Rural Kansas Needs More Physicians. Who's Going to Pay Them?

Kansas Governor Sam Brownback and Lieutenant Governor Jeff Colyer today announced two new programs to bring more doctors to rural Kansas.  As in most rural states, the vast majority of Kansas counties are considered medically underserved, with shortages of doctors, dentists, and other health professionals.

Brownback and Colyer proposed the development of a school of osteopathic medicine in Kansas and a new rural medical residency program.  Both are admirable goals that could help to produce more physicians who will practice in rural Kansas communities.

But training more doctors is only part of the solution.  These doctors also need to be supported after they complete their training and begin to practice.  And here, Brownback and Colyer had little to offer.

The ideas for the osteopathic school and the residency program came from the Lt. Governor's Rural Health Task Force, which met over the course of the last year to assess rural health in Kansas and develop solutions to the workforce shortages, underfinancing, and other problems that have plagued rural areas for decades.  The back story, however, is that the task force was established so the administration could show it was doing something about rural health as it resisted an obvious answer - expansion of KanCare, the state's Medicaid program. 

Accepting federal funding to expand KanCare would bring hundreds of millions of new health care dollars to rural Kansas to cover the uninsured, and at the same time support struggling local hospitals and other providers and create thousands of new jobs (many for all these new physicians).  All discussions of KanCare expansion, however, were shut down by Lt. Gov. Colyer during meetings of the task force.  We don't want Obamacare here in Kansas.

So the question remains.  How are these new rural Kansas physicians going to be paid?  Workforce follows financing, not the other way around (i.e., if the money is there, the doctors will follow).  Is a young physician interested in rural practice likely to locate in Kansas, where many of her patients are uninsured and will not be able to pay for services, or look next door to Colorado, which has expanded it's Medicaid program?

Enhanced workforce, innovative delivery models, and other common solutions to rural health problems are great, but they only go so far.  At the end of the day, we also need money to pay for these programs.  It's right in front of us.  But Gov. Brownback and Lt. Gov. Colyer refuse to see it.