By LAUREN WEBB
Kaiser Health News

SALINA — The University of Kansas School of Medicine-Salina opened in 2011 — a one-building campus in the heart of wheat country dedicated to producing the rural doctors the country needs.

Now, eight years later, the school’s first graduates are settling into their chosen practices — and locales. And those choices are cause for both hope and despair.

Of the eight graduates, just three chose to go where the shortages are most evident. Two went to small cities with populations of fewer than 50,000. And three chose the big cities of Topeka (estimated 2018 population: 125,904) and Wichita (389,255) instead.

Their decisions illustrate the challenges facing rural recruitment: the lack of small-town residencies, the preferences of spouses and the isolation that comes with practicing medicine on one’s own.

But the mission is critical: About two-thirds of the primary care health professional shortage areas designated by the federal Health Resources and Services Administration in June were in rural or partially rural areas. And it’s only getting worse.

As more baby boomer doctors in rural areas reach retirement age, not nearly enough physicians are willing to take their place. By 2030, the New England Journal of Medicine predicts, nearly a quarter fewer rural physicians will be practicing medicine than today. Over half of rural doctors were at least 50 years old in 2017.

So Salina’s creation of a few rural physicians a year is a start, and, surprisingly, one of the country’s most promising.

Only 40 out of the nation’s more than 180 medical schools offer a rural track. The Association of American Medical Colleges ranked KU School of Medicine, which includes Salina, Wichita and Kansas City campuses, in the 96th percentile last year for producing doctors working in rural settings 10 to 15 years after graduation.

“The addition of one physician is huge,” said William Cathcart-Rake, the founding dean of the Salina campus. “One physician choosing to come may be the difference of communities surviving or dissolving.”

The Draw Of Rural Life

By placing the new campus in Salina (population: 46,716), surrounded by small towns for at least 50 miles in every direction, the university hoped to attract and foster students who had — and would deepen — a bond to rural communities.

And, for some, it worked out pretty much as planned.

One of the school’s first graduates, Sara Ritterling Patry, lives in Hutchinson (population: 40,623). Less than an hour from Wichita, it isn’t the most rural community, but it’s small enough that she still runs into her patients at Dillons, the local grocery store.

“Just being in a smaller community like this feels like to me that I can actually get to know my patients and spend a little extra time with them,” she said.

After all, part of the allure of a rural practice is providing care womb to tomb. The doctor learns how to deliver the town’s babies, while serving as the county coroner and the public health expert all at once, said Robert Moser, the head of the University of Kansas School of Medicine-Salina and former head of the state health department.

He would know — he worked for 22 years in Tribune, Kansas (population: 742).

For another of the original Salina eight, Tyson Wisinger, that calling brought him back to his hometown of Phillipsburg (population: 2,486) after his residency. His kids will go to his old high school, where his graduating class was all of 13 people, and he’ll take care of their baseball teammates. Plus, they’ll grow up living minutes away from generations of extended family.

“I can’t have imagined a situation that could have been more rewarding,” Wisinger said.

The Rural Challenge

But the road to rural family medicine also includes a thing called “windshield time” — the amount of time needed to travel between clinics or head to the closest Walmart.

Then there’s figuring out just how far their patients will need to drive to get to the nearest hospital — which for Drs. Daniel Linville and Jill Corpstein Linville is a solid four hours for more advanced care from their new practice in Lakin, Kansas (population: 2,195).

Their outpost in southwestern Kansas can feel a little bit like a fishbowl. “We do life with some of our patients,” Corpstein Linville said.

Already, the Linvilles have delivered babies and handled a variety of ailments there.

The pair met and married during their four years in Salina — they jokingly call it a “full-service med school.” They completed a family medicine residency in Muncie, Indiana. Then they were recruited by a rural practice that helped them avoid what Moser calls the most dreaded words in rural medicine: “solo practice.”

New doctors don’t want to practice alone, especially as they develop their sea legs, due to the strains of constantly being on call and having singular responsibility for a town. Telemedicine, where doctors can easily consult with other physicians around the country via web video or phone, is helping, as are physician assistants.

Diverging From The Path

Claire Hinrichsen Groskurth, another member of the first graduating class, always intended to return to a small town similar to where she grew up.

“The first thing that threw me off was I fell in love with surgery and OB-GYN,” she said. “Then the second thing that threw me off was marrying another doctor,” whose life goals headed in a different direction.

She’d been a member of the Scholars in Rural Health program at Kansas University that seeks out rural college students who are interested in medicine. She also had committed to the Kansas Medical Student Loan program, which promises to forgive physicians’ tuition and gives a monthly stipend if they agree to work in counties that need physicians, or in other critical capacities.

But when she realized she might specialize, she decided to take out federal loans for her final years. She had to pay back the first year of the special loan with 15% interest.

