emphasize stipend and incentive increases for

Primary Care and Rural programs (e.g. Scholars in Rural Health, Kansas Medical Loan Program, Bridging Program, and Rural Track Residency programs such as Smokey Hill and Junction City) Create new programs to reduce educational debt and

improve incomes Devote resources to preserving programs targeted at recruitment and retention of minority students,

residents and faculty (such as those previously funded under Title VII) Adjust UME and GME selection and admission criteria

to influence eventual physician retention and distribu tion patterns (e.g. more recruitment, admission, and support of geographically, ethnically, and socio-economi cally varied students/trainees) Complete analysis of admissions, KMSL, GME and

other program data to identify characteristics associated with eventual Kansas and rural Kansas practice Mandate electronic re-licensure survey completion by

all physicians using the Kansas Board of Healing Arts system Create similar mandates and data coordination across

agencies for mid-level providers (physician assistants, nurse practitioners, mid-wives, nurses) Support ongoing collection, monitoring and analysis of

provider workforce data, on a two-year cycle Identify and empower an appropriate agency or

organization to oversee this scheduled activity (e.g. Kansas Health Policy Authority) Where possible, coordinate data collection with the

recommended mandatory electronic re-licensure survey Obtain practitioner, hospital, practice group, and

healthcare organization data on planned and current recruitment/hiring activities

2


Rationales Supporting the Primary Recommendations

One of the principal determinants of location of practice for newly trained physicians is the location of their residency and fellowship training programs. The state’s current GME ratio deficits pose a risk to workforce development. Physi-cians in Kansas are more likely to have attended in-state medical schools than physicians in other states (31% vs. 29% nationally) and 55% of KU School of Medicine (KUSOM) graduates say they plan to practice in Kansas at time of gradu-ation. Unfortunately, licensed Kansas physicians are less likely than the national average to have completed GME training in-state (37% vs. 45% nationally).

Decades of studies have shown that GME graduates are most likely to practice within short geographic distances from the site of their GME training. Thus, increased size and/or geographically redistributed GME training programs should be seriously considered. Furthermore, as compared to their national peers, a higher proportion of KUSOM gradu-ates express an intention to practice in rural or underserved communities. Therefore, expanding the GME position num-bers, enhancing stipends, locating new and more attractive GME positions closer to rural and underserved communities, and/or use of monetary incentives and repayment programs for residents, might retain more KUSOM students and even-tually result in improved supply ratios.

The findings of this report support continued action by Kansas governmental and legislative authorities and the hospitals in the state to build incentives for GME retention of KU SOM graduates. Unfortunately, such program de-velopment is especially needed in the primary care training programs. In Wichita, increasing stipends and benefits is the primary concern, since a number of programs are having some difficulty in recruiting the best candidates at the cur-rent levels of resident compensation.

Increasing medical school class size should be a leading consideration. Since many schools across the country are planning expansions in reaction to projected future shortfalls, the Kansas student cohort may require expansion to keep up. Because the current ratio of admissions to applicants at KUSOM is relatively low despite a relatively large class size, there seems to be an adequate supply of candidates to fill a significantly expanded class. However, should nearby regional medical schools increase class sizes, absent a correspond-ing increase in the size of the KUSOM class, native Kansans might elect to pursue medical education outside the state, reducing the size and quality of the pool of students available

for admission to KUSOM. If increasing UME is a near-term consideration, resources will be needed to provide the infrastructure and faculty necessary to accommodate more students. Among the resources to be considered, is the ready availability of GME opportunities in the state.

While many medical school graduates view the transition to GME as an opportunity to train in new venues, a signifi-cant number of students, particularly those with strong social and cultural ties in the state where their medical school is located, desire to remain at their “home school” for their graduate training. Thus, if physician retention is a goal, an increase in UME class size should be accompanied with a parallel increase in GME program size. Furthermore, an in-crease in UME class size absent increased GME opportunities likely will exacerbate the state’s status as a net exporter of newly graduated physicians. Finally, with further study it may be possible to identify additional characteristics of candidates for admission to the UME and GME programs that predict increased likelihood of remaining in the state and/or inclina-tion to serve in rural or underserved areas and to select for these characteristics.

Given the current retention statistics over four- and five-year time periods, the proposed expansions of the UME and GME programs alone would have only a minimal impact on the problem of physician mal-distribution within the state. The regional deficits must be addressed by policy initiatives and programs that are beyond the domain of educational programs and institutions. Policy initiatives will need to be multi-faceted and include collaborative planning across stake-holders and institutions.

Final report recommendations deal with future workforce tracking and projections. This report was limited by the re-porting bias inherent to the “voluntary” Kansas State Board of Healing Arts licensure survey. In addition to the poor survey response rates resulting from a “voluntary” physician survey, there are problems related to “physician-in-training” and “pri-mary practice location” classification which have influenced all of the findings within this report.

Because of these limitations, the Kansas Physician Work-force Advisory Board suggests that The Kansas Health Policy Authority Board consider mandating electronic Board of Healing Arts annual licensure renewal survey completion for physicians of all specialties. To address the existing biases and response deficits related to the current survey methodol-ogy, questions should be added to obtain complete physician residency data. Similar mandates must be put in place for the Board of Nursing Arts so that all health care providers may be accounted for in future workforce analysis and planning.

3

Kansas Physician Workforce Report University of Kansas Medical School4

Report IntroductionKansas’s physician workforce is similar to that of the U.S.

with regard to age, gender, and specialty mix, though it dif-fers in several other ways. With 5,579 active physicians, the state has a lower than average per capita supply of physicians (203 physicians for every 100,000 residents versus a national average of 246). International Medical Graduates (IMG) ac-count for only 9% of Kansas’s physicians (compared with a national percentage of 23%). Comparisons of Kansas’s physi-cian workforce against other states in the nation are summa-rized in Section II.

Retention of Students and TraineesUsing data from undergraduate medical education datasets

as a denominator, Kansas is a “net exporter” to the rest of the country. Kansas has as nearly as many medical students (26.0 vs. 26.6 per 100,000) and only half as many physicians in residencies and fellowships (18.4 vs. 34.3 per 100,000) as the U.S. as a whole. Nearly two-thirds (62%) of the physi-cians that attend medical school in Kansas eventually practice outside the state. One-third (38%) remain in Kansas; less than the national average of 39%. Physicians who complete GME in Kansas are slightly less likely to remain in-state than elsewhere in the nation. (45% vs. 48%) (Using GME dataset data as a denominator) (See Section II).

Using practice licensure dataset data as a denominator, physicians in Kansas are 31% more likely to have attended in-state medical schools than physicians in other states (38% vs. 29% nationally); while they are 25% less likely to have completed GME training in-state (36% vs. 45% nationally).

Regional Workforce VariationKansas’ regions vary widely in their physician supply, from

more than 250 physicians per 100,000 in Northeastern Kan-sas to less than 125 physicians per 100,000 in Southeastern Kansas. Eighty-four percent (84%) of the state’s active physi-cians practice in two regions (Northeast and South-central). The age distribution of physicians is fairly uniform across all regions. Northeastern Kansas and South-central Kansas con-tain virtually all of the Graduate Medical Education programs in the state as well as the largest population groupings and percentage of urban areas. However, there are exceptions to the concentration of physicians in the NE and SC; other parts of the state have higher per capita supplies of some special-ties, including Radiology, Orthopedics and General Surgery.

Specialty DistributionNearly 60% of MDs and DOs in the state are non-primary-

care specialists compared to 65% nationally (these percentag-es are difficult to validate due to incomplete survey data both nationally and locally). Kansas demonstrates a real disparity in the proportion of MDs and DOs choosing certain special-ties; for example, only 1% of specialists practice in the areas of Infectious Disease and Nephrology, only 2% of specialists practice in Pulmonary Medicine, and only 3% specialize in Hematology. It is very likely that these percentages relate to the mechanism by which the State Board of Healing Arts collects and verifies the annual re-licensure survey. Some specialties account for a much higher percentage of total cur-rent active specialist physicians, Radiology (15%), Anesthesia (13%), and Ob/Gyn (11%), and these numbers may also relate to physician survey response or non-response.

Overview of Chart Book Section I presents basic data on physicians in Kansas, their

demographics, per capita numbers, and medical education. Section II presents information comparing other states

across the region and nation and data on medical school enrollment; retention of medical students, residents and fellows; and other medical education related information. Section III contains data about regional variation in the

physician workforce within Kansas, including information on per capita supply, trainees per capita,

Kansas Physician Workforce

5.579 Active Physicians (203 per 100,000)675 Residents and Fellows (25 per 100,000)

Undergraduate Medical Education 38% In-State UME Grads 62% Out-of-State UME Grads

Demographics 22% Female 30% of Aged 55 and older 38% in Primary Care


demographics, and work setting. Section IV contains more detailed information about the

specialty supply, and per capita primary care supply. Section V presents workforce projections including

projected population changes, physician distribution, new license retention, and primary care over 25 years. Section VI summarizes Rural Physician Recruitment and

Retention Programs Section VII uses data from the AAMC resident survey

and data from the KUMC Office of Graduate Medical Education to compare and summarize graduate medical education stipends. Section VIII provides summary recommendations projected population changes, physician distribution,

new license retention, and primary care over 25 years.

I. Physician DemographicsKansas currently has 5,579 physicians working more than

20 hours per week (“active”) and 675 physicians in training (residents and fellows). This gives a ratio of 203 active physi-cians per 100,000, which is 17% lower than the national average of 245 physicians per 100,000.

Kansas’s physician workforce is similar to the rest of the country in that: 38% of physicians are in primary care specialties 30% of physicians are aged 55 or older 22% of active physicians are femaleConsistent with the national average, women make up a

larger proportion of younger physicians; thirty-four percent (34%) of physicians under 45 in the state are female, com-pared to 11% of physicians aged 55 and older.

3467

2101

710

5579 675

0 1000 2000 3000 4000 5000 6000 7000

Medical School Students

Active Physicians and Physicians in Training

Active Primary Care

Active Specialists MD/DO

Physicians in Training

Figure I.1: Active Physician & Physicians in Training in Kansas

(Note: Active physicians include those working 20 hours or more per week providing patient care, doing research or administration, and those who are teaching but excludes physicians in training).

153.3177.5

108.7

186.5

120.3

250.6

050

100150200250300

NE NC NW SW SC SE

KS=203

Figure I.2: Active Physicians per 100,000 by Region in Kansas

(Note: Kansas has 203 physicians per capita as a whole; however, many are concentrated in the heavily populated Northeast region.)

5


Figure I.3: Age Distribution of Active Physicians in Kansas and the US.

8%

28%

34%

22%

8%7%

28%31%

21%

13%

0%

5%

10%

15%20%

25%

30%

35%

40%

Under 35 35-44 45-54 55-64 65 or Older

KansasUS

6

Figure I.4: Gender of Active Physicians by Age Range in Kansas

48%68% 78% 87% 95%

52%32% 22% 13% 5%

0%

20%

40%

60%

80%

100%

Under 35 35-44 45-54 55-64 65 or Older

Male Female

(Note: Physicians who are not classified are not included)

II. Medical Education and Physician Retention

Seventy-one percent (71%) of physicians who completed UME in Kansas are concentrated in 9 states, including Kansas. Forty-six percent (46%) of physicians completing their gradu-ate medical education (GME) in the state are practicing in the state (using licensure data). The state’s retention rate is lower than the national average (48%). Seventy-seven percent (77%) of the physicians who completed GME training in Kan-sas are concentrated in 9 states, including Kansas (Table II.6).

There are currently 710 medical students in Kansas; only about 1% of the national total. There are roughly 350 students in the preclinical phase (Years 1 and 2 of medical school) of their training in Kansas City. For the clinical phase of their

education (Years 3 and 4) approximately 110 students are based in Wichita and the remaining 250 are based in Kansas City. All (100%) are enrolled in the University Of Kansas School Of Medicine, the only medical school in the state. Due to the lack of private and osteopathic schools, Kansas has far more students enrolled in public medical education than the national average of 50% (See Figure II.1). Kansas has a similar number of medical students per capita than the US as a whole (26.0 vs. 26.6 per 100,000, respectively).


