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1 c o n n e c t i o n s Rural Health Education and Services Vol. 15 No. 2 Fall 2007 What s Inside... Page 3 Mass-casualty Simulation Training Page 6 Health Care at the Core Page 7 Kansas Recruitment Center - Job listings Page 15 Stories from Greensburg Page 16 Study Finds Rural Physicians Satisfied Page Rural Kansas Photography Contest Winners Rural Safety Net Clinics In demand and helping communities survive Pittsburg s hospital, university and school district combined efforts in 1997 to offer affordable, accessible child care services. When they realized the schools had to send children home because they didn t have the required physicals or shots, they set up a clinic in a classroom during enrollment to give free physicals and shots. It turned out the demand for health care services was so great that the program ballooned and is now based in a new 10,500-square-foot building that opened in May in Pittsburg. The resulting Community Health Center of Southeast Kansas also opened a new satellite clinic this fall in Columbus, which is 30 miles to the south and located in Cherokee, the state s second poorest county. The Southeast Kansas health center has seen patients from 26 counties and expects 50,000 patient visits in We used to see 20 or 30 patients in a week; today we see 200 patients a day, said Krista Postai, CEO of the Community Health Center of Southeast Kansas. We truly subscribe to the safety net concept. We want to catch those people who have fallen through the cracks. Physician assistant Kim Dansel provides care at Greeley County Health Services. It wasn t long ago that the town s one-chair outreach dental clinic at a church was staffed one day a week and had a waiting list of 700 people. Now the area has a 12-chair dental clinic, which also provides training for dental hygiene students. When the Pittsburg clinic became a federally qualified health center (FQHC) in May 2003, it had 11 employees; today the staff numbers 75. The medical staff of one part-time physician has grown to include four fulltime physicians, five nurse practitioners, three psychologists, one master s level social worker, three dentists and three dental hygienists. The Southeast Kansas center is one of a dozen rural and urban clinics throughout the state designated as FQHCs for under-served areas. Their federal funding totaled $8.2 million this year, according to Barbara Gibson, director of the state primary care office at the Kansas Department of Health and Environment. Other rural FQHC locations include Garden City, Great Bend, Hutchinson, Salina, Emporia and Junction City. Kansas increases support To help meet the growing need for health Continued on page 4

2 From The Director... Lorene R. Valentine Kansas Connections is published four times a year by the University of Kansas Medical Center, Rural Health Education and Services, Kansas City and Wichita. KUMC is an AA/EO/Title IX Institution. (316) DIRECTOR Lorene R. Valentine EdITOR /GRAPHIC DESIgNER Amanda Gardner 2 Kansas c o n n e c t i o n s New Web Site helps promote rural Kansas A new Web site, which gives rural Kansas health care communities the opportunity to showcase their organization to possible new recruits, has been announced. This new site has been given the appropriate name Focus on Kansas and can be found at The Kansas Recruitment Center (KRC) determined there was a need to develop a Web site that would allow health care professionals who are looking for job opportunities the ability to browse and learn about rural Kansas communities, all in a single, well organized site. Communities who sign up to be a part of Focus on Kansas are given the opportunity to work with a web developer to create Web pages which highlight their rural health care organization and community. In addition, each community is honored as a Spotlight Community on the sites home page on a rotating basis. KRC sends out a unique blast to interested candidates each time a new community is added to the site. KRC clients who have taken advantage of this new service have been very satisfied and are able to incorporate it into their marketing and recruiting efforts. KCO 2007 is a success Each year, Rural Health Education and Services hosts the Kansas Career Opportunities (KCO) events. The events, held in both Wichita, Kan., and Kansas City, Kan., are designed to introduce medical students, resident physicians, and allied health students to current and potential career opportunities in rural communities throughout Kansas. The Kansas City event, held on Oct. 18, 2007, in the Hixson Atrium of the University of Kansas Medical Center, attracted 164 participants. Twenty-seven exhibitors were on hand to introduce participants to the communities and opportunities throughout the state. On Oct. 25, the Wichita KCO event attracted 109 participants. These resident physicians, allied health, medical and nursing students had the opportunity to meet with 35 exhibitors. Mark Mingenback, VP, Professional Services Central Kansas Medical Center, Great Bend, was the moderator for the panel discussion, Scoring with your Community. Panelists included: Barry Weis, Director, Physician Recruitment and Retention, Salina Regional Health Center, Salina; John Mosier, MD, Herington Hospital, Herington, Kan., and Christian Cupp, MD, Scott County Hospital, Scott, City. Thank you to each participant, exhibitor, and panelist for making the 2007 Kansas Career Opportunities events a success! Family Medicine resident Aref Zaman, MD, visited with Mark Mingenback of Great Bend at KCO in Kansas City. Summit on Enhancing Primary Care Education The Summit on Enhancing Primary Care Education was held on October 25 and 26, 2007, in Wichita. The goal of the summit was to establish a plan and goals in regards to the improvement of primary care education and therefore solutions to generate an increase in the primary care workforce in Kansas. Key members from the following orga- Continued on back page

3 Mass-casualty Simulation Trains Kansas Four years of planning by the University of Kansas Medical Center culminated Oct when 800 professionals from health care, public safety and government participated in 10 profession-specific training tracks before taking part in a 48-hour simulation of a mass-casualty disaster in a partially collapsed building in Wichita. The training tracks varied from one to three days in length and took place at multiple locations in Wichita preceding the full-scale simulation. Tracks included: emergency operations center, command, fire rescue, law enforcement (including road patrol officers, SWAT and bomb teams), emergency medical services, disaster medicine, hospitals, government officials, media relations and public health. There also were hospital tracks for burn treatment, toxicology/radiology and pediatric disaster life support. Several hospitals in south-central Kansas participated in the hospital mass casualty drill on Oct. 19. The disaster simulation took place Oct in a partially collapsed building at Washington and Waterman in Wichita. The training and simulation were designed to encourage inter-agency David Cook, PhD, assistant vice chancellor, External Affairs, and project director, University of Kansas Medical Center, explained how the mass-casualty simulation would work, to the media at the site on Oct. 19, cooperation and build relationships among first-responders as well as to offer agencies the opportunity to test their skills in real-time, said David Cook, Ph.D., assistant vice chancellor, external affairs for KU Medical Center, who was project director for Responding to Terrorist Incidents & Major Disasters: Preparedness and Response Training. The 80 faculty members involved included experts from several fields as well as representatives from Rescue Training Associates of Deerfield, Fla., who played key leadership roles during the Oklahoma City bombing, Hurricane Katrina and 9/11, according to Cook. KU Medical Center began planning for a statewide terrorism response and disaster preparedness training in December Since then, more than 11,000 emergency responders representing 13 professions have attended 120 educational and training activities throughout the state. The goal was to train one first responder or community member per 190 Kansans. Topics included agriterror, avian influenza and weapons of mass destruction. The goals and curriculum evolved from interviews with more than 600 professionals from hospitals and health care, fire, law, emergency management and emergency medical services. The training event was sponsored by the University of Kansas Medical Center with funds from the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, Office of Preparedness and Emergency Operations and the South Central Kansas Homeland Security Council with funds provided to the State of Kansas from the Department of Homeland Security, Office of Domestic Preparedness For more information, visit ea.kumc.edu/newsroom. 3

