With the United States facing a shortage of physicians over the next decade, health care groups and lawmakers are scrambling to increase the number of doctors – primary care providers in particular – to serve an aging population.
Kansas meets only about 65 percent of its physician needs, according to the Health Resources & Services Administration. Missouri is even worse off, meeting only about 30 percent of its physician needs. Many Missouri counties are designated Health Professional Shortage Areas, meaning they have only one provider in the area to serve at least 3,500 people.
With their focus on prevention and primary care, osteopathic medical schools may be in a position to pick up some of the slack, especially in rural areas where the physician shortage is particularly acute.
Kansas Gov. Sam Brownback recently announced plans to explore building a new osteopathic medical school in the state. And in Missouri, Kansas City University of Medicine and Biosciences (KCU) is expanding into Joplin, opening the first new medical school in the state in nearly half a century. A ribbon cutting is planned for June 6.
A growing workforce
When KCU President Dr. Marc Hahn graduated from Des Moines University, an osteopathic medical school, in 1984, there were only 12 colleges of osteopathic medicine in the country. More than 30 years later, that number has nearly quadrupled, the schools graduating about 500 percent more osteopathic students. Today about one in four medical students is enrolled in an osteopathic college.
The first school of osteopathic medicine in the country, A.T. Still University, was founded in Kirksville, Missouri, in 1892 by Andrew Taylor Still. Deviating from traditional medical practice, Still focused on anatomical problems that created what he called an unhealthy blood and nerve flow throughout the body.
It wasn’t until the 1930s and 1940s, however, that residency programs and internships in osteopathic medicine were approved. An accrediting body, the American Osteopathic Association, was recognized in the 1950s and by 1973, Doctors of Osteopathic Medicine (D.O.s) became eligible for licensure in all 50 states.
Dr. Stan Kozakowski, director of medical education for the American Academy of Family Physicians, says the two kinds of physicians, allopathic (M.D.s) and osteopathic, often worked separately in hospitals and practices until the late 1980s, when greater integration occurred.
Although D.O.s may focus more on holistic care and perform spinal manipulation, he says there’s little difference between the way M.D.s and D.O.s practice today. In fact, by 2020 both will be accredited through the Accreditation Council for Graduate Medical Education, which now accredits only allopathic physicians.
Hahn says KCU is able to accept up to 270 students in each class annually. Its sister campus in Joplin will hold as many as 162. Demand is high: Each year KCU receives about 6,000 applications, or 22 for every available spot. The demand in Joplin is expected to be nearly as high.
Osteopathic schools have become significant feeders into the practice of primary care. While some graduates become specialists, about 60 percent of all doctors of osteopathy go on to become primary care providers – nearly three times the number of M.D.s practicing in the area, Hahn says.
That’s not a coincidence.
“The philosophy lends itself to a physician/patient relationship and not quite as much to the production of physician scientists, which many academic medical centers focus on,” says Dr. Boyd Buser, an osteopathic physician and president of the American Osteopathic Association.
The instructors are also heavily weighted toward primary care providers rather than the subspecialists who teach at allopathic medical schools.
Shortage hot spots
Groups like the American Academy of Family Physicians (AAFP) have projected a need for 149,000 additional physicians nationwide by 2020; the American Medical Colleges warns of a deficit of up to 35,600 primary care physicians nationwide by 2025.
Many factors have contributed to the growing primary care shortage. One is the high cost of medical school – it averages around $50,000 a year. And once they begin practicing, primary care doctors are reimbursed at lower rates and tend to have the lowest salaries of any physician. A 2016 Medscape survey found that primary care doctors and pediatricians earn a little more than $200,000 annually. That compares with upwards of $400,000 a year for cardiologists and orthopedic specialists.
At the same time, more people have gained health insurance through the Affordable Care Act, putting more patients in the system. And people are living longer lives, often managing multiple chronic conditions as they age.
While no one disputes there will be some sort of primary care physician shortage in coming years, not every geographical area will feel the pinch equally. In other words, the problem may be less a shortage than maldistribution, leaving mainly rural communities underserved.
“It’s safe to say that Clay, Jackson and Johnson counties are solid in terms of workforce,” says Dr. Michael Munger, president-elect of the American Academy of Family Physicians. “But if you get outside of the core – into areas like Wyandotte, Platte, Cass and Miami counties – you start to see where we really have a shortage of primary care physicians per population.”
According to AAFP workforce data, many rural counties in Missouri and Kansas have a ratio of 7,000 people for every one physician. A handful of rural counties have no physicians at all.
Filling the gaps
That’s where osteopathic medical schools may help. KCU’s Joplin campus and many other osteopathic schools are located in underserved areas. The idea is to address rural health issues by producing physicians who will stay in those regions. Forty percent of the graduates of KCU, the No. 2 producer of physicians in Missouri, practice in rural and underserved areas, Hahn says.
“It was a strategic decision to locate the campus in that community,” Hahn says, referring to the Joplin campus. “We have the ability to impact the health care needs of a four-state rural area as well as a number of tribal nations which are located in that region, especially on the Oklahoma side.”
Buser, of the American Osteopathic Association and a professor at the University of Pikeville-Kentucky College of Osteopathic Medicine, says his college does this by giving admissions preference to candidates from rural and underserved areas. Pikeville and other colleges also have mission statements explicitly stating their emphasis on primary care and their desire to produce graduates who will go on to practice in rural and underserved communities.
Many of the rural osteopathic colleges also work with local community hospitals to train their physicians. They do this because physicians are more likely to practice near where they did their residency, Buser says.
“In Pikeville, we take students from the hills, train them in the hills and they stay there to practice,” he says.
In Joplin, the need for medical providers has been even greater since the 2011 tornado that destroyed St. John’s Regional Medical Center. To better prepare for the future, the city came together with KCU to train – and retain – new doctors for the region. The community offered more than $30 million in philanthropic dollars and 40 acres of land from the former St. John’s site for the KCU campus.
“When we open the doors this spring, it will be like a phoenix rising from the ashes on the grounds of the destroyed St. John’s hospital,” Hahn says.
Joplin Mayor Mike Siebert says recruitment and retention have always been hard in rural areas. He says the city had been talking to KCU for some time about opening a medical school. But it wasn’t until after the tornado destroyed large swathes of the city in 2011 that things came together.
Mercy Hospital and Freeman Hospital West worked in concert to ensure the needs of the medical school are met. And Missouri Southern State University is updating its facilities to accommodate premed students. The university has created a program that offers 25 local high school students admission into the school with a guaranteed spot at KCU after graduation.
“One of the things that has always been something that helps toward getting physicians in an area is if they have a local connection … and I think that’s what this opportunity brings,” Siebert says. “We are able to have a conversation with students graduating that we would have never been in conversation with before.”
Tammy Worth is a freelance journalist based in Blue Springs, Missouri.