Figure II.1: Medical School Enrollment in Kansas, the US, and Selected States*

100%

50%

8%

80%

31%

34%

63%

56%

16% 29% 20% 13%

0%

20%

40%

60%

80%

100%

Kansas US Pennsylvania Michigan Illinios

Allopathic Public Schools Allopathic Private Schools Osteopathic Schools

710 77,244 6,209 2,685 5192

(Note: Eastern and Great Lakes states were utilized for comparison in this and other figures/graphs within this report because of the availability of data in a 2005 Association of American Medical Colleges report prepared for the state of PA.. The KUMC Analysis Team did not have AMA Physician Masterfile data available to conduct appropriate state-level analyses for states other than KS. To avoid data costs, the Team used data from the PA report to conduct state comparisons.)

Figure II.2: Enrollment per 100,000 Population in Kansas, the US, and Selected States

Figure II.3: Active Physicians by Location of UME

38%

62%

KS (n=5,579)

29%

71%

US (n=721,076)

13.5

4

21.3

12.9

9

31.5

22.9

4.1 5.3 5.2

26.0

14.7

0%

20%

40%

60%

80%

100%

Kansas US Pennsylvania Michigan Illinios

Allopathic Public Schools Allopathic Private Schools Osteopathic Schools

26.6 50.226.0 26.6 41.0

White - Practicing in same state as UMEGrey - Not practicing in state of UME


State Ranking Comparisons: Kansas & Adjacent States

State National Ranking State National Ranking

Colorado 14 Missouri 21

Missouri 24 Kansas 25

South Dakota 34 Oklahoma 32

Oklahoma 39 South Dakota 37

Kansas 40 Nebraska 40

Nebraska 46 Colorado 47


Missouri 2 Missouri 8

Nebraska 3 Nebraska 15

Oklahoma 19 Colorado 28

South Dakota 20 Oklahoma 40

Kansas 21 Kansas 41

Colorado 44 South Dakota 45


Nebraska 1 Missouri 11

Oklahoma 4 Nebraska 13

Missouri 11 Oklahoma 17

Kansas 14 Kansas 22

South Dakota 25 Colorado 26

Colorado 36 South Dakota 44

Active Physians In-State: Proportion That Attended In-State Medical

Schools

Active Physicians In-State: Proportion Who Completed a Residency or

Fellowship In-State

Active Physicians per 100,000 Population

Proportion of International Medical Graduates

Number of Medical Students per 100,000 Population

Physicians in Residencies and Fellowships per 100,000 Population


Figure II.4: Active Physicians per 100,000 in Kansas and selected states

203245

281237 243

050

100150200250300

Kansas US Pennsylvania Illinois Michigan

MD/DO

Figure II.5: Gender of Active Physicians in Kansas, the US, and Selected States

74% 74% 71%

22% 26% 26% 26%

74%78%

29%

0%

20%

40%

60%

80%

100%

KS US PA OH IL

Male Female

(Physicians with unspecified gender are not included)

Table II.6: Rates of In-State Retention of Medical Students, Selected States

State % Retention Total Graduates Practice In State Practice Out of State

California 63% 33,547 21,044 12,503

Texas 59% 31,256 18,431 13,725

Arkansas 57% 4,347 2,499 1,848

Michigan 45% 20,906 9,412 11,494

Ohio 42% 25,611 10,655 14,956

Kansas 38% 6,681 2,532 4,149

Pennsylvania 35% 43,469 15,259 28,210

Vermont 13% 2,905 373 2,532

New Hampshire 9% 1,582 150 1,432

District of Columbia 7% 15,436 1,013 14,423

US 39% 540,953 210,723 330,230


Missouri has the largest share of Kansas UME graduates due to the close proximity of the only medical school in Kan-sas. California, which receives the next largest share, is a net importer of physicians from Kansas and many other states.

The University of Kansas School of Medicine sponsors 675 residents and fellows in its graduate medical education pro-grams. Except for a few osteopathic residency positions op-erating in Wichita, the school is directly or indirectly respon-

Table II.7: Practice Location of Currently Active Physicians Completing UME in Kansas

State of Practice Number of Kansas UME Graduates

Percent of all Kansas UME Graduates

Kansas 2,532 37.8%

Missouri 709 10.6%

California 419 6.3%

Texas 264 4.0%

Colorado 252 3.8%

Oklahoma 150 2.2%

Arizona 147 2.2%

Washington 137 2.1%

Florida 135 2.1%

Other 1,936 28.9%

Total 6,681 100.0%

Table II.8: Retention of Active Physicians Who Completed In-State GME

State % RetentionActive Physicians Who

Completed In-State GME

Practice In State

Practice Out of State

Alaska 71% 41 29 12

California 68% 68,890 46,866 22,024

Nevada 61% 603 369 234

Illinois 49% 37,312 18,350 18,962

Michigan 46% 29,402 13,566 15,836

Kansas 45% 4,803 2,171 2,632

Pennsylvania 43% 44,843 19,305 25,538

Wyoming 28% 282 79 203

New Hampshire 25% 1,462 361 1,101

District of Columbia 15% 15,035 2,232 12,803

US 48% 677,105 322,227 354,878


sible for the operation of all GME programs in the state. The school’s programs in Wichita, supported by a consortium agreement between the school and the Via Christi and Wesley health care systems, is responsible for 260 of these positions including 14 in the Smokey Hill Family Medicine program in Salina. The remaining 415 positions are the responsibility of the Kansas City campus, including 2 positions in a Family Medicine program in Junction City.

Out of all of the 4,803 actively practicing physicians in the U.S. who completed GME training in Kansas GME pro-grams, less than half (45%) are currently practicing in the state, reflecting the state’s role as an “exporter” of physicians to the rest of the country. Out of all of the active licensed physicians in the KBHA dataset, only 36% of physicians prac-ticing in Kansas completed a GME training program in the state, compared to the national average of 45%.

Figure II.9: Active Physicians by Location of GME

(Note: some physicians categorized above as out of state GME could actually be physicians who did not complete GME programs, or have unavailable data in national datasets).

Table II.10: Practice Location of Currently Active Physicians Completing GME in Kansas

State of Practice Number Completing GME in Kansas Share of GME Completers (%)

Kansas 2,171 45.2%

Missouri 481 10.0%

Texas 254 5.3%

California 198 4.1%

Oklahoma 154 3.2%

Colorado 119 2.5%

Nebraska 87 1.8%

Illinois 81 1.7%

Florida 79 1.6%

Other 1,179 24.5%

Total 4,803 100.0%(Note: the denominator for these calculations is different than in figure II.8. This table uses national datasets and a denominator of the total U.S practicing physicians who have a Kansas GME program listed as their GME training site).

36%

64%

45%

55%

0%

10%

20%

30%

40%

50%

60%

70%

In state GME Out of State GME

KS US


AAMC Medical School Graduation Questionnaire 2003-2005

10a. Do you plan to locate your practice in an underserved area?

YesNo Undecided

10.b. If yes, indicate the likely location:

Rural communityInner-city communityOther

11. Where do you plan to practice?

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontana

Kansas, U of All Schools

2003 2004 2004 2005Percent Percent Percent Percent

35.3 33.3 34.3 23.2 33.3 28.1 28.4 36.931.4 38.6 37.3 39.9100.0 100.0 100.0 100.0

66.7 64.7 64.8 44.2

29.6 21.6 35.2 55.83.7 13.7 0.0 0.0 100.0 100.0 100.0 100.0

0.7 0.0 0.0 1.4 0.0 0.0 0.0 0.2 0.0 0.0 0.0 1.20.0 0.0 0.0 0.1 6.6 5.4 3.6 11.52.0 2.7 3.6 1.60.0 0.7 0.6 0.50.0 0.7 0.0 0.10.0 0.0 0.0 0.96.0 2.7 0.6 3.00.7 0.7 1.2 3.0 0.0 0.0 0.6 1.00.0 0.7 0.6 0.21.3 1.4 0.0 3.50.0 0.0 0.0 1.70.0 0.0 0.0 0.455.0 61.2 48.8 1.70.0 0.7 0.0 0.71.3 0.0 0.0 1.30.0 0.0 0.0 0.20.0 0.0 0.0 1.60.7 0.7 0.6 2.1.07 0.0 0.6 3.70.7 2.0 1.8 1.10.0 0.0 0.6 0.72.6 0.0 1.8 1.20.0 0.7 0.0 0.4


NebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklanhomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNewfoundlandNew BrunswickNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanOther

0.7 0.0 0.0 0.50.0 0.0 0.0 0.10.0 0.0 0.0 0.10.0 0.0 0.0 0.81.3 1.4 0.0 0.30.0 0.7 0.0 7.02.0 2.0 0.6 2.20.0 0.0 0.0 0.30.0 0.0 0.6 2.00.7 0.0 0.6 0.22.0 2.7 0.0 0.70.7 0.0 0.0 1.60.0 0.0 0.0 1.00.0 0.0 0.0 0.10.0 1.4 0.0 1.00.0 0.0 0.0 0.60.7 0.7 0.0 1.84.0 2.0 0.6 3.90.0 0.0 0.0 0.50.0 0.7 0.0 0.21.3 0.0 0.0 1.20.0 0.0 0.0 1.10.0 0.0 0.0 0.30.0 0.0 0.0 1.00.0 0.0 0.0 0.10.0 0.0 0.0 0.00.0 0.0 0.0 0.00.0 0.0 0.0 0.00.0 0.0 0.0 0.00.0 0.0 0.0 0.00.0 0.0 0.0 0.00.0 0.0 0.0 0.00.0 0.0 0.0 0.00.0 0.0 0.0 0.00.0 0.0 0.0 0.08.6 8.2 0.0 100.0

Kansas, U of All Schools

2003 2004 2004 2005

(Note: Data collected at the time of graduation from medical students by the American Association of Medical Colleges (AAMC).These data show that a large number of graduating KU SOM students intend to eventually practice in Kansas. They also indicate that, at the time of graduation, a higher proportion of Kansas graduates plan to practice in underserved or rural communities as compared to the pool of graduates from all other U.S. medical schools. Historically, KUSOM has been recognized as having among the highest proportion, and because of its class size, the greatest number of its graduates entering primary care training in Family Medicine as compared to all other U.S. medical schools.)


III. Regional Variation in Kansas

There are 105 counties in Kansas which together comprise six regions classified as Northwest, North Central, North-east, Southwest, South Central, and Southeast.

As shown below, there is only one medical school in Kan-sas. The University Of Kansas School Of Medicine’s main campus which hosts both preclinical and clinical students

is located in Kansas City (Wyandotte County). A clinical campus for third and fourth year medical student training is located in Wichita (Sedgwick County). (See Table III.1).

The population of Kansas is estimated at 2,735,502 (2004), making it the 32nd most populous state in the US. Nearly half of the state population is concentrated in the Northeast region (1,289,859); the North-central region is the least populated (122,602).

Table III.1: Summary of Population and Medical Schools by Region

Figure III.1a: Regional Variation in Number of Physicians Per Capita

153.3177.5

108.7

186.5

120.3

250.6

0

50

100

150

200

250

300

NE NC NW SW SC SE

Figure III.1b: Regional Variation in Number of Primary Care Physicians Per Capita

72 74

56

79

58

82

0102030405060708090

NE NC NW SW SC SE

14

KS=203

R e g i o n Po p u l a ti o n A l l o p a th i c S ch o o l

Northeast (NE) 1,289,859 University of Kansas School of Medicine

North Central (NC) 122,602

Northwest (NW) 131,803

Southeast (SE) 253,598

South Central (SC) 771,055 University of Kansas School of Medicine - Wichita

Southwest (SW) 166,585

Kansas (total) 2,735,502


Figure III.2: Regional Variation in Number of Physicians in Training Per Capita

32.3 32.8

2022242628303234

Northeast Southcentral

Table III.3a: Active Physicians by Region and Age Group

(Note: numbers a residents per 100,000 population)

KS=24.7

col col col col col col col% % % % % % %

Under 35 456 8% 16 7% 16 9% 244 8% 9 5% 152 11% 19 6%

35-44 1559 28% 63 27% 48 26% 929 29% 50 27% 389 27% 80 26%

45-54 1890 34% 81 35% 72 38% 1128 35% 48 26% 475 33% 86 28%

55-64 1236 22% 51 22% 42 22% 688 21% 58 32% 311 22% 86 28%

65+ 437 8% 23 10% 10 5% 240 7% 17 9% 113 8% 34 11%

Total 5578 234 188 3229 182 1440 305

n

KS Northwest Northcentral Northeast Southwest Southcentral Southeast

n n

Age Group

n nn n

In Kansas, nearly one-third (34%) of active physicians are between 45 and 54 years old while 36% are under the age of 45. The remaining 30% of physicians are 55 and older and may retire in the next 10 to 15 years.