4 Safety net Clinics continued from Front page services, this year s Kansas legislature also appropriated $5.2 million for 31 state-funded urban and rural clinics which provide care and prescriptions to under-served populations. That support is up from $3.2 million for 24 clinics last year, according to KDHE figures. The state legislature has really stepped up to the plate and recognized this could be the model of the future, Postai said. Kansas has 33 clinics who are members of the Kansas Association of the Medically Underserved. The clinics provided care in 2006 to 148,000 people across the state, according to Val Renault, KAMU spokesperson. Fiftyseven percent of those patients were uninsured, and 63 percent were living in poverty. The number of uninsured Kansans is estimated at 300,000. An in-house survey at Greeley County Health Services (GCHS) revealed that 56 percent of patients don t have insurance. But having health insurance doesn t mean patients are always able to Greeley County Health Services, Tribune, Kan. has four physicians (left to right): Randy Fahrenholtz, MD; Robert Moser, MD; Robyn Liu, MD; and Wendel Ellis, DO. afford health care, said Chrysanne Grund, project director for GCHS, which is based in Tribune and serves Wallace, Greeley and Hamilton counties along the Colorado border. You might still have a high co-pay 4 Kansas c o n n e c t i o n s or a $2,500 deductible. If you ve got to bring in four kids with the flu you could easily owe $150 to $200 without lab or X-rays, she said. A National Health Service Corps site, GCHS has a long history of offering sliding-fee scales for payment, according to Grund. The sliding fee is a big part of how we keep health care affordable and help our patients keep their dignity, she said. The most important thing for me here is that the emphasis has always been on patient care. We do what it takes to take care of the patient. It never mattered whether we were caring for a patient with insurance. Because of the increased allocation from the legislature, GCHS funding from the Kansas primary care grant program this year increased from $60,000 to $90,000. The system includes an 18- bed hospital and clinic in Tribune plus primary-care clinics in Syracuse and Sharon Springs. Tri-county cooperation When Grund started working at the clinic in Sharon Springs 14 years ago, the Tribune hospital and clinics were separate entities. Integrating into one system, securing grants and participating as a National Health Service Corps site have helped ensure health care services in an area severely hit by drought from 1997 to We had some really tough periods with patients ability to pay in those years, Grund said. We ve worked hard to develop programs that can be profitable in that type of system. We re not always in the black on the clinic side, but the admissions that funnel to the hospital help make the entire system work. GCHS has just added its fourth physician and finished construction of a new medical clinic on land donated by a patient in Wallace County, culminating completion of a 10-year dream, Grund said. The clinic expects to move into the 6,000-square-foot space in early November. The collaboration between the two counties started in 1992 when Wallace County lost its doctor and invited the health system in Tribune to host a clinic in Sharon Springs. Southeast Kansas clinic In another corner of the state, the Southeast Kansas center in May moved from a 1,500-square-foot double-wide modular building into a new $1.5 million building. Crawford County donated the land and three families came forward with $1 million in donations to construct a new clinic on the site of the town s original hospital, which was built to treat the miners, who had little money. We are finally providing comprehensive coordinated care in one location -- medical, mental health, dental, pharmacy, Postai said. The new satellite Columbus clinic received $716,667 in federal funds earlier this year and is staffed with a physician and two nurse practitioners. To get those funds we had to demonstrate incredible need, Postai said. She said she d never felt so welcomed anywhere in her life as when the clinic opened in Columbus. It was like the soldiers marching into Paris in World War II, she said. We re just so glad to be there and they re so glad to have us. To help accommodate working families, the clinic is open two evenings a week and on Saturday. Children continue to be a priority with the Southeast Kansas center and comprise 40 percent of the patient load, she said. Dental staff are going to every school in Cherokee and Crawford counties and doing dental screenings at no cost. We can certainly help adults Continued on next page

5 but we have the opportunity to set the course for the rest of children s lives. About 15 percent of the center s funding comes from a federal grant. Thirty percent of patients are uninsured, Postai estimates. The others have Medicaid, Medicare or private insurance, but often have difficult meeting co-pay or deductibles. We can slide their bill down to $10 and we do it with dignity. You can have two members of your family working but you still may not be able to afford a $200 prescription. Our providers are very sensitive. If patients can t afford to pay us we don t deny care. We have people who come in and pay $2 on their bill. We make sure they have their medications if they can t afford them. And the staff is so dedicated she learned that one of the nurse practitioners was trying to help a patient find a job. The center s board members 80 percent of whom are patients at the clinic also volunteer in a variety of ways, including a retired nurse who gives shots and a bilingual member who teaches a child-birth education class in Spanish. It s important to serve the community s specific needs, Postai said. For the Southeast Clinic that means offering an interpreter, a pediatrician who speaks Arabic and understands the culture, walk-in vaccinations being available six days a week and hours that extend into the evening. We serve a diverse population, Postai said. We try to shape ourselves by what community needs. It s not a cookie-cutter approach. Receiving funds Many of the funding programs for safety net clinics require all persons be accepted regardless of their ability to pay, a sliding-fee scale and an interdisciplinary approach using nurse practitioners or physician assistants, according to Gibson. To receive a federal subsidy, factors besides being in a medically underserved area are considered, she said. They look at not just the populationto-provider ratio but also infant mortality rates and low-birth rate, poverty levels and percentage of elderly as well as other indicators of poor health status and need. It s more than provider supply because there could be plenty of doctors but no one seeing Medicaid patients or providing a sliding-fee schedule. They look at whether there is a financial barrier to care. The community health center model is not very practical in sparsely populated areas so support can also come in the form of a Federally Certified Rural Health Clinic, which provides funds on a cost basis, according to Gibson. The federal government realizes that if you re in a shortage area and you re one of the only players in town who ll see Medicare, Medicaid and the uninsured your practice won t be as profitable, she said. Kansas has 183 private practices and clinics that benefit from these federal funds. It s complicated how we finance rural health care, Gibson said. It s important to keep rural America as stable as possible when it s losing population every year. She attributes the increased need for subsidies in recent years in part to employers reducing insurance coverage, new businesses not offering it and parttime workers not being eligible. But even having health insurances doesn t mean someone can afford the out-ofpocket expenses, she noted. There are those who have just catastrophic coverage and can t afford the deductible or co-pay. The biggest challenge in rural areas is the sparse population which makes it difficult to organize a complex health system for them locally, she said. Some FQHC sites, such as Hutchinson and Great Bend, have programs that began as a collaboration between the hospital and health department. It s advantageous to a hospital to have a safety net clinic because otherwise patients may seek more expensive care through the emergency room. The Salina Family It s complicated how we finance rural health care. It s important to keep rural America as stable as possible when it s losing population every year. Barbara Gibson, director of the state primary care office at the Kansas Department of Health and Environment Health Care has a unique collaboration with the Smoky Hill Family Medicine Residency Program, whose residents gain experience in rural medicine and provide valuable care to patients. While clinics can receive federal and state support, efforts have to begin at the community level, Postai noted. It definitely is a grassroots initiative. 5

