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The effort to keep the small town doctor around

Doctors in rural communities are a valuable and often scarce commodity.

Tess Vigeland: The year 2008 marked a turning point for human civilization. That was the first year that more people on the planet moved to and were living in cities.

This shift is putting a strain on the health care system in rural communities. Reporter David Weinberg talks about one university's possible solution to the nationwide shortage of small town doctors.


David Weinberg: If you drive east west out of Kansas City on I-70 through acres of green soy bean and corn fields, you'll eventually come to Salina, Kansas: population 50,000.

Cathy Haney grew up in rural Kansas.

Cathy Haney: As a high school student, I knew every doctor in town. I saw him on the street, I knew who he was, and two or three of them knew my name. Today I walk in there and there's not that many medical people.

Haney says one of the downfalls of having hardly any small town doctors is that they have less time to spend with patients.

Haney: there was a lot more personal interaction with the doctors. I don't feel that they are as involved in the community.

Jill Corpstein: I'm from Atchison, Kansas. It's about an hour north of Kansas City.

Jill Corpstein is one of the eight students in a new program created by Kansas University. It's located in Salina, Kansas, and has one main goal: To keep doctors in small towns. Jill knows what it's like to grow up without a doctor nearby.

Corpstein: I grew up on a farm and my parents raised beef cattle and we have corn and soy beans and cows and pigs. I did not go to the doctor very much growing up, and I know my dad does a lot of self-doctoring as well as other people. Can't say I remember my doctor growing up, because I did see him very much.

The Salina program encourges students to serve in rural communities after they graduate.

Corpstein: I feel like the program promotes it but they want us to be good doctors number one, no matter where we end up. So they promote the rural area but I am going to go where I feel like I am the best at.

Dr. William Cathcart-Rake is the director of the Salina program.

Cathcart-Rake: We have 110 counties in Kansas. At least 85 of those counties are critically undeserved.

The problem doctor Cahcart-Rake says is that students from rural Kansas have go to medical school in big cities.

Cathcart-Rake: We have problems with young physicians going to Kansas City with every intention of coming back to rural communities to practice.

But instead they fall in love, they get married and they start to put roots down in the city.

Cathcart-Rake: Hopefully if we train them in smaller communities, they can meet their spouses here, they can network here and they have those connections which hopefully can be lifelong.

When these students graduate, one of the biggest things that could lure them away from small towns is, of course, money.

Cathcart-Rake: Reimbursement rates for rural areas tends to be less then some of the reimbursement rates for big cities. Being a small town doc isn't always as financially rewarding as being a large town plastic surgeon or dermatologist.

The Salina program hopes to keep doctors away from big cities by offering financial incentives.

Claire Hendrickson: Its called the KMS repayment program.

Claire Hendrickson is one of the students in the program who has signed on to the repayment program.

Hendrickson: If you take the program, for every year you give back to a rural area, they pay for your tuition.

The program gives Claire a living stipend, and for every year she works in an underserved county after she graduates, a year of her tuition is reimbursed.

Cathcart-Rake: But with that comes a tag which means that if they don't practice primary care in an undeserved area in Kansas, they have to pay that back with interest. So they have got those hooks in them.

Dr. Cathcart-Rake hopes students will consider the benefits of small town life when they ultimately decide where to practice.

Cathcart-Rake: We have a lot of salt of the earth people. Even if they can't pay, they are concerned about how they can pay. I had a patient come in yesterday and she brought in a great big gift basket. These things happen all the time in smaller communities -- they are your friends, you get to know them and you laugh and cry with them.

It will be another five years before the first class graduates from the Salina program.

For now, people in rural Kansas have to deal with long drives to doctor's office. If the Salina program succeeds, it could be a model for keeping doctors in small towns across the country.

In Salina, Kansas, I'm David Weinberg for Marketplace Money.

About the author

David Weinberg is a general assignment reporter at Marketplace.

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