Table III.3b: Primary Care Physicians by Region and Age Group

col col col col col col col% % % % % % %

Under 35 281 13% 14 14% 14 16% 140 13% 7 7% 89 15% 16 11%

35-44 643 31% 27 27% 28 31% 322 30% 33 35% 186 30% 46 31%

45-54 672 32% 37 37% 25 28% 359 34% 26 28% 192 31% 32 22%

55-64 374 18% 11 11% 17 19% 182 17% 23 24% 105 17% 36 24%

65+ 131 6% 9 9% 4 4% 57 5% 5 5% 38 6% 18 12%

Total 2101 99 89 1061 94 610 148

n n n n

Northeast Southwest Southcentral SoutheastAge Group

KS Northwest Northcentral

n n n


Figure III.4: Active Physicians by Region and Gender

3169 150 1201776

125 780218

879 36 20558

21 23032

0%10%20%30%40%50%60%70%80%90%

100%

KS NW NC NE SW SC SE

Male Female

(Note: Physicians whose gender is unknown are not included)

Table III.5: Active Physicians by Region and Primary Specialty

Specialty

nPer

Capita nPer

Capita nPer

Capita nPer

Capita nPer

Capita nPer

Capita nPer

Capita

Anesthesia 281 10.3 6 4.6 8 6.6 167 13.0 2 1.2 92 11.9 6 2.4

Cardiology 161 5.9 7 5.3 4 3.3 99 7.7 0 0.0 42 5.4 9 3.6

ENT 86 3.1 2 1.5 3 2.5 57 4.4 2 1.2 18 2.3 4 1.6

Gastro 83 3.0 1 0.8 3 2.5 64 5.0 0 0.0 15 1.9 0 0.0

General Surgery 223 8.2 18 13.7 10 8.2 95 7.4 13 7.8 68 8.8 19 7.5

Hem/Onc 69 2.5 4 3.1 3 2.5 44 3.4 1 0.6 13 1.7 4 1.6

Infectious Disease 27 1.0 0 0.0 0 0.0 21 1.6 0 0.0 6 0.8 0 0.0

Nephrology 43 1.6 0 0.0 1 0.8 26 2.0 0 0.0 15 1.9 1 0.4

Ob/Gyn 248 9.1 7 5.3 8 6.6 144 11.2 9 5.4 63 8.2 17 6.7

Ophthalmology 165 6.0 7 5.3 6 4.9 109 8.5 5 3.0 28 3.6 10 4.0

Orthopedics 228 8.3 15 11.5 8 6.6 124 9.6 7 4.2 61 7.9 13 5.1

Pulmonary 63 2.3 7 5.3 1 0.8 34 2.6 1 0.6 12 1.6 8 3.2

Radiology 325 11.9 13 9.9 14 11.5 201 15.6 7 4.2 73 9.5 17 6.7

Urology 85 3.1 8 6.1 5 4.1 46 3.6 2 1.2 18 2.3 6 2.4

Total 2087 76.3 95 72.5 74 60.7 1231 95.5 49 29.5 524 68.0 114 45.1

SW SC SEKS NW NC NE

(Note: Physicians who do not report their specific specialty are not included.)


Table III.6: Number of Physicians per 100,000 Population in Kansas Regions, by Primary Specialty

Specialty KS NW NC NE SW SC SE

Adolescent Med 0.1 0.0 0.0 0.2 0.0 0.0 0.0Allergy/Immuno 1.5 1.5 0.0 2.2 0.0 1.2 0.0Allergy-Peds 0.0 0.0 0.0 0.0 0.0 0.1 0.0Anesthesiology 10.3 4.6 6.6 13.0 1.2 11.9 2.4Cardiology-Peds 0.8 1.5 0.0 1.3 0.0 0.3 0.0Cardiovascular Disease 5.9 5.3 3.3 7.7 0.0 5.4 3.6Dermatology 2.1 2.3 0.0 3.2 1.8 1.4 0.0Dermatopath 0.1 0.0 0.0 0.2 0.0 0.0 0.0Diabetes 0.3 0.0 0.0 0.3 0.0 0.5 0.0EM 7.5 5.3 3.3 10.2 3.6 6.0 3.6Endo 0.9 0.8 0.0 1.6 0.0 0.4 0.0Endo-peds 0.2 0.0 0.0 0.5 0.0 0.0 0.0Family Med 40.3 48.9 51.6 35.8 26.5 49.0 35.6Gastro 3.0 0.8 2.5 5.0 0.0 1.9 0.0General Practice 2.9 4.6 3.3 1.9 6.0 2.6 5.5General Prev Med 0.1 0.0 0.0 0.1 0.6 0.1 0.0Geriatrics 0.3 0.0 0.0 0.4 0.0 0.5 0.0Gynecology 0.6 0.0 0.0 1.0 0.6 0.1 0.4Hematology 0.3 0.0 0.8 0.5 0.0 0.0 0.4Hem/Onc - Peds 0.3 0.8 0.0 0.5 0.0 0.3 0.0Infectious Dis 1.0 0.0 0.0 1.6 0.0 0.8 0.0Internal Med 21.7 16.0 13.1 27.4 18.1 17.9 13.8Neonatal Med 1.4 0.0 0.0 2.2 0.0 1.4 0.0Nephrology 1.4 0.0 0.8 1.8 0.0 1.8 0.4Nephrology-Peds 0.1 0.0 0.0 0.2 0.0 0.1 0.0Neurology 3.1 3.8 1.6 4.7 0.6 2.1 0.8Neurology-Child 0.3 0.8 0.0 0.3 0.0 0.4 0.0Neuropath 0.1 0.0 0.0 0.2 0.0 0.0 0.0Nuclear Med 0.2 0.0 0.0 0.2 0.0 0.3 0.0


Nutrition 0.0 0.0 0.0 0.1 0.0 0.0 0.0Obstetrics 0.1 0.0 0.0 0.2 0.0 0.0 0.0Ob-Gyn 9.1 5.3 6.6 11.2 5.4 8.2 6.7Occup/Industrial 1.6 0.0 0.0 2.7 0.0 1.0 0.0Oncology 1.9 2.3 1.6 2.5 0.6 1.4 1.2Ophthalmology 6.1 6.1 4.9 8.5 3.0 3.6 4.0Otology 0.1 0.0 0.0 0.2 0.0 0.1 0.0Otorhinolaryngology 3.2 1.5 2.5 4.5 1.8 2.3 1.6Pathology 4.8 3.1 4.9 6.2 3.0 3.5 3.2Pathology-clinical 0.3 0.8 0.0 0.5 0.0 0.1 0.0Pathology-Forensic 0.2 0.0 0.0 0.2 0.0 0.4 0.0Pediatrics 12.0 5.3 4.1 17.2 6.0 9.7 4.0Pharmacology 0.0 0.0 0.0 0.1 0.0 0.0 0.0Phys Med/Rehab 2.3 2.3 0.8 3.4 0.6 1.4 1.6Psychiatry 8.8 3.1 6.6 12.3 8.4 6.4 2.4Psych-Child 1.8 0.0 0.0 3.1 0.6 0.8 0.4Psychoanalysis 0.0 0.0 0.0 0.1 0.0 0.0 0.0Psychosomatic Med 0.2 0.0 0.0 0.3 0.0 0.1 0.0Pulmonary Dis 2.3 5.3 0.8 2.6 0.6 1.6 3.2Radiology 2.7 2.3 0.8 3.4 3.0 2.2 1.2Radiology-Diag 9.2 7.6 10.7 12.2 1.2 7.3 5.5Radiology-Nuclear 0.0 0.0 0.0 0.1 0.0 0.0 0.0Radiology-Peds 0.0 0.0 0.0 0.1 0.0 0.0 0.0Radiology-Onc 1.2 0.8 1.6 1.5 1.2 0.9 1.2Rheumatology 1.0 1.5 0.0 1.2 0.0 1.0 0.4Sports Med 0.1 0.0 0.0 0.1 0.6 0.0 0.0Surg-Abdominal 0.1 0.0 0.0 0.1 0.0 0.4 0.0Surg-Cardiovas 1.8 0.8 0.8 2.0 0.0 2.5 0.4Surg-Colon/Rectal 0.4 0.0 0.0 0.7 0.0 0.4 0.0Surg-General 8.2 13.7 8.2 7.4 7.8 8.8 7.5Surg-Head/Neck 0.1 0.8 0.0 0.1 0.0 0.0 0.0Surg-Hand 0.2 0.0 0.0 0.2 0.0 0.3 0.0Surg-Maxillofacial 0.1 0.0 0.0 0.3 0.0 0.0 0.0Surg-Neuro 1.1 0.0 0.8 1.5 0.0 1.3 0.0Surg-Orthopedic 8.4 11.5 6.6 9.8 4.2 8.0 5.1Surg-Peds 0.3 0.0 0.0 0.6 0.0 0.1 0.0Surg-Plastic 1.9 0.0 0.0 3.3 0.6 1.2 0.0Surg-Thoracic 0.1 0.0 0.8 0.2 0.0 0.0 0.0Urology 3.1 6.1 4.1 3.6 1.2 2.3 2.4Other 1.4 0.8 0.0 1.6 0.0 1.8 1.2Radiation Therapy 0.3 0.8 0.0 0.3 0.0 0.0 0.8Physiatry 0.1 0.0 0.0 0.3 0.0 0.0 0.0KS Overall 203.6 178.6 154.1 250.4 109.0 185.9 120.2






Table III.6: Continued

(Note: Physicians who do not report their specific specialty are not included.)


Comparison of Kansas as a whole to Kansas without the Northeast Region

Of the 5,579 active physicians in Kansas, 3,233 or 58%, practice in the Northeast region. When the northeast region is removed, the physician workforce changes in several ways. With only 2,349 active physicians, the remaining regions have a much lower supply of physicians per capita (162 per

100,000 population overall) compared with the state as a whole (203). Without the northeast region, Kansas has a higher percentage of active physicians in primary care posi-tions (44% vs. 38%), which is due to the lack of specialists in the remaining regions of Kansas.

Table III.7: Comparison of Kansas Workforce without the Northeast Region to State as a whole

Kansas Kansas w/o NE RegionActive Physicians 5579 2349Physicians per capita 203 162Residents and Fellows 675 258Residnets and Fellows per capita 258 18In-State UME 38% 40%Out-of Stae UME 62% 60%%Female 22% 20%%Aged 55 and older 30% 32%%Primary Care 38% 44%

Table III.8: Active Physicians per 100,000 People in Kansas, the US, and Selected States

162203

245281

237

0

50

100

150

200

250

300

KS w ithout NERegion

Kansas US Pennsylvania Illinois

MD/DO

(Note: with the northeast region removed, Kansas has a lower supply of physicians per capita than the state as a whole and a much lower supply than the national average).


The next five tables do not represent recommendations or goals for future physician workforce supply. They represent statistic manipulations conducted by the Analysis Team to show the number of physician providers needed to take the least served state regions to levels of service present across the U.S. as a whole. The final two tables show statistically

what changes in KS educational/training program size would produce in numbers of retained professionals given stable retention trends. Data in these tables are not benchmarks or suggestions, they are data manipulations meant to illustrate variance given hypothetical scenarios.