6 Health Care at the Core Rural communities depend on local health care Health care has become the number-one issue facing the 40,000 members of the state s largest rural organization, according to Harry Watts, director of governmental relations for Kansas Farm Bureau (KFB), which was established in 1919 Harry Watts as a nonprofit agency to represent the state s farmers and ranchers. In the past, KFB members were primarily concerned with agricultural issues, but in the last couple of years the focus has shifted to saving their rural communities, and at the cornerstone of that is the affordability and accessibility of health care, said Watts, who is a native of Hays and has been with KFB for six years. In trying to stem the outward migration from Kansas rural communities that has been going on for decades, KFB members see health care as the most important issue. The last census showed that 96 Kansas counties had lost population in the last decade, continuing a trend that began for many of them in the 1930s. We believe in rural communities and want to turn the tide, Watts said. Health care is right in the middle of that so we re embarking on a fairly significant rural health initiative. The declining rural populations have made it difficult to keep hospitals and clinics open, and to recruit physicians, nurses, pharmacists and other health care professionals, he said. When you have to drive a patient great distances it becomes a problem. The lack of health care options provides another reason for young people to move to metropolitan areas, he noted. In addition to decreasing the population base, this means wealth and assets will also leave the area. There are probably in excess of $200 billion of rural assets in Kansas, he said. The average age of our members is the late fifties. That means that in the next 10 to 20 years, those assets will go where the kids are. To encourage economic diversity and retain youth in rural communities, the KFB is working on legislation that includes the creation of the Kansas Rural Policy Authority to work on these issues. Health care is expected to be a major topic in this year s legislature. Watts said he often hears from young farmers and ranchers who say there is no incentive for them to stay, especially when health care costs exceed their budget. Health insurance is so costly for those who are self-employed they often have to get secondary jobs, Watts said. It just amazes me that 85 percent of family farm income now comes from income other than farm work. In addition to making it easier for farmers, ranchers and other small business owners to participate in association health plans and voluntary regional insurance purchasing cooperatives, the KFB supports these measures to preserve health care delivery to rural Kansas: Encouraging undergraduate students to enter the health care professions; promoting medical education in rural areas; and matching medical students with residency programs located in rural areas or residency programs with required rural rotations. Giving urban providers incentives to participate in respite, locum tenens and sabbatical programs for rural physicians. Encouraging family medicine as a specialty and working with the Kansas Legislature to fund family medicine education that addresses the needs of the rural community. Provide state scholarship programs for health care professionals that require recipients to provide services in underserved areas in Kansas (and create disincentives for any recipient to buyout the contract). Visas for foreign doctors, nurses and other health care professionals who are qualified, willing to work in rural areas and sponsored by a rural hospital or clinic. Programs which implement joint use and cooperation among health care facilities, school districts, municipal and county governments to enhance health education, preventive health care and efficiency of care. Establish innovative managed-care programs through incentives for government, providers and private insurers where medical services are offered through a network of physicians and hospitals at discounted costs. Encourage the Kansas Legislature to provide more flexibility in the allocation of per diem rates for nursing staff for local home health care. Watts knows saving every rural community will be a challenge. It s not going to be easy but we have a significant membership base that can roll up its sleeves and make a difference. It s going to be difficult to turn the tide. We won t save every rural community but we can create new thinking. 6 Kansas c o n n e c t i o n s

7 K A N S A S R E C R U I T M E N T C E N T E R November 2007 The mission of the Kansas Recruitment Center (KRC) is to assist Kansas rural communities in recruiting and retaining physicians and other health care providers. KRC works with hospitals, private physician practices, community health centers, and other organizations recruiting physicians, nurses, physician assistants or other health care professionals. KRC is also a health care career service for physicians, physician assistants, nurses, nurse practitioners and other allied health professionals. KRC assists candidates in finding a community and practice or career opportunity that meets their requirements. Services are provided to candidates at no charge. Candidates should refer to a position by number when they are calling about a specific opening. For more information, contact the University of Kansas Medical Center, Rural Health Education and Services, or , or visit the Web site at NORTH CENTRAL KRC Hematologist/Oncologist new cancer center approved by the Commission on Cancer, American College of Surgeons; current staff: 3 physicians and 1 mid-level; patient population is adult thru geriatric; facility amenities include chemotherapy room w/window wall, counseling room, wig room KRC Pulmonary Medicine/ Critical Care 26-physician multi-specialty clinic; currently 10 specialties; additional services include full-service lab, nuclear medicine, echo and vascular testing, ultrasound, and full x-ray unit; full-service acute facility and surgery hospital nearby KRC Invasive and Interventional Cardiologist 26-physician multi-specialty clinic; currently 10 specialties; additional services include a full service lab, nuclear medicine, echo and vascular testing, ultrasound, and full x-ray unit; full-service acute facility and surgery hospital nearby KRC Internist 26-physician multi-specialty clinic; currently 10 specialties; additional services include a full service lab, nuclear medicine, echo and vascular testing, ultrasound, and full x-ray unit; full-service acute facility and surgery hospital nearby KRC Nephrologist 26-physician multi-specialty clinic; currently 10 specialties; additional services include a full service lab, nuclear medicine, echo and vascular testing, ultrasound, and full x-ray unit; full-service acute facility and surgery hospital nearby KRC Family Physician group practice, 25-bed CAH, acute medical, skilled nursing unit, 24-hour emergency, IP & OP surgery, OB, very active rehab department KRC General Surgeon group practice affiliated with a regional medical center that serves a population of 60K; the medical center s state-of-the-art technologies include a full laparoscopic system, family birthing rooms, well-equipped intensive