Plus, her now-husband, who went to Kansas University’s Wichita campus, needed to be in a large enough city to accommodate further training to become a surgeon. So Hinrichsen Groskurth delivers babies as she thought she would — but in Wichita.

The spousal coin can flip both ways: Ritterling Patry needed to find a place that worked for her husband’s farming of corn, sorghum, soybeans and wheat. So the smaller city of Hutchinson it was.

Flaws In The Pipeline

Most medical school students come from urban areas and are destined to stay there, said Alan Morgan, the head of the National Rural Health Association. Producing doctors for the vast swaths of rural America needs to be more of a priority at every step in the education pipeline, experts said.

Many academic centers sell students on the party line that they’ll be overworked, underappreciated and underpaid, according to Mark Deutchman, director of the University of Colorado School of Medicine’s rural program. “They take people who are interested in primary care or rural and beat it out of them throughout their training,” he said.

And that kind of rhetoric often influences the opinion of their medical school peers, which those in rural health might resent.

“Small does not mean stupid,” Moser said.

Medical students everywhere should be exposed to rural options, according to Randall Longenecker, who runs Ohio University Heritage College of Osteopathic Medicine’s rural programs.

“If a medical student never ever goes to a rural place, they never find out,” he said. “That’s why students need to meet rural doctors who love what they do.”

The federal government recently allocated $20 million in grants to help create 27 rural residency programs — programs where newly minted doctors go for practical training before they can be fully licensed. That’s a big jump from the 92 programs now active.

For Jill Corpstein Linville, the pipeline also needs to start at more schools like Salina that are promoting rural medicine from Day One.

“So when you hear rural medicine, you know that it’s a thing and don’t kind of cringe,” she said. “You don’t think it’s someone taking care of a cow.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

KANSAS CITY (AP) — Authorities say a kindergartner brought an unloaded gun to a Kansas City elementary school in a backpack, apparently without knowing it was there.

Kansas City Public Schools said in a news release that a teacher was notified after the Faxon Elementary School student found the weapon Tuesday. Police said that the school’s security then secured the gun. The student’s parents and state welfare officials were notified.

The district statement said, “There is every reason to think that the child was unaware that a firearm had been placed in the backpack.” The district said it was unable to comment further because of the ongoing investigation and student confidentially requirements.

Large skull has been donated to Sternberg Museum in Hays

KDWPT

EMPORIA – A mid-August kayak trip down the Arkansas River in south-central Kansas took a fascinating turn for sisters Ashley and Erin Watt when they happened upon a massive skull protruding from a sandbar. It was partially buried nose down, but they immediately knew the shape was unique. When they pulled it from the sand and saw the large teeth of a carnivore, they knew they had something special.

With a little research, Ashley and Erin determined they had likely found a bear skull. They shared their exciting discovery in a Facebook post, which caught the eyes of local Kansas Department of Wildlife, Parks and Tourism (KDWPT) game warden Chris Stout. Stout shared the photos with colleagues, and they eventually reached Sternberg Museum of Natural History paleontologists Dr. Reese Barrick and Mike Everhart who provided insight into the significance of the finding.

While Barrick and Everhart quickly verified the sisters’ suspicions that this was a bear skull, the large size – approximately 16 inches long by 8.5 inches wide – and fossilized appearance left them questioning whether this was a modern grizzly or a more primitive species from the past. The skull is believed to have been deposited into the Ark River sands – an excellent substrate for preservation – and maintained there until it was displaced by this year’s historic floods.

“The bear skull was washed out of the same river sediments that routinely produce the skulls and bones of the American bison, some of which could date back as far as the last Ice Age,” said Everhart, who serves as the Adjunct Curator of Paleontology at the Sternberg Museum. “Whether it is hundreds or thousands of years old, the skull gives us a better insight into the richness of life on the plains before Western man.”

Grizzly bears are native to Kansas and are thought to have occurred throughout most of the state, but history suggests the species was likely extirpated by the middle 1800s. Perhaps the most likely scenario is that this skull did belong to the modern species. Though old enough to have partially fossilized, the skull is in excellent condition; except for the loss of a few minor teeth, it is largely intact and minimally worn.

Though there are several historical accounts of grizzly bears in Kansas, this could be the first physical evidence of their former presence, pending species verification, of course.

“It’s been pretty amazing not only discovering the skull but also the crowdsourcing used to determine how truly exceptional this find is,” said Ashley. “We can’t wait to see what further information can be uncovered about this incredible animal.”

Ashley, a former agriculture teacher at Oxford Jr/Sr High School, and Erin, an Animal Science student at West Texas A&M University, have graciously donated the specimen to the Sternberg Museum in Hays.

DETROIT (AP) — Bargainers for General Motors and the United Auto Workers reached a tentative contract deal on Wednesday that could end a monthlong strike that brought the company’s U.S. factories to a standstill.