Physician Number Variation from National Ratio Per 100,000 Population (245)

Region

Current N in Kansas or Region

Current N per 100,000

National AverageRatio per 100,000

N needed to reach National Average Ratio

Variation from National Average

in total N

Kansas 5579 203 245 6702 1123Northeast 3233 250 245 3233 0Northcentral 188 153 245 300 112Northwest 234 177 245 322 88Southwest 181 108 245 408 227Southcentral 1438 185 245 1890 452Southeast 305 120 245 621 316

Primary Care Physician Variation from National Ratio Per 100,000 Population (85)

Region

Current N in Kansas or Region

Current N per 100,000


N needed to reach National Average Ratio

Variation from National Average

in total N

Kansas 2101 77 85 2352 251Northeast 1060 82 85 1096 36Northcentral 88 72 85 104 16Northwest 98 74 85 112 14Southwest 95 57 85 142 47Southcentral 611 79 85 655 44Southeast 149 58 85 215 66

(Note: Given current calculations from the KDHE Office of Local and Rural Health, many rural regions of the state maintain greater levels of primary care shortage than ratios described above would suggest. This is because counties with very low population densities could statistically be served by less than 100% of a physician. Unfortunately, physicians often cannot work less than 100% and must practice near colleagues to share call coverage. We have therefore constructed the following table.)


Primary Care Regional Variation from National Ratios Weighted by Marginal FTE Coverage Percentages

Region

Current N per

100,000


Percentage Deviation from

National Average

Percentage of Counties

P.C. Physician Sortage MUA

Percentage of Counties

P.C. Physician Sortage MUA or <3.0 FTE

Weighted Percentage Deviation

from National Average

Kansas 77 85 91% 51% 56% 40%Northeast 82 85 97% 52% 52% 47%Northcentral 72 85 85% 20% 30% 60%Northwest 74 85 87% 62% 82% 16%Southwest 57 85 67% 68% 68% 21%Southcentral 79 85 93% 47% 47% 49%Southeast 58 85 68% 31% 38% 42%

(Note: This table multiplies the percent deviation from national averages by the percentage of counties within each region that were considered MUA or had less than 3.0 FTE primary care physicians for 2004. It therefore provides a weighted evaluation of underservice in the state and for the six regions.)

Medical School Expansion Effects on In-state Physician Numbers Assuming Stable RetentionPotential Effect of KUMC UME Class Size Increases – “Medical School”

Percent Increase N

Projected Number of Students Retained as In-state Physicians

Projected Students who Become Out-of-

State Physicians

Additional In-state Physicinas Produced

per year

Current 178 68 110 010% 195 74 121 620% 213 81 132 1330% 231 94 162 26

Residency Expansion Effects on In-state Physician Numbers Assuming Stable RetentionPotential Effect of KUMC GME Class Size Increases – “Residency”

Percent Increase N

Projected Number of Residents Retained as

In-state Physicians

Projected Residents who Become Out-of-

State PhysiciansAdditional Physicinas

Produced per year

Current 135 61 74 010% 149 69 82 820% 162 73 89 1230% 176 79 97 18


IV. Specialty Specific DataThere were 5,579 physicians in Kansas in 2004 (not includ-

ing those in GME). In this section, we analyze the 5,569 physicians whose specialty is known. As shown in Figure IV.1 and Figure IV.3, 38% (2101) of active physicians are in primary care specialties (Family Medicine, Internal Medicine, Pediatrics, General Practice).

The overall specialty distribution of physicians in Kan-sas is similar to national averages. However, the state has a slightly higher percentage of physicians in general surgery and slightly lower percentage of physicians in obstetrics and gynecology compared to the national average.

Figure IV.1: Specialists and Primary Care Physicians in Kansas and Selected States

44.1% 37.7% 34.2% 36.9% 38.3%

61.7%62.3%55.6% 65.8% 63.1%

0%

20%

40%

60%

80%

100%

KS w /o NE Region KS PA IL MI

Primary Care Specialty

Primary Care (US) = 35.2%

Figure IV.2: Primary Care and Specialist Physicians per Capita in Kansas and Selected States

71.693.5 85.7 88.290.3

127.4

179.9

146.6 142.1

76.8

0

40

80

120

160

200

KS w /o NE Region KS PA IL MI

Primary Care Specialists

Primary Care (US)= 84.7

Specialists (US) = 155.7

Kansas has slightly less primary-care and specialty physi-cians per capita than the nation as whole. The number of

specialty physicians in Kansas is almost 130 per 100,000 people, compared with a national average of 156.


Figure IV.3: Physician Specialty by Age in Kansas

n Col % n Col % n Col % n Col % n Col % n Col %Anesthesia 19 4.7% 82 6.7% 122 8.9% 49 5.5% 9 3.1% 281 7%Cardiology 2 0.5% 37 3.0% 72 5.3% 34 3.8% 15 5.1% 160 4%ENT 4 1.0% 29 2.4% 21 1.5% 25 2.8% 7 2.4% 86 2%Gastro 2 0.5% 21 1.7% 29 2.1% 22 2.5% 9 3.1% 83 2%General Surgery 16 3.9% 72 5.9% 58 4.2% 51 5.8% 26 8.8% 223 5%Hem/Onc 0 0.0% 15 1.2% 25 1.8% 20 2.3% 8 2.7% 68 2%Infectious Disease 0 0.0% 7 0.6% 12 0.9% 7 0.8% 0 0.0% 26 1%Nephrology 1 0.2% 13 1.1% 12 0.9% 13 1.5% 4 1.4% 43 1%Ob/Gyn 28 6.9% 70 5.7% 84 6.1% 55 6.2% 11 3.7% 248 6%Ophthalmology 5 1.2% 52 4.2% 52 3.8% 43 4.9% 13 4.4% 165 4%Orthopedics 20 4.9% 67 5.4% 65 4.8% 55 6.2% 20 6.8% 227 5%Pulmonary 3 0.7% 7 0.6% 28 2.0% 22 2.5% 3 1.0% 63 2%Radiology 24 5.9% 93 7.6% 92 6.7% 88 9.9% 27 9.2% 324 8%Urology 3 0.7% 22 1.8% 22 1.6% 28 3.2% 10 3.4% 85 2%Primary Care 281 68.9% 643 52.3% 672 49.2% 374 42.2% 131 44.6% 2101 50%Total 408 100.0% 1230 100.0% 1366 100.0% 886 100.0% 294 100.0% 4183 100%

Specialty 65 and over TotalUnder 35 35-44 45-54 55-64

Figure IV.4: Age of Active Physicians by Specialty in Kansas

n Row % n Row % n Row % n Row % n Row % n Row %

Anesthesia 19 6.8% 82 29.2% 122 43.4% 49 17.4% 9 3.2% 281 100.0%

Cardiology 2 1.3% 37 23.1% 72 45.0% 34 21.3% 15 9.4% 160 100.0%

ENT 4 4.7% 29 33.7% 21 24.4% 25 29.1% 7 8.1% 86 100.0%

Gastro 2 2.4% 21 25.3% 29 34.9% 22 26.5% 9 10.8% 83 100.0%

General Surgery 16 7.2% 72 32.3% 58 26.0% 51 22.9% 26 11.7% 223 100.0%

Hem/Onc 0 0.0% 15 22.1% 25 36.8% 20 29.4% 8 11.8% 68 100.0%

Infectious Disease 0 0.0% 7 26.9% 12 46.2% 7 26.9% 0 0.0% 26 100.0%

Nephrology 1 2.3% 13 30.2% 12 27.9% 13 30.2% 4 9.3% 43 100.0%

Ob/Gyn 28 11.3% 70 28.2% 84 33.9% 55 22.2% 11 4.4% 248 100.0%

Ophthalmology 5 3.0% 52 31.5% 52 31.5% 43 26.1% 13 7.9% 165 100.0%

Orthopedics 20 8.8% 67 29.5% 65 28.6% 55 24.2% 20 8.8% 227 100.0%

Pulmonary 3 4.8% 7 11.1% 28 44.4% 22 34.9% 3 4.8% 63 100.0%

Radiology 24 7.4% 93 28.7% 92 28.4% 88 27.2% 27 8.3% 324 100.0%

Urology 3 3.5% 22 25.9% 22 25.9% 28 32.9% 10 11.8% 85 100.0%

Primary Care 281 13.4% 643 30.6% 672 32.0% 374 17.8% 131 6.2% 2101 100.0%

Total 127 100% 587 100% 694 100% 512 100% 163 100% 2082 100%

45-54 55-64Specialty 65 and over TotalUnder 35 35-44


Figure IV.5: Specialty Distribution of Active Physicians by Gender for Kansas

n Col. % n Col. % n Col. %

Anesthesia 153 6.4% 36 5.2% 189 6.1%

Cardiology 112 4.7% 6 0.9% 118 3.8%ENT 57 2.4% 2 0.3% 59 1.9%Gastro 64 2.7% 5 0.7% 69 2.2%General Surgery 140 5.9% 14 2.0% 154 5.0%Hem/Onc 38 1.6% 7 1.0% 45 1.5%Infectious Disease 15 0.6% 1 0.1% 16 0.5%Nephrology 28 1.2% 2 0.3% 30 1.0%Ob/Gyn 105 4.4% 71 10.3% 176 5.7%Ophthalmology 104 4.4% 18 2.6% 122 4.0%

Orthopedics 161 6.7% 7 1.0% 168 5.5%Pulmonary 46 1.9% 3 0.4% 49 1.6%

Radiology 189 7.9% 31 4.5% 220 7.2%Urology 60 2.5% 1 0.1% 61 2.0%Primary Care 1113 46.6% 487 70.5% 1600 52.0%Total 2387 100% 691 100% 3076 100%

Specialty Male Female Total

Figure IV.6: Gender Distribution of Active Physicians by Specialty for Kansas

n Row. % n Row. % n Row. %

Anesthesia 153 81.0% 36 19.0% 189 100%Cardiology 112 94.9% 6 5.1% 118 100%ENT 57 96.6% 2 3.4% 59 100%Gastro 64 92.8% 5 7.2% 69 100%General Surgery 140 90.9% 14 9.1% 154 100%

Hem/Onc 38 84.4% 7 15.6% 45 100%

Infectious Disease 15 93.8% 1 6.3% 16 100%Nephrology 28 93.3% 2 6.7% 30 100%Ob/Gyn 105 59.7% 71 40.3% 176 100%Ophthalmology 104 85.2% 18 14.8% 122 100%Orthopedics 161 95.8% 7 4.2% 168 100%

Pulmonary 46 93.9% 3 6.1% 49 100%

Radiology 189 85.9% 31 14.1% 220 100%

Urology 60 98.4% 1 1.6% 61 100%

Primary Care 1113 69.6% 487 30.4% 1600 100%

Total 1272 86% 204 14% 1476 100%

Specialty Male Female Total


V. Workforce Projections

Cheyenne Rawlins Decatur Norton Phillips Smith Jewell Republic Washington Marshall Nemaha Brown

Doniphan

Sherman Thomas SheridanGraham Rooks Osborne Mitchell

CloudClay Riley Pottawatomie Jackson

Atchison

Ellis RussellLincoln Ottawa

DickinsonGeary Wabaunsee

Shawnee

Jefferson

Leavenworth

Greeley Wichita Scott Lane Rush Barton

EllsworthSaline

Morris

Lyon

OsageDouglas Johnson

Hamilton Kearny Finney HodgemanPawnee

Stafford

RiceMcPherson

ChaseCoffey

Franklin Miami

Marion

Anderson Linn

Stanton Grant Haskell

GrayFord

EdwardsPratt

Reno HarveyButler Greenwood Woodson Allen Bourbon

Morton Stevens SewardMeade Clark

Kiowa

ComancheBarber

Kingman

Harper

Sedgwick

Sumner Cowley

Elk

Chautauqua

Wilson

Montgomery

Neosho

Labette

Crawford

Cherokee

Wallace Logan Gove TregoWyandotte

Ness

Change in County Population from 2000 to 2004

Northwest (-4.6%) Northcentral (-1.8%) Northeast (+4.3%)

Southwest (-1.2%) Southcentral (+1.3%) Southeast (-1.9%)

Decline of 10% or more Decline of 5% to 10% Decline of of up to 5% Increase of 10% or more Increase of 5% to 10% Increase of of up to 5%


Number of New MD/DO Licenses Each Year & Number of Active Licenses in 2004 by Original License Year

0

100

200

300

400

500

600

700

75 (36%)

76 (41%)

77 (40%)

78 (47%)

79 (42%)

80 (44%)

81 (37%)

82 (37%)

83 (37%)

84 (35%)

85 (34%)

86 (32%)

87 (31%)

88 (32%)

89 (34%)

90 (33%)

91 (31%)

92 (30%)

93 (33%)

94 (36%)

95 (29%)

96 (27%)

97 (33%)

98 (37%)

99 (41%)

00 (43%)

01 (48%)

02 (49%)

03 (49%)Original License Year (% still active in 2004)

New Licenses/Year Active License in 2004

This Figure uses Kansas Board of Healing Arts data and provides the number and percent of active MD/DO licenses at the end of calendar year 2004 in columns representing the year of original licensure. The figure allows for an estimate of the retention percentage of practicing physicians, with the active license status based on a single year (2004). Larger

blue columns represent the total number of new licenses is-sued in that year and smaller red columns represent the num-ber, out of the larger column, that were still active licenses at the end of 2004 (for example, looking at the original license year of 2000, there were 448 new licenses issues and at the end of 2004, 193 (43%) of those licenses were still active).