care unit, ER, Level II nursery, fixed site MRI and CT; salary: $200,000-$250,000; great benefits; H1-B Visa opportunity KRC Orthopedist group practice affiliated with a regional medical center that serves a population of 60K; the medical center s state-of-the-art technologies include a full laparoscopic system, family birthing rooms, well-equipped intensive care unit, ER, Level II nursery, fixed site MRI and CT; competitive salary; great benefits; H1-B Visa opportunity KRC General Surgeon hospital-employed, 25-bed CAH with new surgical addition in progress; current staff: 3 family practitioners, 1 surgeon, 1 mid-level; additional hospital facilities include a 30-bed long-term care unit and an outreach clinic that is staffed 3.5 days per week; hospital services include OB, a full lab, diagnostic imaging, physical therapy; KRC Family Physician for 25-bed CAH w/ 2 satellite clinics; OB required, prefer ability to do c-section; currently 3 family physicians, 1 surgeon, 1 radiologist, 2 PAs, and 1 NP on staff; call is 1:5; hospital services include general surgery, cardiac rehab, cardio pulmonary, radiology, OB, OT, PT, CT scans, MRI, x-ray; salary is negotiable; full benefits KRC Family Physician 25-bed CAH; hospital services include: on-site CT, mobile MRI and ultrasound, lab, x-ray, swing beds, urology clinic, cardiac clinic; salary: $145,000- $155,000, potential for production bonus; full benefits; KRC Family Physician with OB for a 25-bed CAH and rural clinic; hospital does OB and the family practitioners may perform c-sections; general surgeon, 2 family practitioners, and 2 NPs on staff; currently, call is 1:4 and they locum tenens ER coverage 1 weekend/month; hospital services include OB, ER, lab, radiology, specialty care, and long term care; salary is $140,000-$160,000; full benefits KRC C Family Physician w/o OB or surgery, 12-bed CAH; rural health clinic attached to hospital; 83 staff members at hospital, including PA; call time is 1:2 and non-call time is completely off for practitioner; hospital services include acute care, swing bed, ER, PT, cardiac rehab, ADA certified, and outpatient clinics for cardiac and orthopedics; salary is $135,000-$160,000; full benefits KRC C Family Physician 25-bed CAH and rural health clinic; current staffing includes 1 physician and 1 PA; call is 1:3; hospital ser- Continued 7

8 vices include acute care, swing bed, ER services, therapy department, full service lab and x-ray, contracted sonogram and mammogram, and mobile CT scan unit; salary: $135,000- $150,000; full benefits KRC Physician Assistant KRC Nurse Practitioner to work with 2 Gastroenterologists in a 26-physician multi-specialty clinic; currently 10 specialties; Gastroenterology experience preferred, but willing to train the right person; clinic services include a full service lab, nuclear medicine, echo and vascular testing, ultrasound, and full x-ray unit; full service acute care facility and surgery hospital nearby; salary is competitive and negotiable; opportunity for incentive bonus; all clinic benefits available KRC Gastroenterologist a 26-physician multi-specialty group with 3 Gastroenterologists seeks BC/BE Gastroenterologist to join a well established, busy practice; early partnership, surgical hospital ownership, excellent benefits and a large referral area make this an excellent opportunity KRC General Surgeon for multi-specialty clinic that is owned and operated by 25 physicians representing 11 medical specialties; 3 general surgeons on staff; call is 1:4; full service acute care facility nearby as well as a surgery hospital; salary and benefits are negotiable KRC Family Physician without OB for 25-bed CAH; currently 3 FPs, 1 surgeon, and 1 mid-level on staff; additional hospital facilities include a 25-bed long term care unit and outreach clinic that is staffed 2 ½ days per week; rotating local on-call backup; hospital services include lab, diagnostic imaging, rehab services, surgical services, ER, OR, and respiratory therapy; salary is $145,000-$165,000; full benefits KRC Physical Therapist Assistant for 25-bed CAH with brand new PT Dept.; currently 3 PTs, 1 CPTA, 1 Exercise Physiologist, 1 Massage Therapist and an assistant on staff; treats an average of 40 patients/ day including inpatient, outpatient, and long term care; caseload includes cardiac rehab, ortho, and neuro; experienced therapists and new graduates encouraged to apply; must have KS licensure or be eligible; hospital services include OB, lab, diagnostic imaging, and PT; salary is $38,000-$50,000; benefits 8 Kansas c o n n e c t i o n s KRC Emergency Medicine for 25-bed CAH; currently 3 FPs, 1 surgeon, and 1 mid-level on staff; 25-bed long term care unit and outreach clinic that is staffed 2 ½ days per week; rotating call; hospital services include lab, diagnostic imaging, rehab services, surgical services, ER, OR, and respiratory therapy; salary is $145,000-$165,000; full benefits KRC Family Physician for ER in a 25-bed CAH; currently 3 FPs, 1 surgeon, and 1 mid-level on staff; 25-bed long term care unit and outreach clinic that is staffed 2 ½ days per week; rotating call; hospital services include lab, diagnostic imaging, rehab services, surgical services, ER, OR, and respiratory therapy; salary is $145,000-$165,000; full benefits KRC Laboratory Supervisor for 25-bed CAH that supports a health clinic; currently 3 med techs and 1 phlebotomist on staff; average of 30 patients/day; hospital services include cardiac rehab, PT, CT, mobile MRI and ultrasound, lab, x-ray, scopes, swing beds, urology clinic and cardiac clinic; CLIA required; experience preferred, but new graduates encouraged to apply; salary is negotiable KRC Family Physician for a 25-bed CAH; they are expanding their medical staff to treat patients at the Rural Health Clinic and hospital; must have experience in a rural ER; hospital services include acute care, preventive medicine, PT, hospice, EMS, OB, surgery, and swing bed; call is 1:4 or 1:5; salary is $180,000 with a bonus package; full benefits; KRC Family Physician without OB for two-campus, 99-bed hospital with secondary campus 20 miles southwest; hospital services include a full laparoscopic system, family birthing rooms, ICU, ER, Level II nursery, MRI and CT, PT, OT, speech rehab, cardio-respiratory, lab, respite care, mammography; oncology, orthopedics, pulmonology, cardiology, nephrology outpatient clinics available; salary is $140,000 + production incentive + sign-on bonus; call is 1:2; full benefits KRC Orthopedic Surgeon with interest in fracture care, joint replacement, and sports medicine for well-established group practice; currently 2 orthopedic surgeons and 3 PA s on staff; call is 1:3; full ancillary services available; new Q-Rad Radiographic System on premises; excellent compensation; benefits KRC Family Physician w/ or w/o OB (OB preferred) for well-established group practice; currently 4 physicians and 1 ARNP on staff; weekend call is 1:5; lab, mammography, and x-ray services on premises; full service acute hospital and surgical hospital nearby; salary is competitive; full benefits KRC Obstetrician/Gynecologist for single specialty clinic with OB/GYN practice; must be board certified or eligible; 385-bed hospital; 125 physicians currently on staff; hospital services include behavioral health, cancer, cardiology, emergency services, lifeline, radiology, rehab, sleep disorders center, and a wound care clinic; salary is competitive; full benefits; H-1B opportunity KRC Orthopedist for successful single specialty clinic w/ thriving Ortho practice; must be board certified or eligible; 385-bed hospital; 125 physicians currently on staff; hospital services include behavioral health, cancer, cardiology, emergency services, lifeline, radiology, rehab, sleep disorders center, and a wound care clinic; salary is competitive; full benefits; H-1B opportunity KRC Pediatrician for private practice opportunity with privileges at the 385- bed hospital; services include behavioral health, cancer, cardiology, emergency services, lifeline, radiology, rehab, sleep disorders center, and a wound care clinic; must be board certified or eligible; salary is competitive with loan forgiveness; full benefits; H-1B opportunity KRC Child Psychiatrist for progressive Behavioral Health Department; practice expenses are paid by the health center; call is 1:4; the 385-bed hospital s services include behavioral health, cancer, cardiology, emergency services, lifeline, radiology, rehab, sleep disorders center, and a wound care clinic; salary is competitive and negotiable; full benefits; H-1B opportunity KRC Radiation Oncologist for growing staff at state-of-the-art Cancer Care Center; the 385-bed hospital s services include behavioral health, cancer, cardiology, emergency services, lifeline, radiology, rehab, sleep disorders center, and a wound care clinic; salary is competitive and negotiable; 125 physicians currently on staff; salary is competitive and negotiable; full benefits; H-1B opportunity Continued