The deal, which the union says offers “major gains” for workers, was hammered out after months of bargaining but won’t bring an immediate end to the strike by 49,000 hourly workers. They will likely stay on the picket lines for at least two more days as two union committees vote on the deal, after which the members will have to approve.

Terms of the tentative four-year contract were not released, but it’s likely to include some pay raises, lump sum payments to workers, and requirements that GM build new vehicles in U.S. factories. Early on, GM offered new products in Detroit and Lordstown, Ohio, two of the four U.S. cities where it planned to close factories.

The company offered to build a new electric pickup truck to keep the Detroit-Hamtramck plant open and to build an electric vehicle battery factory in or near Lordstown, Ohio, where GM is closing an assembly plant. The battery factory would employ far fewer workers and pay less money than the assembly plant.

GM and the union have been negotiating at a time of troubling uncertainty for the U.S. auto industry. Driven up by the longest economic expansion in American history, auto sales appear to have peaked and are now heading in the other direction. GM and other carmakers are also struggling to make the transition to electric and autonomous vehicles.

Meanwhile, President Donald Trump’s trade war with China and his tariffs on imported steel and aluminum have raised costs for auto companies. A revamped North American free trade deal is stalled in Congress, raising doubts about the future of America’s trade in autos and auto parts with Canada and Mexico, which last year came to $257 billion.

Amid that uncertainty, GM workers have wanted to lock in as much as they can before things get ugly. They argue that they had given up pay raises and made other concessions to keep GM afloat during its 2009 trip through bankruptcy protection. Now that GM has been nursed back to health — earning $2.42 billion in its latest quarter — they want a bigger share.

If approved, the contract agreement will set the pattern for negotiations at Fiat Chrysler and Ford. It wasn’t clear which company the union would bargain with next, or whether there would be another strike.

The union’s bargainers have voted to recommend the deal to the UAW International Executive Board, which will vote on the agreement. Union leaders from factories nationwide will travel to Detroit for a vote on Thursday. The earliest workers could return would be after that.

In past years, it’s taken a minimum of three or four days and as long as several weeks for the national ratification vote. Workers took almost two weeks to finish voting on their last GM agreement, in October of 2015. Then skilled trades workers rejected it, causing further delays.

“The No. 1 priority of the national negotiation team has been to secure a strong and fair contract that our members deserve,” union Vice President Terry Dittes, the chief bargainer with GM, said in a statement Wednesday. The agreement, he said, has “major gains” for UAW workers.

This time around — with a federal corruption investigation that has implicated the past two UAW presidents and brought convictions of five union officials — many union members don’t trust the leadership and likely won’t want to return to work until they’ve gotten a chance to vote on the deal themselves.

In August, the FBI raided the suburban Detroit home of UAW President Gary Jones. He has not been charged and has not commented on the raid. Earlier this month, Jones’ successor as union regional director in Missouri was charged in a $600,000 embezzlement scheme, and another UAW official pleaded guilty to taking kickbacks from union vendors. Eight other people — including five UAW officials — have been convicted over the past two years of looting a jointly run Fiat Chrysler-UAW training center for blue-collar workers. Another official was charged in September.

There’s also no guarantee that the first contract deal with GM will pass. Some workers on the picket lines have said they may not vote for the first offer.

“We’re not just going to take the first thing that they give us,” worker Tina Black said last month from the picket line at an engine and transmission plant in Romulus, Michigan, near Detroit’s main airport.

But Louis Rocha, president of a UAW local in Orion Township, Michigan, said recently that union bargainers have taken strong positions against the company. “I think we’re going to be OK,” he said of the ratification vote.

The strike had shut down 33 GM manufacturing plants in nine states across the U.S. It was the first national strike by the union since a two-day walkout in 2007 that had little impact on the company.

SALINE COUNTY — Law enforcement authorities are investigating a suspect on drug charges after a traffic stop in Salina.

Just after 1a.m. Wednesday, a 2019 Dodge Durango driven by Alberto Lopez, 49, of Louisville, Ky., was southbound on Interstate 135, according Saline County Sheriff Roger Soldan.

A deputy sheriff stopped the SUV  after the driver allegedly exited onto State Street without stopping at the stop sign.

During the traffic stop, the deputy noticed an open beer container in the vehicle and tested Lopez, but did not arrest him for driving under the influence.

The Salina Police Department’s K-9, Karma, was called in and hit on the scent of marijuana in the vehicle, according to Soldan. Deputies located 106 pounds of marijuana divided into 98 packages in the back of the vehicle.

Deputies arrested Lopez on requested charges that include Possession of marijuana with intent to distribute, No tax stamp, Possession of drug paraphernalia, Having an open container of alcohol and Failure to stop at a stop sign.