Number of New MD/DO Licenses Each Year & Number of Active Licenses in 2004 by Original License Year


Percent of Active MD/DO Licenses at the End of 2004 by Original License Year

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03

Original License Year

Percent of Active MD/DO Licenses at the End of 2004 by Original License Year

This Figure uses the same Kansas Board of Heal-ing Arts data and provides the percentage of active MD/DO licenses at the end of calendar year 2004 in a column representing the year of original licensure.

It provides an estimate of the retention percentage of practicing physicians by original license year (as of 2004) for the past 29 years.


Practice Hours, Age, and Gender Among Kansas PhysiciansAverage work hours per week

Practice hours per week Number Percent1 to 20 hours 740 19%

21 to 39 hours 489 12%40 to 49 hours 967 25%50 to 59 hours 780 20%60 to 69 hours 714 18%70 to 79 hours 226 6%

80+ hours 16 <1%Total 3932 100%

Average work hours per week by age category

Age Group N Mean SD25 to 34 195 45.86 15.5835 to 44 1024 42.90 18.6745 to 54 1413 41.68 19.8555 to 59 573 42.32 19.5860 to 64 373 41.05 18.8865 to 74 298 38.51* 19.3775 + 56 29.85* 20.14

(Note: the 65-74 and the 75+ age groups work a statistically significant fewer number of hours than the 25-44 year olds)

Percentage of physicians working part-time (< 40 hours per week) and full-time (40+ hours per week) by age group

Age Group n % n %25 to 34 44 23% 151 77%35 to 44 288 28% 736 72%45 to 54 446 32% 967 68%55 to 59 169 30% 404 71%60 to 64 133 36% 240 64%65 to 74 119 40% 179 60%75 + 30 54% 26 46%Total 1229 2703

<40 hours/week 40+ hours/week

(Note: For all age categories, except those 75+, the majority worked at least 40 hours per week. For the 75+ group slightly more then half worked less than 40 hours per week.)


Average work hours per week by gender

Mean SD Mean SD p ES42.79 hrs 19.51 38.44 38.44 18.16 .23

Male (N+3061) Female (N+864)

Percentage of physicians working part-time (< 40 hours per week) and full-time (40+ hours per week) by gender

Gender <40 40+ TotalMale 900 (29%) 2161 (71%) 3061 (100%)

Female 329 (38%) 535 (62%) 864 (100%)Total 1229 2696 3925

Average hours worked per week

(Note: On average, males worked significantly more hours per week then females (42.79 hours > 38.44 hours, p < .05). Similarly, signifi-cantly more males worked at least 40 hours per week as compared to females (71% > 62%, p < .05). It should be noted that the effect sizes associated with these significant differences were relatively small, .23 and .31 respectively, suggesting that the significant differences may have little practical consequences. A multivariate analysis of variance using age and gender revealed only a significant main effect for age, with older persons working fewer hours then younger physicians as noted in the earlier univariate age-group analysis. The lack of significance for gender in the multivariate analysis suggests that age is a more informative variable for average work hours then gender.)


Percent Distribution of Physicians (MD/DO) and Kansas Population by Region in 2004

3.37

57.95

4.19

25.78

5.47 3.249.27

6.094.48

47.06

4.82

28.28

-2.85-3.8-2.5-0.63

10.89

-1.11

-10

0

10

20

30

40

50

60

70

80

90

100

North Central North East North West South Central South East South West

Region

Perc

ent

Physicians Population Difference

Percent Distribution of Physicians (MD/DO) and Kansas Population by Density in 2004

1.674.45

8.91

71.86

3.42

10.3415.7

19.6813.12

50.87

20.99

-6.56-6.79-5.89-1.75

-10

0

10

20

30

40

50

60

70

80

90

100

Frontier Rural Densely-SettledRural

Semi-Urban Urban

Population Density

Perc

ent

Physicians Population Difference

Region


Percent population and physician (MD/DO) increase using the 2004 data as baseline after accounting for retirement and 43% retention of new physicians till 2010 and then decreasing

it 1% each year until 33% in year 2020, after which it's constant

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

40.00

2010 2015 2020 2025 2030

Year

% in

crea

se

Population increase Physician increase

Kansas Workforce (MD/DO) projection and change of 20% in physician numbers after accounting for retirement and 43% retention of new physicians till 2010 and then decreasing


0

50

100

150

200

250

300

350

2000 2005 2010 2015 2020 2025 2030 2035

Year

Phys

icia

ns p

er 1

00K

Per 100K Per 100K up 20% Per 100K down 20%

31


Kansas Workforce (Primary Care) projection and change of 20% in physician numbers after accounting for retirement and 43% retention of new physicians till 2010 and then decreasing


0

20

40

60

80

100

120

140

2000 2005 2010 2015 2020 2025 2030 2035

Year

Phys

icia

ns p

er 1

00K


Percent population and physician (Primary Care) increase using the 2004 data as baseline after accounting for retirement and 43% retention of new physicians till 2010 and then

decreasing it 1% each year until 33% in year 2020, after which it's constant

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

40.00

2010 2015 2020 2025 2030

Year

% in

crea

se


32


Percent population and physician (MD/DO) increase using the 2004 data as baseline after accounting for retirement and 43% retention of new physicians in 2005 and then decreasing it

1% each year until 33% in year 2015, after which it's constant

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

2010 2015 2020 2025 2030

Year

% in

crea

se


Kansas Workforce (MD/DO) projection and change of 20% in physician numbers after accounting for retirement and 43% retention of new physicians in 2005 and then decreasing it

1% each year until 33% in year 2015, after which it's constant

0

50

100

150

200

250

300

350

2000 2005 2010 2015 2020 2025 2030 2035

Year

Phys

icia

ns p

er 1

00K


33


Kansas Workforce (MD/DO) projection and change of 20% in physician numbers after accounting for retirement (age 75 males, 65 females) and 43% retention of new physicians in 2005 and then

decreasing it 1% each year until 33% in year 2015.

0

50

100

150

200

250

300

2000 2005 2010 2015 2020 2025 2030 2035

Year

Phys

icia

ns p

er 1

00K


Percent population and physician (MD/DO) increase using the 2004 data as baseline after accounting for retirement (age 75 males, 65 females) and 43% retention of new physicians in 2005 and then

decreasing it 1% each year until 33% in year 2015.

0.00

5.00

10.00

15.00

20.00

25.00

2010 2015 2020 2025 2030

Year

% in

crea

se


34


VI. Graduate Medical Education Stipends

Using data from the AAMC resident survey and internal data from the KUMC Office of Graduate Medical Education, this summary compares data for fiscal year 2005-2006.

For 2005-2006 from the AAMC survey, the mean first year stipend for residents was $42,070. At the University of Kan-sas, the mean first year stipend for residents was $38,603.

The mean second year resident stipend from the AAMC national survey was $43,082. From the University of Kansas it was $39,885.

For regional comparison, according to the AAMC survey data, the average first year resident’s stipend in the Midwest was $41,566. Furthermore, based on the AAMC survey, the 50th percentile for the first year resident’s stipend was $41,819 and the 25th percentile was $40,586 for the Midwest region. In the western region of the United States the AAMC survey showed a mean stipend of $40,701 for first year residents and 50th and 25th percentile values of $40,512 and $39,215, respectively.

These data show that the University of Kansas stipends for 1st year residents of $38,603 falls below the mean nationally and below the 25th percentile for the primary regions of the U.S. in which its programs compete for graduating medical students.

VII. Physician Recruitment and Retention Programs

A number of programs have been designed to address the chronic problem of assuring an adequate rural physician workforce in Kansas. Among the current programs are: Premedical School Programs, Scholars in Rural Health (for-merly the Scholars in Primary Care) (1997), Kansas Medical Student Loan Program (KMSLP) (1978), Kansas Bridging Program (1991), the J-1 Visa Program (1990’s, then re-estab-lished in 2002) and the National Health Services Corp (1972, Kansas participation started in 1980’s).

Most of the existing recruitment and retention programs aim to address the varying needs of students, residents and physicians across the full spectrum of medical training. These programs serve the state by developing prospective students

and residents in and attracting practicing physicians to Kan-sas. As outlined below, the programs range in focus from the premedical phase of education through programs designed to retain the physicians already in active practices in Kansas.

Premedical programsPrimary Care Workshop

The Primary Care Workshop is a one-day workshop that prepares Kansas students to shadow physicians. Students will observe doctor-patient communications and write patient case summaries. Students participate in several large-group sessions in which they discuss professionalism, patient con-fidentiality, ethics, hygiene, safety, and OSHA requirements. They also engage in three small-group sessions to learn about doctor-patient communications, the fundamentals of taking a medical history and checking vital signs, and assessment and therapy management. KU Medical Education Directors serve as the faculty for the workshops.

Approximately 40 students are accepted into each work-shop. Applicants must be Kansas residents or students attending Kansas colleges and have attained sophomore standing with a cumulative grade point average of 3.25. The application to the Primary Care Workshop includes comple-tion of the application form, receipt of college transcripts, and a one-page personal statement.

This workshop (originally the Summer Mentor Program begun in 1996) is offered twice per year (June on the Wichita campus and January on the Kansas City campus) at no charge to the student participants. The School of Medicine would like to expand the program to include a fall semester offering in Salina

Premedical Student ConferenceKansas physicians, KU School of Medicine faculty and stu-

dents, and other invited presenters lead conference attendees in discussions that explore the medical profession, current issues in medicine, and key pieces to the application process. For a small registration fee, premedical students participate in this day-long event that includes a keynote address by a physician and four breakout sessions selected by each participant.

Breakout topics cover 12-15 areas including subjects such as: preparing for the MCAT interviewing financial aid


surviving medical school US healthcare system. Other popular sessions are those in which panels of KU

medical students and panels of practicing Kansas physicians share their insights regarding medical school and life as a practicing physician. In selecting panel participants, a special effort is made to secure physicians who practice in rural Kansas.

This annual event, begun in 1995 as a conference for south central Kansas premedical students and expanded the fol-lowing year to include a statewide audience, has now served more than 2,500 premedical students. To provide easier accessibility for students in the western part of the state, the conference location rotates between Emporia, Manhattan, and Wichita.

Pre-med Advisor ConferenceSince 1995, the admissions department has held an annual

fall conference for premedical advisors. Attendees include Kansas undergraduate advisors and faculty members, as well as advisors from nearby colleges in neighboring states. The goals of these annual meetings are to educate advisors about the KU SOM admissions process and to inform them of any changes in the undergraduate medical program that might impact their students’ application decisions. In addition to KU admissions information, presentation and/or discussion topics have included national changes in admissions (e.g., the new computer-based MCAT), KU curriculum changes, KU combined degree programs, best advising practices, profes-sionalism, cultural awareness, and KU student support ser-vices. The conference has provided a forum to build relation-ships between premed advisors and KU SOM faculty/staff as well as between advisors from different undergraduate institutions.