9 KRC Radiologist for wellestablished private practice group; must be board certified or board eligible; the 385-bed hospital s services include behavioral health, cancer, cardiology, emergency services, lifeline, radiology, rehab, sleep disorders center, and a wound care clinic; salary is competitive and negotiable; 125 physicians on staff; salary is competitive and negotiable; full benefits; H-1B opportunity KRC Physician Assistant KRC Nurse Practitioner for Rural Health Clinic attached to 25-bed CAH; hospital services include CT on site, mobile MRI and ultrasound twice/week, lab, x-ray, cardiac rehab, urology clinic, cardiac clinic, and eye surgeon; no call; salary is competitive and negotiable; benefits; H-1B opportunity KRC C Physician Assistant KRC C Nurse Practitioner for 25-bed CAH and rural health clinic; currently 1 physician and 1 PA on staff; call is 1:4; hospital services include acute care, swing bed, ER, therapy dept; lab, x-ray, contracted sonogram and mammogram, and a mobile CT scan unit; salary is $72,000-$80,000; benefits KRC Physician Assistant w/ or w/o OB for 25-bed CAH with attached clinics; PA will provide family care and ER coverage; hospital services include acute care, preventive medicine, PT, hospice, EMS, OB, surgery, and swing bed; currently 2 clinics and each is responsible for 50% call; salary is $65,000- $75,000; benefits KRC C Obstetrician/Gynecologist to join practice for a two-campus, 99-bed, regional acute care hospital; currently the number of births is 450 annually but is expected to grow; call is divided in two, unassigned will be 1:4 and practice call will be 1:2; NP will cover physician s first call about ½ of the time; salary is $240,000-$300,000 + production and signon bonus; full benefits KRC Hematologist/Oncologist board certified or eligible, for region s Cancer Center; currently 3 physicians and 1 mid-level on staff; pop. is adult thru geriatrics; facility includes chemo room w/ window wall, counseling room, wig room, etc.; salary is competitive; signing bonus; full benefits KRC Family Physician w/o OB for 20-bed CAH w/ 5 rural health clinics; hospital services include diagnostic radiology; lab, RT, 24-hour ER, acute and intermediate care, cardiac rehab, PT, OT, and speech therapy; currently 2.25 physicians, 2 PAs, and 1 NP on staff; call is 1:5 w/ separate contract for holidays and weekends; salary is 100% production-based, guaranteed first 2 years; full benefits NORTHEAST KRC Medical Technologist 24- bed CAH; experienced and new graduates encouraged to apply; hospital services include inpatient, outpatient, swing bed, OB; salary: $37,000-$52,000 depending on experience; full benefits KRC C Internist private practice in building attached to hospital; this internist would join 3 other internists, in seeing a quickly growing patient population and to share call; clinic office space, practice management services, and a start-up loan to cover initial business expenses are available; call is 1:4; family practice physicians perform ER coverage; net income guarantee of $160,000 (negotiable depending on training and experience); benefits KRC Family Physician group practice located next to a 28-bed CAH; prefer OB, but not required; currently 3 physicians and 1 mid-level on staff; call is 25%; salary and benefits are not predetermined as this is considered an independent practice KRC General Surgeon for group practice; currently 1 general surgeon on staff; limited call coverage; hospital is a 28-bed CAH and supports a satellite clinic; salary is structured on a fee-for-service basis; benefits are negotiable; H-1B opportunity KRC Family Physician with OB for 24-bed CAH with 2 satellite clinics; currently 2 family physicians and 2 NP s on staff; call is 1:5; hospital services include inpatient, outpatient, sub acute, surgery, OB, PT and OT, lab, radiology, and outreach clinics; salary is $125,000-$175,000; full benefits KRC Obstetrician/Gynecologist for hospital-employed group practice; the community and hospital are growing hospital service area is 45,000 and they expect 30,000 new residents within the next 6 years; hospital is undergoing a $40 million expansion over the next two years; salary is competitive and negotiable; full benefits KRC Cardiologist for 120-bed, hospital-based regional health center with a variety of services; call is no more than 10 days/ month; salary is competitive and negotiable; strong vacation and benefits package; H-1B and J-1 opportunity KRC Hematologist/ Oncologist for 120-bed, hospital-based regional health center; serves an 8-county population of approx. 186,000 people; physician needed to diagnose and treat tumors, and blood and blood-forming tissue disorders; call is no more than 10 days/month; salary is competitive and negotiable; strong vacation and benefits package; KRC Pulmonologist/Critical Care for multi-specialty group with internal medicine, cardiology, gastroenterology, oncology, and pulmonary/critical care specialties; call is no more than 10 days/month; salary is competitive and negotiable; strong vacation and benefits package; KRC Pharmacist with Kansas licensure for 150-bed hospital-based regional health center; pharmacist prepares and dispenses drugs, monitors patient drug therapies, and provides drug information; hospital uses electronic MAR and bed-side verification; currently 4 pharmacists on staff; salary is competitive and negotiable; full benefits KRC Physician Assistant to support interventional cardiologist developing heart program within 150-bed, hospital-based regional health center; experienced and new grads are encouraged to apply; salary is competitive and negotiable; full benefits KRC Oral and Maxillofacial Surgeon for group practice, with opportunity for partnership; call is no more than 10 days/ month; salary is competitive and negotiable; strong vacation and benefits package available; KRC Family Physician for 40-bed CAH; hospital services include ER, swing bed, Oncology Nursing, outpatient IV therapies, specialty clinics, PT, OT, and speech therapy; physician can be employed by hospital or join a group; salary is competitive and negotiable; full benefits; H-1B and J-1 opportunity Continued 9

10 KRC Pharmacist registered pharmacist for 91-bed hospital; currently 1 pharmacist, 2 RNs, 1 pharm tech, and 3 support staff; experienced as well as new grads encouraged to apply; salary is $62940-$93163 depending upon experience; full benefits KRC Infectious Disease for 120-bed, hospital-based regional health center; serves pop. Of 186,000; physician to direct care of patients with acute or chronic infectious diseases including HIV/AIDS, tuberculosis, and osteomyelitis; salary is competitive and negotiable; strong vacation and benefits package; H-1B and J-1 visa opportunity KRC C Family Physician to join established, hospital-owned and managed practice, located in new clinic on hospital campus; physician will join two other physicians in the Rural Health Clinic; call is 1:5; family physicians perform ER coverage; salary is $150,000- $160,000; full benefits NORTHWEST KRC Orthopedist 2 positions available for group practice; 190+ bed stateof-the-art medical center with an in-clinic MRI and wellness facility; 90 physicians on active medical staff; salary negotiable; benefits; H1-B and J-1 opportunity KRC Plastic Surgeon 190+ bed state-of-the-art medical center with new wellness facility; currently 90 physicians on active medical staff; salary negotiable; benefits KRC Gastroenterologist 190+ bed state-of-the-art medical center with new wellness facility; currently 90 physicians on active medical staff; salary negotiable; full benefits; KRC Nephrologist 190+ bed state-of-the-art medical center with new wellness facility; currently 90 physicians on active medical staff; salary negotiable; full benefits; KRC Family Physician with OB, prefer c-section certified; 25-bed CAH; currently 3 physicians and 1 mid-level; call is 1:4 as secondary to ARNP (primary ER call); full service hospital including med/surg acute care, OB/nursery, ER, outpatient, surgery/recovery, diagnostic imaging, lab, PT, RT, inpatient pharmacy, ambulance, specialty clinic, primary care clinic; salary includes base + productivity 10 Kansas c o n n e c t i o n s incentive, approximately $150,000+ depending on OB and procedures; full benefits; H-1B opportunity KRC Respiratory Therapist 25- bed CAH that includes a 2 physician hospitalbased clinic and a 68-bed long term care facility; hospital services include acute care, swing bed, OB, diagnostic, lab, respiratory, specialty clinic, ER, and ICU; staff includes 2 full time therapists and 3 prn therapists; daily average of 15 patients; rotating call; open to experienced therapists and new graduates and CRTT or RRT KRC General Surgeon 190+ bed, state of the art medical center and wellness facility; currently 90 physicians on staff; call time is 1:3; salary is negotiable; benefits; H-1B and J-1 opportunity KRC Internist 190+ bed, state of the art medical center and wellness facility; currently 90 physicians on staff; call is 1:5; salary is negotiable; benefits; an outstanding hospital in a positive and progressive environment; KRC Family Physician without OB for 190+ bed, state of the art medical center and wellness facility; currently 90 physicians on staff; call is 1:6; salary is negotiable; benefits; an outstanding hospital in a positive and progressive environment KRC C Family Physician for 25- bed CAH; OB preferred; rural health clinic onsite (4-day schedule); currently 3 family physicians, 1 general surgeon, 1 mid-level on staff; call is 1:5 ER and 1:3 OB; hospital services include acute care, intermediate care, ER, lab, x-ray, PT, RT, specialty clinics, cardiac rehab, skilled nursing, and chemotherapy administration; salary is $140,000-$150,000 + incentives; full benefits; J-1 and H-1B opportunity KRC Family Physician for hospital-based group practice; position is combo of outpatient services in a new rural health clinic and inpatient services in the 25-bed CAH; currently 2 physicians in the group practice; call is 1:4; hospital will provide coverage every 5th weekend of the month; hospital services include acute care, swing bed, x-ray, CT, mobile sonography, lab, ER, home health, hospice outpatient clinics, surgery, PT, RT, and cardiac rehab; salary is $150,000-$175,000 with incentives; full benefits; J-1 and H-1B opportunity KRC Physician Assistant KRC Nurse Practitioner for hospital-based group practice; position is a combo of outpatient services in a new rural health clinic and inpatient services in 25-bed CAH; 2 physicians will be part of group practice; call is 1:4; hospital will provide coverage every 5th weekend of the month; hospital services include acute care, swing bed, x-ray, CT, mobile sonography, lab, ER, home health, hospice outpatient clinics, surgery, PT, RT, and cardiac rehab; salary is competitive; full benefits KRC C Family Physician for 25-bed CAH with a 33-bed long term care unit; 2 clinics - one in town, and one 15 miles away; new physician will work in the clinic 4.5 days and will round on long term care patients, and on their hospital patients; OB preferred, but not required; no high-risk OB; currently 1 physician (does OB), 1 NP, and 2 PAs on staff; call is 1:4 with 2nd call backup for the PAs; hospital services include acute care, ER, minor surgery, OB, EECP, PT, OT, and speech; salary is $150,000-$165,000, full benefits; H-1B and J-1 opportunity KRC Physical Therapist for 25-bed CAH; building new hospital; 1 PT and 1 PTA on staff; responsibilities include evaluation, planning and administering therapy treatment to an avg. of 20 patients/day; hospital services: lab, OB, PT, stress testing, cardiac rehab, diagnostic imaging, CT, MRI, EKG, nuclear medicine, ER, ultrasound, and general surgery; 4 satellite clinics; experienced and new graduates encouraged to apply; must have Kan. licensure or be eligible; salary is negotiable; full benefits KRC Anesthesiologist to join group of 4 anesthesiologists; group has exclusive agreement with hospital to provide services; currently 4 physicians and 6 CRNA s; 193-bed hospital provides cardiothoracic surgery, general surgery, orthopedics, peds, OB, internal medicine, pulmonology, neurology, and family medicine; salary is $250,000; full benefits; KRC C Family Physician w/o OB for a health center that operates a 24-bed CAH, 2 rural health clinics, 8 specialty clinics, and a retirement community; the family physician sees patients in a rural health clinic setting and long-term care facility, and participates in the admission and delivery of inpatient care; call is no more than 1:3 ½ ; currently 3 full-time providers on staff; salary is $150,000-$170,000 + productivity bonus starting 2nd year + Continued

11 $10,000 sign-on bonus; excellent benefits; H- 1B and J-1 opportunity KRC C Internist for health center; to see patients in a rural health clinic setting and long-term care facility, and participate in the admission and delivery of inpatient care; call is no more than 1:3 ½ ; 3 full-time providers on staff; salary is $150,000-$170,000 + productivity bonus 2nd year + $10,000 sign-on bonus; excellent benefits; KRC Family Physician w/o OB for 18-bed CAH; patient population is pediatric thru geriatric in variety of settings; hospital services include lab, x-ray, rehab, mobile CT & MRI, interactive TV, and EMR equipment; excellent opportunity with an up-and-coming rural healthcare facility; currently 1 physician and 1 mid-level on staff; call is 1:3 with ER; flexible schedule; salary is $120,000+ with sign-on and production bonuses; full benefits; KRC Internist for 18-bed CAH; patient population is pediatric thru geriatric in variety of settings; hospital services include lab, x-ray, rehab, mobile CT & MRI, interactive TV, and EMR equipment; excellent opportunity with an up-and-coming rural healthcare facility; 1 physician and 1 mid-level on staff; call is 1:3 with ER; flexible schedule; salary is $120,000+ with sign-on and production bonuses; full benefits; KRC Pediatrician for 18-bed CAH; patient population is pediatric thru geriatric in variety of settings; hospital services include lab, x-ray, rehab, mobile CT & MRI, interactive TV, and EMR equipment; excellent opportunity to learn and grow with an up-andcoming rural healthcare facility; currently 1 physician and 1 mid-level on staff; call is 1:3 with ER; flexible schedule; salary is $120,000+ with sign-on and production bonuses; full benefits; KRC Medicine-Pediatrics for 18-bed CAH; patient pop. is pediatric thru geriatric in variety of settings; hospital services: lab, x-ray, rehab, mobile CT & MRI, interactive TV, and EMR equipment; excellent opportunity; 1 physician and 1 mid-level on staff; call is 1:3 with ER; flexible schedule; salary is $120,000+ with sign-on and production bonuses; full benefits; KRC Family Physician w/o OB, outpatient and inpatient caseload; 24-bed CAH with a rural clinic on-site; hospital services: outpatient surgery, med surg, CT, lab, and radiology; 2 internists on staff; call is 1:3 and includes ER; salary is competitive and negotiable; full benefits; KRC Pulmonologist/Critical Care Physician for 2 physician team, practice attached to hospital; the 190+ bed stateof-the-art medical center s services include pulmonary/critical care, sleep lab, cardiology, cardiac surgery, orthopedics, OB/GYN, general surgery, internal medicine, neurology, infectious disease, urology, pediatrics, and oncology; currently 90 physicians on staff; call is 1:3; salary is competitive and negotiable; full benefits; KRC Physician Assistant KRC Nurse Practitioner for 24- bed CAH, rural health clinic on-site; outpatient and inpatient caseload; hospital services: outpatient surgery, med surg, CT, lab, and radiology; 2 internists on staff; this position responsible for participating in call coverage; competitive salary is negotiable; full benefits KRC Radiologist for well-established, hospital-based, state-of-the-art medical center and wellness facility; currently 90 physicians on staff; call is 1:4; salary is negotiable; full benefits; positive and progressive environment; KRC Radiologic Technologist for 25-bed CAH serving a tri-state area; diagnostic imaging dept. features x-ray, CT, mammography, ultrasound, dexa-scan, and mobile MRI & nuclear medicine; 4 full-time and 2 part-time radiographers