Open HouseOn both the Wichita and Kansas City campuses, the School

of Medicine conducts regular open houses for premedical college students and interested high school students. These events provide prospective medical students, and occasionally parents and significant others, with information about prepa-ration for medical school and the application procedure. A medical student panel answers questions about life as a medical student, and other medical students lead open house guests on a tour of the campus. Approximately 500 persons attend these events each year. There is no fee to participate.

School DaysSpecific events, similar to open houses, are offered for

undergraduate groups who wish to visit the Kansas City cam-pus. The number of visitors for these activities varies. For example, “FHSU Day” usually has 20-25 participants, while “KSU Day” has 50-75 each year.

Campus VisitsThe admissions dean annually visits the campuses of more

than 20 Kansas colleges and universities. These visits af-ford premedical advisors and students an opportunity to learn about KU School of Medicine. The sessions consist of informal presentations, providing ample time for questions about the school, the admissions process and the curriculum. Student participant numbers range from 150 at KU to only a few at the smaller institutions. Due to limited resources (time and financial), visits to the 19 Kansas community col-leges are made on a less regular basis.

KU Senior Day at KUMC

The School of Medicine annually hosts a KU Senior Days program for the KU undergraduate admissions office. Ap-proximately, 60 Kansas high-school senior students who have an interest in medicine, and their parents, are invited to par-ticipate in this event. Representatives from both the KU and the KUMC campuses present information and answer ques-tions about preparing for medical school. Also participating are financial aid representatives and medical students.

High school and middle school student visits to KUMC

In conjunction with the Schools of Nursing and Allied Health, the School of Medicine hosts about 15 groups of Kansas middle- and high-school students each year. These are either students in health-careers exploration or advanced biology classes or students who participate in summer pro-grams. The average number of participants in these sessions is 20. Similarly, about twice per month during the school year, the Wichita campus hosts high-school groups of ap-proximately 20 students. Approximately 600 students are engaged in these activities each year.

Health Careers Pathways ProgramsFor more than a decade, admissions staff presented


information to participants in several of the annual programs that fell under the Health Careers Pathways Programs um-brella. Funded by Title VII, these HCPP programs targeted minority and rural Kansas high-school and college students. Each year, several (10-15) of the students who had been in-volved in the HCPP pipeline applied to the School of Medi-cine. Federal budgetary cuts will eliminate external funding of HCPP, resulting in the loss of programming for middle school, high school, and college students.

College Career and Graduate/Professional School Fairs

Admissions representatives only occasionally participate in college career and graduate/ professional school fairs that are held on larger campuses. Generally, these events are not productive in terms of numbers of prospective medical applicants reached. We think the reason our contacts are so limited during these events is that we are already reaching out to prospective applicants via other KU School of Medi-cine programs.

Scholars in Rural Health ProgramThe Scholars in Rural Health Program (formerly, Scholars

in Primary Care) was started in 1997. Its primary goal was to provide assured admission to medical school for selected rural Kansas students. The students participate in a longitu-dinal premedical curriculum with supplementary rural health care experiences. The program targets premedical students from rural areas with a high probability of a successful medi-cal career in hopes that they will eventually return to rural communities to practice. The program is designed to shape the students’ experiences toward rural health in preparation for entry into medical school.

Eligible applicants submit an application to the KU School of Medicine Office of Admissions. After an interview process similar to regular admission, selected students are accepted for medical school matriculation at the successful completion of their undergraduate studies. The program started with six students per year and recently was expanded to a maximum of ten.

Once accepted to the program the Scholars in Rural Health are required to maintain a 3.50 or higher cumulative grade point average, participate in programs designated by the School of Medicine for the Scholars in Rural Health Program and achieve a satisfactory score on the MCAT examination.

Participants are assigned a rural mentor in the region of

his or her home community for shadowing experiences for an accumulated total of 200 hours. During these mentor visits participants are exposed to the variety of health care services in their communities. The Scholars in Rural Health program is implemented and coordinated through the Of-fice of Admissions. The program has been directed by Dr. K. James Kallail, PhD since its inception. Participants in the Scholars in Rural Health Program are given priority for avail-able student loans through the Kansas Medical Student Loan Program (KMSLP).

The program to date has just completed its first cycle. Of the inaugural group of 6 scholars who just finished their resi-dencies in 2006, 5 are in primary care specialties and one is in a rural practice. Others from this group will likely enter rural practice after they complete additional postgraduate medical education.

Programs for Medical StudentsKansas Medical Student Loan Program (KMSLP)

The KMSLP has been a successful program directed at medical students to attract them to primary care in rural parts of the state. Since its inception for the people of Kansas by the Legislature in 1978, the basic premise has remained the same: pay for the tuition and offset living expenses for medical students that are willing to serve in primary care practices in underserved areas in the state. The program is administered by Student Financial Aid in the Student Services Office. The target population has been and continues to be the rural underserved.

The basic provisions are as follows: Provide for annual in-state tuition Provide a monthly living stipend of $1,500.00 for 9-11 months (while the student is enrolled in medical school)In exchange for the above support the student is obligated to: Enter a primary care residency (General Internal Medicine, Family Medicine, General Pediatrics or Emergency Medicine) Enter a full time primary care practice in any of the rural counties in the state upon completion of the above residency (excluding the four counties of Johnson, Shawnee, Douglas and Sedgwick). In lieu of rural service the physician can satisfy their obligation by a full


time academic practice in Primary Care in Kansas City or Wichita. Repay one year of service for each year of participation in the KMSLPThe student is considered in default if they fail to meet the

above obligations. As penalty for default the student then owes the balance of their loan plus 15% interest which has ac-cumulated since the origination of each year of participation.

There have been 438 participants in the program since 1992, representing 17% of the matriculated students from 1992-2006. Of these, 178 (41%) of the KMSLP participants have completed their obligations, 145 (33%) in deferment status while they are completing their residencies, and 84 (19%) are practicing in underserved areas in compliance with the requirements for loan forgiveness. Only 31 (7%) of all participants are out-of-compliance and repaying the principal and interest on their loans. Of the 178 who have fulfilled all their obligations, 111 (62%) did so by practicing in under-served areas while only 63 (35%) elected to a monetary payoff of their loans (these figures add up to less than 100% because 4 individuals had their obligations cancelled as a result of death). As of August 2006, active licensure informa-tion was available for 165 (93%) of the 178 individuals who completed their obligations to the KMSLP. Of these, 107 (65%) satisfied their obligation through service. The real success of the program lies in the fact that 90 of the 107, or 84%, have remained in the state to provide medical services. Fifty of the 105 counties in Kansas are served by one or more 1992-2006 recipients of assistance from the KMSLP. There are plans to revise the program to increase participation. The section that follows summarizes the Kansas practice locations of the 178 participants that have completed their obligations.

Location of Kansas Medical School Loan Program Re-cipients (1992-2006) that completed their Obligation

This section provides current practice locations of the 178 recipients of the Kansas Medical School Loan (KMSL) pro-gram who have completed their obligation for the graduat-ing classes of 1992 through 2006. The status of these KMSL participants is provided below.

Status Number PercentCompleted by service (Forgiven)

111 62.4%

Paid in full 63 35.4%Deceased 4 2.2%TOTAL 178 100%

A total of 13 (7%) recipients were excluded from further analyses due to: deceased, inactive license status, and/or have not graduated from medical school. Therefore, a total of 165 KMSL recipients were available for further analyzes.

Kansas practice location for each recipient was determined by the Kansas Board of Healing Arts licensure database which was current through August 2006. Of the 165 recipients, 111 (67%) are practicing in Kansas. Of these 111, 81% (n=90) completed their obligation through service and 19% (n = 21) paid in full.

Of the 107 recipients that fulfilled their obligation through service, 84% are practicing in Kansas and of the 58 that paid in full, 36% are practicing in Kansas.

StateCompleted by Service

Paid in Full Total

KS 90 21 111Not KS 17 37 54Total 107 58 165

There is information on where individuals completed their obligation and the location of their current practices location for 95 (58%) of the 165 recipients. Of these 95, 53 com-pleted their obligation through service and 42 completed by repayment. Of the 53 recipients that completed their obliga-tion through service, 42% are practicing in the same Kansas county where they completed their service obligation, 26% are practicing in a different Kansas county, and 32% are not practicing in Kansas. Of the 42 recipients that completed their obligation by paying off their loans, 5% are practicing in the same county were they practiced while making their payments, 7% are practicing in a different Kansas county, and 88% are not practicing in Kansas.


Kansas county location of KMSL recipients who have completed their obligation. Location information is from Kansas Board of Healing Arts database, August 2006.

County Completed by Service Paid in Full TotalAN- Anderson 1 0 1AT - Atchison 2 0 2BB - Bourbon 2 0 2BR - Brown 4 0 4BT - Barton 1 0 1BU - Butler 5 0 5CD - Cloud 1 0 1CF - Coffey 2 0 2CL - Cowley 1 0 1CY - Clay 3 0 3DG - Douglas 1 2 3DK - Dickinson 1 0 1FI - Finney 3 0 3FO - Ford 2 0 2FR - Franklin 2 0 2GE - Geary 0 1 1HV - Harvey 5 0 5JO - Johnson 7 7 14KE - Kearny 1 0 1LB - Labette 1 0 1LV - Leavenworth 0 1 1LY - Lyon 5 0 5MC - Mitchell 1 0 1MG - Montgomery 1 0 1MI - Miami 2 0 2MN - Marion 2 0 2MP - McPherson 3 0 3PT - Pottawatomie 2 0 2RL - Riley 4 0 4RN - Reno 6 0 6SA - Saline 5 0 5SG - Sedgwick 11 9 20SN - Shawnee 1 1 2TH - Thomas 1 0 1WL - Wilson 1 0 1Not KS 17 37 54Total 107 58 165



Doniphan



Atchison



Shawnee

Jefferson

Leavenworth


EllsworthSaline

Morris

Lyon



Stafford

RiceMcPherson

ChaseCoffey

Franklin Miami

Marion

Anderson Linn


GrayFord

EdwardsPratt



Kiowa

ComancheBarber

Kingman

Harper

Sedgwick

Sumner Cowley

Elk

Chautauqua

Wilson

Montgomery

Neosho

Labette

Crawford

Cherokee


Ness

Current Location of Kansas Medical Student Loan Program RecipientsThat Completed Their Obligation Through Service (1992-2006)

1 Physician 2 Physicians 3 Physicians 4 Physicians 5 Physicians 6 Physicians 7+ Physicians

(Location from KS Board of Healing Arts license database - Sept 2006)

1

1

1

1 1

1

1

1

1 1

1

1

1

4

4

3

3

3

5

56

11

7

52

22

2

2

2 2

2

5

1 11

2 7

9


Doniphan



Atchison



Shawnee

Jefferson

Leavenworth


EllsworthSaline

Morris

Lyon



Stafford

RiceMcPherson

ChaseCoffey

Franklin Miami

Marion

Anderson Linn


GrayFord

EdwardsPratt



Kiowa

ComancheBarber

Kingman

Harper

Sedgwick

Sumner Cowley

Elk

Chautauqua

Wilson

Montgomery

Neosho

Labette

Crawford

Cherokee


Ness

Current Location of Kansas Medical Student Loan Program RecipientsThat Completed Their Obligation Through Repayment (1992-2006)





Doniphan



Atchison


Dickinson Geary Wabaunsee

Shawnee

Jefferson

Leavenworth


EllsworthSaline

Morris

Lyon

Osage

Douglas Johnson


Stafford

RiceMcPherson

ChaseCoffey

Franklin Miami

Marion

Anderson Linn


GrayFord

EdwardsPratt



Kiowa

ComancheBarber

Kingman

Harper

Sedgwick

Sumner Cowley

Elk

Chautauqua

Wilson

Montgomery

Neosho

Labette

Crawford

Cherokee


Ness

Current Location of Kansas Medical Student Loan Program RecipientsThat Completed Their Obligation Through Service or Repayment (1992-2006)