on staff; experienced and new graduate encouraged to apply; must have AART (CT) certification; additional certification in other modalities preferred; call includes 1 day/week and every 5th weekend; salary is $34,320-$45,660; full benefits KRC Family Physician for group practice in 24-bed CAH and 36-bed long term care unit; currently 3 family physicians and 1 NP on staff; family physician will work in clinic w/in walking distance of hospital; call is 1:4 days; hospital services include OB, OR, OP, CT, PT, RT, mammography, and cardiac rehab; 1 satellite facility; salary is $100,000; loan repayment and relocation available KRC Physician Assistant to support Cardiologist within a 190+ bed, stateof-the-art medical center and wellness facility; experienced Pas and new grads encouraged to apply; currently 90 physicians on medical staff; salary is competitive and negotiable; full benefits; outstanding hospital in a positive and progressive environment KRC C Family Physician w/ OB for newly remodeled rural health clinic on campus of 25-bed CAH; currently 2 physician and 2 mid-levels on staff; ER call is 1:5 and OB call is 1:3; C-section ability a plus; hospital services include 16-slice CT, on-site MRI, CRNA and orthopedic surgeon; salary is $170,000- $200,000; full benefits SOUTH CENTRAL KRC Family Physician w/o OB; 2 physicians and 1 NP on staff, 24-bed CAH with on-site clinic; hospital services: CT, travel MRI, Dexxa, full-service surgery; salary: $130,000-$140,000 (2 yr. contract); relocation and CME allowance; possible loan repayment KRC Pediatrician group practice in a peds-only clinic connected to 82-bed hospital with Level 2 nursery (gestation not < 32 wks); complete EMR/HER; 3 pediatricians, 1 ARNP; call 1:4 weekdays, 1:4 weekends; salary: $116,000; full benefits, production after one year; part-time considered KRC C Internist KRC C Family Physician w/o OB for 25-bed CAH; hospital services: acute care, swing bed, lab, x-ray, PT, OT, 24-hour ER, mobile CT scan, ultrasound, mammogram, and bone density screening; call is 1 evening/week and 1:5 weekends; salary: $150,000-$160,000 with up to a 2 year contract; full benefits; H-1B and J-1 opportunity KRC Registered Nurse hospital based rural health clinic connected to a 25-bed CAH; prefer acute care or surgery experience in hospital setting; will consider new graduates; day shift (7:00am-3:00pm); 2.2 FPs and 1 PA on staff; hospital services: x-ray, CT, ultrasound, lab, surgery, specialty clinics, mobile MRI, and telerad; salary: $33,800-$44,000; benefits KRC Family Physician w/o OB for hospital-based rural health clinic connected to a 25-bed CAH; 1 offsite rural clinic; 2.2 FPs and 2 PA s on staff; backup call only; hospital services: x-ray, CT, ultrasound, lab, surgery, specialty clinics, mobile MRI, and telerad; salary: $145,000-$160,000; full benefits Continued 11

12 KRC Family Physician new position with or w/o OB; based in a new rural health clinic across the street from the hospital; the 25-bed CAH s services include ER, OR, lab, x-ray, MRI, CT scan, ultrasound, RT, PT, OT, speech therapy, EKG, EEG, and sleep studies; no call on weekends, during the week, call is 1:3; salary: $140,000-$160,000; full benefits; KRC C Otolaryngologist for new group practice; strong physician support for ENTs; the 105-bed hospital s services include pediatrics, OB, general surgery, medical, ICU, inpatient rehab, gero-psychiatry unit, and ER; call would not exceed 10 days/mo; salary is competitive and negotiable; full benefits; H-1B and J-1 opportunity KRC C Family Physician w/o OB for 25-bed CAH with attached clinic; 1 physician, 1 general surgeon, and 2 mid-levels on staff; call is 1:4; to be responsible for patient care at clinic, hospital rounds, and ER call; hospital services: general acute, skilled, intermediate care, CT, and PT; salary is $170,000- $200,000; full benefits; H-1B opportunity KRC C Director of Physical Therapy for 25-bed CAH with 3 rural health clinics and a home health dept; responsibilities: overseeing PT dept, providing PT to inpatient, outpatient, and home health patients, and paperwork to bill for services rendered; currently a contract therapist and PTA on staff; avg. of 10 patients/day; experienced therapists preferred, new grads considered; hospital services: acute care, swing bed, long-term care, home care, and outpatient; salary is $47,000-$73,000 depending on experience; benefits KRC C Urologist for progressive multi-specialty group practice; salary is $350,000 (guaranteed first year), with possible production bonus; excellent benefits KRC C Orthopedist for progressive multi-specialty clinic; salary is $350,000 (guaranteed first year), with possible production bonus; excellent benefits KRC Internist for patient-centered, family-focused, hospital-based rural health clinic; clinic is connected to a 25-bed CAH; 2.2 family physicians and 2 PAs on staff; unless the physician has an interest in primary call coverage, the call responsibility is based on backup coverage; hospital services: x-ray, CT, ultrasound, lab, surgery, specialty clinics, 12 Kansas c o n n e c t i o n s mobile MRI, and telerad; salary is competitive and negotiable; full benefits KRC Physician Assistant w/o OB for 25-bed CAH with attached clinic; 1 physician, 1 general surgeon, and 1 mid-level on staff; call is 1:4; the PA is responsible for providing patient care at the clinic, performing hospital rounds, and ER call; hospital services: general acute, skilled, intermediate care, ancillaries including in-house CT, and on-staff PTs; salary is $65,000-$75,000; benefits KRC Registered Nurse for family-focused, hospital-based rural health clinic connected to 25-bed CAH; 2.2 family physicians and 2 PAs on staff; hospital services: x-ray, CT, ultrasound, lab, surgery, specialty clinics, mobile MRI, and telerad; shift supervisor position available as well as full- and part-time opportunities for RNs; will consider new grads; salary is competitive; full benefits KRC C Internist for progressive multi-specialty group practice; call will vary w/ 4 other internists; established patient base; 11 specialties, 23 physicians, and 5 mid-levels on staff; salary is $120,000 (guarantee 1st yr) + production bonus; excellent benefits; H-1B opportunity KRC Physician Assistant KRC Nurse Practitioner for community health clinic; currently 3 physicians, 5 PAs and 1 ARNP on staff; caseload consists of birth to geriatric; clinic hours: M-F 8am-5pm; no call; clinic is located on campus of 420-bed hospital; salary is $45,000-60,000; full benefits; H-1B and J-1 visa opportunity KRC Family Physician for community health clinic with 2 pediatric satellite clinics; currently 3 physicians, 5 PAs and 1 ARNP on staff; caseload consists of birth to geriatric; clinic hours: M-F 8am-5pm; no call; clinic is located on campus of 420-bed hospital; salary is $95, ,000; full benefits; H-1B and J-1 visa opportunity KRC Family Physician w/o OB for growing community health center; physician will spend majority of time in the clinic with some supervisory duties of mid-levels; currently 1.5 mid-levels and 1.7 physicians on staff; facility is new with all new equipment; prefer physician willing to accept call; salary is $110,000-$140,000; excellent benefits KRC Physician Assistant for busy community health center; currently 1.5 mid-levels and 1.7 physicians on staff; facility is new with all new equipment; call is included, but is only via telephone; salary is $52,000- $61,648; benefits; experienced and new grads encouraged to apply SOUTHEAST KRC Orthopedist group practice, 2 orthopedic surgeons looking for 3rd partner; 1 mid-level, office manager, 2 rad techs, 1 orthopedic nurse on staff; office located in a 100+ bed hospital, recently announced $20 million expansion; salary $350,000; benefits KRC Anesthesiologist with Pain Management office located in hospital; 3 orthopods on staff want to open a pain management clinic; option to work as a solo physician or be hospital-employed; 100+ bed hospital, recently announced $20 million expansion; 37 physicians representing over 15 medical specialties; salary is negotiable; benefits KRC Non-Invasive Cardiologist 100+ bed hospital, recently announced $20 million expansion; 37 physicians representing over 15 medical specialties; option to work as an independent practitioner or be hospital-employed; salary is negotiable; benefits KRC Physiatrist 100+ bed hospital, recently announced $20 million expansion; 37 physicians representing over 15 medical specialties, 3 orthopedic surgeons; option to work as an independent practitioner or be hospital-employed; salary is $250,000 min. w/ yearly performance incentive bonus; benefits KRC Internist multi-specialty group with 4 satellite clinics; staff includes: 6 family physicians, 1 pediatrician, 2 internists, 2 general surgeons, 1 urologist; the clinic offers a full spectrum of care such as family medicine including OB, physical exams and sports physicals, lab and x-ray, EKG testing and bone density studies, minor surgery, wellness exams and preventative medicine, osteopathic manipulations, PT, diabetic education, cancer center; salary is negotiable; full benefits KRC C Obstetrician/Gynecologist can be an independent practitioner or employed by 109-bed hospital; 37 physicians representing over 15 medical specialties; OB unit undergoing renovations central monitor- Continued