1

1

1

1 1

11 1

2

4

5

5

5

5

3

3

3

3

4 2

2 2

2

22

2

1

1

1 11

6

20

14


Doniphan



Atchison



Shawnee

Jefferson

Leavenworth


EllsworthSaline

Morris

Lyon



Stafford

RiceMcPherson

ChaseCoffey

Franklin Miami

Marion

Anderson Linn


GrayFord

EdwardsPratt



Kiowa

ComancheBarber

Kingman

Harper

Sedgwick

Sumner Cowley

Elk

Chautauqua

Wilson

Montgomery

Neosho

Labette

Crawford

Cherokee


Ness

Current Location of Active Kansas Medical Student Loan Program Recipients That are in Compliance (1992-2006)



1

1

1

1 1

1

1

1

1

1

1

1

1 1

1

1

1

1

1

2

2

6

5

4

3

3

3 3

6

67

2

2

2

2

22

2


8

6

6

8

11

26

14

4

4

3

3

3

3

3

4

5

4

4

4

4

41

1

1

1

1

1

12

22

2

2

2

2

22

2 2

21

111

1 1

1

1

1

1

1

11

1

1

1 1

8

8

8


Doniphan



Atchison



Shawnee

Jefferson

Leavenworth


EllsworthSaline

Morris

Lyon

Osage

Douglas Johnson


Stafford

RiceMcPherson

ChaseCoffey

Franklin Miami

Marion

Anderson Linn


GrayFord

EdwardsPratt



Kiowa

ComancheBarber

Kingman

Harper

Sedgwick

Sumner Cowley

Elk

Chautauqua

Wilson

Montgomery

Neosho

Labette

Crawford

Cherokee


Ness

Current Location of KMSL Program Recipients that Completed their Obligation or are Active and in Compliance (1992-2006)

1 Physician 2 Physicians 3 Physicians 4 Physicians 5 Physicians 6 Physicians 8 Physicians 10+ Physicians


There are plans to revise the program somewhat to address a recent plateau in student participation. The revision will address concerns raised in a student survey done in the fall of 2004 and a review of the economic provisions. Portions of the program that are being considered for change are the level of the monthly stipend, the interest penalty and whether to allow retroactive participation in the program.

Rural Primary Care Practice and Research Program

The Rural Primary Care Practice and Research Program (RPCPRP) is a University of Kansas Medical Center Depart-

ment of Family Medicine sponsored elective rotation for medical students. It involves active clinical training as well as health promotion and disease prevention research in rural primary care settings in cities and towns across the state of Kansas. Typically 20-40 medical students elect to participate in the program each summer. The program provides one week of research and clinical skills intensive training and a 6-week mentored clinical experience in a rural primary care practice setting. Students routinely reported excellent clinical learning experiences and engagement in a number of important community activities under the guidance of their physician preceptors


Cheyenne Rawlins Decatur Norton Phillips Smith Jewell Republic Washington Nemaha Brown

Doniphan



Atchison


DickinsonGeary

Wabaunsee

Shawnee

JeffersonLeavenworth

Greeley Wichita Scott Lane Ness Rush Barton

EllsworthSaline

Morris

Lyon



Stafford

RiceMcPherson

ChaseCoffey

Franklin Miami

Marion

Anderson Linn


GrayFord

Edwards

Pratt



Kiowa

ComancheBarber

Kingman

Harper

Sedgwick

Sumner Cowley

Elk

Chautauqua

Wilson

Montgomery

Neosho

Labette

Crawford

Cherokee


Marshall

(7)

(5) (5)

(5)

(5)

(17)

(6)

(5)

(3)

(4)

(8)

(8)

(4)

(4)

(2)

(2)

(2)

(2)

Location of Kansas Bridging Plan Recipients

Kansas Locum Tenens ProgramThe Kansas Locum Tenens program provides temporary

coverage of a rural physician’s medical practice so that the physician can have “time off ” for personal or professional reasons. Locum tenens coverage through this program is available to physicians in any county in Kansas except Doug-las, Johnson, Sedgwick, Shawnee, and Wyandotte.

A rural physician or hospital must submit a request to either campus. A locum tenens provider from the resident or faculty physicians of the University of Kansas School of Medicine (all campuses) will then be selected. Locum tenens providers can select the assignments of their choice, and are paid competitive rates for their services. Providers and

recipients of locum tenens services are matched to cover the types of medical services needed. Locum tenens services are available to rural physicians in Family Medicine, General Internal Medicine, and Pediatrics. The Kansas Locum Tenens program has been very successful and well received by prac-ticing physicians. Fifty-seven counties have received locum tenens coverage.

Kansas Recruitment CenterThe mission of the Kansas Recruitment Center (KRC) is

to assist Kansas’ rural communities in recruiting and retain-ing physicians and other health care providers. KRC ensures that the hiring process proceeds smoothly and provides

Programs for Residents and PhysiciansKansas Bridging Program

The Kansas Bridging Program has been in existence since 1991. The program is administered through the Office of Rural Health at the University of Kansas School of Medicine-Wichita campus. The Kansas Bridging Plan is a loan for-giveness program for resident physicians who are in Family Medicine, General Internal Medicine, General Pediatrics, and Medicine/Pediatrics residency programs in Kansas. Its purpose is to encourage residents to practice in a rural com-munity upon completion of residency training.

The Kansas Bridging Plan consists of two separate loans;

one from the State of Kansas, and the other from a rural health care organization selected by the resident physician and with whom the resident physician signs a practice com-mitment agreement. The combined total of both loans can be up to $26,000. The payments are usually distributed over the second and third years of residency training.

Resident physicians who participate in the Kansas Bridg-ing Plan agree to practice medicine full time in their selected community for 36 continuous months upon completion of their residency training program in exchange for forgive-ness of the loans. The obligation for this loan can be served concurrent with other rural loans and programs. There are 56 counties in the state that have physicians placed through the KBP.


Cheyenne Rawlins Decatur Norton Phillips Smith Jewell Republic Washington Nemaha Brown

Doniphan



Atchison


DickinsonGeary

Wabaunsee

Shawnee



EllsworthSaline

Morris

Lyon



Stafford

RiceMcPherson

ChaseCoffey

Franklin Miami

Marion

Anderson Linn


GrayFord

Edwards

Pratt



Kiowa

ComancheBarber

Kingman

Harper

Sedgwick

Sumner Cowley

Elk

Chautauqua

Wilson

Montgomery

Neosho

Labette

Crawford

Cherokee


Marshall

Kansas Communities that have Received Locum Tenens Services

ongoing support and information about health care hiring trends. In addition, KRC assists candidates in finding the right practice or career opportunity, in making their reloca-tion as easy as possible, and in ensuring that they receive the support and assistance needed to enjoy life in Kansas. The “right” match will make the selection a “win-win” situation for the community and the candidate by increasing the prob-ability of retaining the candidate.

KU Rural Health Education and Services has partnered

with the Kansas Hospital Education and Research Founda-tion (KHERF) on behalf of the Kansas Rural Health Options Project to develop the Kansas Recruitment Center. KHERF has provided funding to support the KRC. The sponsors of the Kansas Rural Health Options Project are the Kansas Department of Health and Environment, Office of Local and Rural Health; the Kansas Hospital Association; the Kansas Board Emergency Medical Services; and the Kansas Medical Society.

KRC Placements

2-6-07


Doniphan



Atchison


DickinsonGeary

Wabaunsee

Shawnee



EllsworthSaline

Morris

Lyon



Stafford

RiceMcPherson

ChaseCoffey

Franklin Miami

Marion

Anderson Linn


GrayFord

EdwardsPratt



Kiowa

ComancheBarber

Kingman

Harper

Sedgwick

Sumner Cowley

Elk

Chautauqua

Wilson

Montgomery

Neosho

Labette

Crawford

Cherokee


Kansas Communities that have had Health Care Professionals placed Through the Kansas Recruitment Center


The National Health Service CorpsThe National Health Services Corps is part of the Depart-

ment of Health and Human Services’ Health Resources and Services Administration (HRSA). The National Health Service Corps (NHSC) began when the Emergency Health Personnel Act was signed into law as Public Law 91-623. The first practitioners were Federal employees, US Public Health Service Commissioned Corps Officers or civil servants as-signed to underserved areas to practice. Amendments to the act in 1972 expanded the pool of clinicians available for service by offering scholarships to dentists, allopathic and os-teopathic physicians, nurse practitioners, physician assistants and certified nurse midwives. In 1987, a loan repayment program was developed.

Kansas began using the NHSC to support physician recruit-ment in the 1980s. In 1998 records indicate that 6 physicians received loan repayment assistance in exchange for practice in rural underserved Kansas communities. In September, 2006 there are 10 MDs and 3 DOs receiving loan repayment assistance as family physicians, obstetricians, psychiatrists and internists serving in Health Professional Shortage Areas (HPSAs).

The State of Kansas also receives federal dollars from the NSHC program administered through KDHE to support a State Loan Repayment Assistance Program. Since 2002, KDHE has provided loan repayment assistance to 4 primary care physicians (3 MD, 1 DO).

J-1 Visa Waiver ProgramThe US Department of Agriculture supported the place-

ment of primary care physicians in federally designated Health Professional Shortage Areas and Medically Under-served Areas throughout the 1990s. The USDA program averaged 10.2 primary care physicians per year in rural shortage areas.

When the USDA program was discontinued in February, 2002, Kansas began evaluating the need for the Kansas Gov-ernor to establish a federally authorized state program. The Conrad/State 30 J-1 visa waiver program began in October, 2002. Kansas has opted to recommend waivers for both primary care and non-primary care specialties as long as no more than 30 waivers per year are requested. If more than 30 applications are received in an annual cycle, primary care will be given priority over specialty practice.

To date, 21 rural and 4 urban counties have received a total of 72 new physicians through the Kansas program. Thirty-six of the physicians are in primary care (Family Medicine, Internal Medicine, Obstetrics, Pediatrics and Psychiatry) and 36 are in non-primary care specialists. Forty-eight physi-cians are in rural practice and 24 are located in 4 of the 5 most populated counties. The new program also averages 10.2 annual placements in rural a county, and an additional 24 in urban counties with underserved populations. Twenty specialists have been placed in rural counties with primary care HPSAs.

J-1 Physicians Placed in HPSA's

0

5

10

15

20

25

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003


Kansas State Loan Repayment ProgramThe Office of Local and Rural Health (OLRH) receives

funding from the federal Health Resources and Services Ad-ministration (HRSA) to administer a State Loan Repayment Program (SLRP) to help with repayment of educational loans for graduates of health professional programs. These loans are made to persons who have been recruited to work in feder-ally qualified underserved areas in Kansas.

The program is designed to help local communities recruit health professionals who agree to practice for at least 2 years in Health Professional Shortage Areas (HPSAs) or Medically Underserved Areas (MUAs). Employment must be with a public or non-profit agency or facility. Priority is given to rural communities and to sites located in areas where pov-erty, economic access or cultural barriers contribute to poor access to primary, dental and mental health care services.

The goal of this program was to assist 10 communities in Kansas by supporting loan repayment for 10 to 13 primary health care providers. In addition to primary care physicians, eligible professions include: nurse practitioners, physician assistants, dentists, dental hygienists, clinical psychologists, clinical social workers, mental health counselors, licensed professional counselors, and marriage and family therapists.

Communities must apply and be selected for participation in the program. The practice site must be located in a feder-ally designated Health Professional Shortage Area (HPSA) or Medically Underserved Area. Placements may also be made to public and private non-profit clinical sites providing primary health services in federally designated HPSAs for underserved populations.

Selected communities are required to provide $1.00 in loan repayment for each $1.00 dollar from the federal grant funds. Selection priority is given to rural and frontier sites. Physicians can qualify for no more than $35,000 per year for a minimum of 2-year loan repayment agreement at an approved site. The maximum award can be up to $105,000 total for three years of obligated service in an approved site. Dentists can have the same benefit. The maximum for non-physicians is $15,000 per year or $45,000 for a maximum three years of obligated service. Loan payments are made at the completion of each year of service. No payments are made for less than one year of completed service. A law was enacted to make all SLRP funds exempt from gross income and employment taxes. This law also excludes these funds from being taken into account as wages in determining ben-efits under the Social Security Act.


This section of the report is organized to highlight 1) key study findings and 2) key advisory board recommendations that should be immediately considered for implementation by appropriate institutions, organizations, departments. Ra-tionale in support of both sections is provided below:

Primary Study Findings Kansas is currently below the National State Average for physicians per 100,000 ratio.

Kansas has a mal-distribution of physicians per 100,000 ratio in it’s six geographic regions, with under service prominent in rural regions (especially SE and SW regions).

This mal-distribution cannot be addressed without simultaneous attention to Primary Care workforce development. Primary Care physicians (Family Medicine, General Internal medicine, Pediatrics) are the only physicians that geographically distribute their practice locales in line with where people live (e.g. rural, urban care).

While the state’s physician supply will increase over the next two decades, Kansas will likely remain behind most other states due to demand trends and expansion plans elsewhere.

Primary Advisory Board Recommendations The State of Kansas should:

Increase Graduate Medical Education (GME or residency) positions Locate GME programs/positions in underserved

geographic regions to enhance recruitment (especially rural) Engage state policy making bodies such as the

Kansas Health Policy Authority Board to review/ recommend improvements in GME support in Wichita, Kansas City, and throughout the state Increase GME stipends (salaries and benefits) to the

AAMC mean for the region Increase Undergraduate Medical Education (UME or

Medical School) positions Create a Primary Care Education Enhancement Task

Force to make recommendations to maintain and enhance KUSOM’s tradition of education for primary care careers Increase incentives and stipends for UME and GME

trainees, J-1 participants and other physicians to maximize retention Emphasize stipend and incentive increases for Primary

Care and Rural programs (e.g. Scholars in Rural Health, Kansas Medical Loan Program, Bridging Program) Create new programs to reduce educational debt,

improve incomes Adjust UME and GME selection and admission criteria

to influence eventual physician retention and distribution patterns (e.g. more recruitment, admission, and support of geographically, ethnically, and socio- economically varied students/trainees) Continue innovations in the UME curriculum to

maintain KUSOM’s tradition of preparing students for success in GME and fostering interest in primary care and service in the state Preserve existing HCPP, Postbaccalaureate, and

Prematriculation Programs for rural and minority candidates (currently funded under Title VII) Mandate electronic re-licensure survey completion by

all physicians using the Kansas Board of Healing Arts system Create similar mandates and data coordination across

agencies for mid-level providers (physician assistants, nurse practitioners, mid-wives, nurses) Support ongoing collection, monitoring and analysis of

provider workforce data, on a two-year cycle Identify and empower an appropriate agency or

organization to oversee this scheduled activity (e.g. KS Health Policy Authority)

The findings in this report suggest that Kansas’ physician workforce ratios are similar to, though slightly lower than many comparable Midwest and Plains states. Kansas has a medical student per 100,000 ratio (26/100,000) that is nearly identical to the overall student per capita ratio for the

VIII. Conclusions and Recommendations


nation (26.6/100,000). On the other hand the State’s resident/fellow or GME to population ratio (18.4 per 100,000) is significantly below the national ratio (34.3 per 100,000). Our supply projections for the next 25 years show that, assuming stability in licensee retention, the state is on an upward supply trend and will, in aggregate, be some-what increased, total (~250/100,000) and primary care (~100/100,000) ratios, in the years to come. Unfortunately, demand is increasing at a more rapid pace than supply can accommodate. And because the state is relatively rural, and physicians tend to congregate in densely populated areas, all regions of the state other than the Northeast region (i.e. Topeka, Lawrence and Kansas City metro) will remain below national averages. We have a significant maldistribution prob-lem. No specific ratio recommendations are being made by this group. But to raise the SE, SC, SW, NW, and NC regions of the state to total physician and primary care national aver-ages would require the addition of hundreds of physicians in each of these areas over the next two decades.

Accurate predictions of future workforce population “need” or “demand” are controversial and complex. Given that health care delivery and financing mechanisms may change significantly in future years, this report focuses more on state and regional comparisons to national averages which in hypo-thetical scenarios might bring the State of Kansas to current median national supply ratios. The report has very impor-tant limitations. Lacking consensus on appropriate levels of primary care, specialty or total physician supply for the state or state regions, we have not utilized demographic and health care data on the aging population, illness burden, consumer health care consumption, etc. to evaluate future demand and include these findings in our projection work.

The state’s current GME ratio deficits pose a risk to work-force development. Physicians in Kansas are 7% more likely to have attended in-state medical schools than physicians in other states (31% vs. 29% nationally) and 55% of KU SOM graduates say they plan to practice in Kansas at time of gradu-ation. Unfortunately, licensed Kansas physicians are 18% less likely than the national average to have completed GME training in-state (37% vs. 45% nationally). It may be that expanded GME position numbers, enhanced sti-pends, new and more attractive GME position loca-tions, or use of monetary incentive and repayment programs for residents would retain more KUMC medical students and result in greater eventual supply ratios. Increased size and/or geographically redistributed GME training programs should be seriously considered. Decades of studies have shown that

GME graduates are more likely to practice within a short geographic distance from the site of their GME training than elsewhere.

The findings of this report support continued action by Kansas governmental and legislative authorities and the hospitals in the state to build incentives for GME retention of KU SOM graduates. Unfortunately, such program de-velopment is especially needed in the primary care training programs. In Wichita, increasing stipends and benefits is the primary concern, since a number of programs are having some difficulty in recruiting the best candidates at the cur-rent levels of resident compensation.

Additional considerations might include chang-ing the characteristics of UME and GME trainees, through admission and selection criteria, in an at-tempt to influence retention ratios in the state.

Increasing medical school class size may also be a consideration. Since many schools across the coun-try are planning expansions in reaction to future shortfalls driven by an aging population with more chronic illness and higher levels of consumption, the student cohort may require expansion to keep up. If increasing UME is a near-term consideration, dis-cussions between the SOM and others will need to discuss resource requirements necessary to accommodate these students.

As shown on page 21, expansions of both UME and GME programs in the state would only make a minimal impact on regional deficits given current retention statistics over four and five year time periods. Thus future programs intended to correct these deficits will need to be multi-faceted and include collaborative planning across stakeholders and insti-tutions.

Final report recommendations deal with future workforce tracking and projections. This report was limited by the re-porting bias inherent to the “voluntary” Kansas State Board of Healing Arts licensure survey. In addition to the poor survey response rates resulting from a “voluntary” physician survey, there are problems related to “physician-in-training” and “primary practice location” classification which have influ-enced all of the findings within this report. Because of these limitations, the Kansas Physician Workforce Advisory Board suggests that The Kansas Health Policy Au-thority Board consider mandating electronic Board of Healing Arts annual licensure renewal survey completion for physicians of all specialties. Simi-lar mandates must be put in place for the Board of Nursing Arts so that all health care providers may


be accounted for in future workforce analysis and planning. Also, it is recommended that additional questions be added to the survey addressing the location of physician’s internships and residencies as well as their completion dates. These questions would allow us to easily determine where

the KS practicing doctors are coming from. State policymak-ers must have accurate and complete data from these sources for effective and timely program development that will opti-mally serve the health needs of our entire state population.

Report Prepared by the Kansas Physician Workforce Advisory Board

Convening Organizations

The University of Kansas Medical Center

The Kansas Department of Health and Environment office of Local and Rural Health

Participating Organizations

Kansas Department of Health Environment – Barbara Gibson

Kansas Academy of Family Physicians – Carolyn Gaughan & Verlin Janzen, MD

Kansas Medical Society - Jerry Slaughter & Allison Peterson

Kansas Hospital Association - Melissa Hungerford, Thomas Bell

Kansas Rural Development Council – Steven Bittel

Kansas Association of Counties, Executive Director, Randall Allen

Kansas League of Municipalities, Executive Director, Don Moler

Onaga Community Hospital, Onaga, KS - Marcia Walsh, COO

Medicine Lodge Memorial Hospital - Kevin White, CEO

Kansas Health Policy Authority – Andrew Allison, PhD

Kansas Farm Bureau – Managing Director of Govern-ment Relations, Harry Watts

University of Kansas Medical Center, Office of Medical Education – Giulia Bonaminio, Anthony Paolo, Michael Kennedy

University of Kansas Medical Center, Department of Family Medicine– Allen Greiner

University of Kansas Medical Center, School of Medi-cine – Glendon Cox, Gerold Minns

University of Kansas Medical Center, Office of External Affairs – Dave Cook

Kansas Department of Health Environment, Office of Local and Rural Health – Barbara Gibson

KUMC Analysis Group Team

K. Allen Greiner

Glendon Cox

Garold Minns

Michael Kennedy

Giulia Bonaminio

Anthony Paolo

Niaman Nazir

Aaron Epp

Report Authors

K. Allen Greiner, M.D., M.P.H., Analysis Group Chair

Anthony Paolo, Ph.D.

Michael Kennedy, M.D.

David Cook, Ph.D.

Glendon G. Cox, M.D., M.B.A., M.H.S.A., Workforce Advisory Board Chair

Niaman Nazir, MBBS, M.P.H.

Aaron Epp, MA

Project Funding:Project Funding Provided by the Kansas Department of

Health and Environment Office of Local and Rural Health, Office of Primary Care. Indirect support was provided

Kansas Physician Workforce ReportAppendix


by the University of Kansas Medical Center and School of Medicine through the Departments of Family Medicine, In-ternal Medicine, Internal Medicine-Wichita and the Offices of External Affairs and the Executive Dean of the School of Medicine.

Conflict of InterestAll team members and authors have completed annual con-

flict of interest disclaimers and declared no material conflicts with regard to this work.

Overall Project Goal:“To improve understanding of current and future health

professions workforce needs in the state of Kansas and to identify the determinants of professional practice patterns in an effort to enhance strategic planning and advance popula-tion health.”

BackgroundScholars and writers have been especially active in address-

ing the supply of U.S. physicians over the last two years. Their interest likely stems from forecasts made following studies of recent changes in how health care is provided. In the 1990s, health care financing shifted considerably as the U.S. experimented with – and subsequently rethought – managed care and cost containment models.

The growing aging U.S. population as well as the expan-sion of demand for physician services in recent years has led several major organizations, including the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME) to call for expansions in U.S. medical education programs over the next two decades. The AAMC has issued recommendations on the primary items to be considered in regional workforce analyses, including:

A profile of the state’s physician workforce

A profile of medical education and training in the state

A demographic analysis of the state’s population

Forecasts of future physician supply and demand in the state (Note: this report was not able to evaluate demand or need)The results from these analyses helps state policy makers

to identify and understand the issues surrounding the state’s physician supply and demand, to assess the magnitude of

problems and timeframe within which they need to be ad-dressed, and to prescribe effective policy measures to address them.

Establishing a panel of interested stakeholders (including, for example, representatives from medical schools, hospi-tals, the state medical society, and regional medical societies, health workforce researchers, state and local government of-ficials, and consumer advocates and consumers) can be a very valuable resource. A panel from within the state can provide guidance, insight, and perspective to all of the data compila-tion, forecasting model calibration, and analysis activities mentioned throughout this document.

An advisory committee may also be in the best position to help develop recommendations for addressing any shortages or surpluses identified by the analysis. Options for respond-ing to potential physician workforce imbalances are numer-ous, and the selection of policy measures often involves vari-ous factors, such as political and economical feasibility, that are not considered in the analysis described in this document. Finally, an advisory committee can help promote continued attention to the findings and recommendations once the study is completed.

This report describes efforts within the State of Kansas to follow the recommendations and guidance of the AAMC and evaluate the regional workforce by organizing a group of stakeholders to track and assist in the analysis effort.

In mid-2005 leaders from the University of Kansas Medical Center convened a diverse group for a “Workforce Advisory Board” and began a series of meetings that led to the devel-opment of this report. Although this group was composed of a varied set of institutional and organizational representa-tives, the final findings of this report were developed by a “Workforce Analysis Sub-group” consisting solely of academic research faculty and staff from the Medical Center. All find-ings were derived from public data and yearly updates may be required for future analysis. Conclusions and recommenda-tions are based on data and analysis findings and on consen-sus developed during meetings of the “Workforce Advisory Board”.

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