13 ing and electronic medical records to be added; approx 300 deliveries/year; level I nursery; 1 OB/GYN and 2 family physicians (perform OB) on staff; salary: $250,000 + sign-on bonus; benefits and vacation if employed by the hospital KRC Physician Assistant for group practice; currently 3 physicians, 3 NP s and 1 PA on staff; salary is $65,000 + signing bonus; vacation includes 12 days/year, 10 paid holidays, and 12 days sick leave; full benefits KRC Nurse Practitioner for group practice; currently 3 physicians, 3 NP s and 1 PA on staff; salary is negotiable; vacation includes 12 days/year, 10 paid holidays, and 12 days sick leave; full benefits KRC C Internist can be independent practitioner in group practice or employed by hospital; position provides outpatient services only; 109-bed acute, intensive and skilled care hospital; 37 physicians representing 15+ medical specialties; salary is $160,000- $170,000 + sign-on and incentive bonuses; benefits and paid vacation if employed by hospital KRC C Hospitalist can be independent practitioner or employed by hospital; patient load will max at 25; 109-bed acute, intensive and skilled care hospital; 37 physicians representing 15+ medical specialties; salary: $170,000-$180,000 with a yearly performance incentive bonus + sign-on bonus; benefits and paid vacation if employed by hospital KRC C Emergency Medicine for family physician, internist, or emergency medicine physician; 109-bed acute, intensive and skilled care hospital; 37 physicians representing 15+ medical specialties; ER sees an avg. of 900 visits/mo.; 3-bed multi-care area, cardiac room, trauma room, and orthopedic room; applying for Level 3 trauma designation; 3 ER physicians forming an LLC; ideally, 4 full-time physicians will provide coverage 24/7 with 12 hour shifts (4 days on, 4 days off); salary is $118/hr for non-er certified and $125 for ER board certified; sign-on bonus available KRC C General Surgeon can be independent practitioner or employed by hospital; 109-bed acute, intensive and skilled care hospital; 37 physicians representing 15+ medical specialties;or undergoing extensive renovations, resulting in 4 OR suites and 2 procedure rooms; approx. 400 surgeries/mo.; salary is $250,000-$350,000 + sign-on bonus; benefits and paid vacation if employed by hospital KRC C Pulmonologist for 148-bed licensed, 105-bed operating medical center; hospital services: acute care, skilled nursing, OB/GYN, ICU, ER, behavioral health, surgery, all clinical ancillary services, and cancer treatment center; not a hospital employee, but will be provided a salary guarantee; benefits KRC C Otolaryngologist for 148-bed licensed, 105-bed operating medical center; hospital services: acute care, skilled nursing, OB/GYN, ICU, ER, behavioral health, surgery, all clinical ancillary services, and cancer treatment center; not a hospital employee, but will be provided a salary guarantee; benefits KRC C Family Physician for busy rural health clinic; 1 family physician, 1 NP, 1 practice administrator, and 1 office coordinator on staff; admitting 25-bed licensed inpatient acute care CAH directly across street; salary is competitive and negotiable; great benefits KRC Family Physician KRC Internist for federal clinic; 70 staff members including 3 physicians, 3 NPs, and 1 PA; call is included; salary is $130,000- $136,000; great benefits SOUTHWEST KRC Family Physician federally qualified community health center, 3 satellites; current staff: 1 physician and 8 mid-levels; no call coverage, no weekends, salary negotiable, benefits; KRC Urologist for multi-specialty group with 27 physicians and 11 specialties; large service area with many referrals; 3 satellite facilities; 100-bed hospital s services: ER, lab, x-ray, CT, MRI, OB, peds, new cardio and ICU services; salary is competitive and negotiable; full benefits; KRC Registered Nurse 25-bed acute care setting including swing bed unit and ER; experienced nurses and new graduates encouraged to apply; ASN or BSN acceptable; 12-hour evening shift 3 days a week; salary depends on experience; benefits KRC Registered Nurse nursing home unit; experienced nurses and new graduates encouraged to apply; ASN or BSN acceptable; 12-hour evening shift 3 days a week; salary is negotiable; benefits KRC Lab Tech 25-bed acute care setting with swing bed unit and ER; first shift; will cross-train into radiology with training provided if needed; salary is negotiable; benefits KRC C General Surgeon 45-bed county owned, not-for-profit, rural hospital; 2 physicians and 1 PA on staff; call negotiable; hospital services: radiology, lab, OB, ER, mobile MRI, CT, swing bed, acute care, general surgery, pediatric care, RT, ICU, home health, and PT; salary is $250,000-$300,000; full benefits KRC Family Physician 25-bed hospital; patient care provided at clinic and extended care facility; hospital services: general medical-surgical, skilled nursing, ER, OB, geriatrics, inpatient, outpatient, and long term care; 1 family practitioner, 1 part-time general surgeon, and 1 NP on staff; call 1 week every 3-4 weeks; salary is $150,000-$170,000; benefits KRC Physician Assistant KRC Nurse Practitioner for 25- bed hospital; patient care provided at the clinic and extended care facility; patient caseload includes women s health, child health, diabetic care, and ER; currently 1 family practitioner, 1 part-time general surgeon, and 1 NP; salary range: $70,000-$95,000; benefits KRC Nurse Practitioner KRC Physician Assistant community health center with 3 satellite facilities; 1 physician, 6 NPs, 2 PAs, and 1 volunteer physician on staff; no call coverage or weekends; salary range is $58,000, negotiable; full benefits KRC C Family Physician w/o OB for multi-specialty group practice; strictly outpatient, clinic-based; 2 family physicians, 5 internists, and 3 pediatricians on staff; call is shared with family physicians and internists; the 132-bed admitting hospital s services: acute care, OB, emergency medicine, surgery, oncology, rehab, wound care, cardiology, orthopedics, and neurology; salary is $150,000; full benefits KRC C Obstetric Nurse for 45-bed, county owned, not-for-profit, rural hospital; should have at least 2 years experience and eligible for KS licensure; required certifications ACLS, NRP, BCLS, PALS; 3 FT nurses and 2 prn nurses; hospital services: radiology, Continued 13

14 lab, OB, ER, MRI (mobile), CT, acute care, swing bed, general surgery, pediatric care, RT, ICU, home health, and PT; salary is $37,000- $48,000; full benefits KRC Physical Therapist for a new 20-bed CAH and 43 bed long-term care unit; under direction of an experienced PT, this PT will provide services for post-op orthopedic patients, athletic injuries and geriatrics; experienced therapists and new grads encouraged to apply; Director, PTA, and an aide currently on staff; hospital services include orthopedic surgery, swing bed, CT scan, ultrasound, home health and long-term care; salary is $62,000- $83,000; full benefits KRC Dermatologist for multi-specialty group with 27 physicians and 11 specialties; large service area with many referrals; group also supports 3 satellite facilities including an urgent care clinic; the local 100-bed hospital s services include ER, lab, x-ray, CT, MRI, OB, peds, new cardio and ICU services; salary is competitive and negotiable; full benefits; KRC Family Physician without OB to treat patients in an inpatient or outpatient setting; currently 2 PA s and 2 part-time physicians on staff; call is 1:3; outpatient clinics have a podiatrist, cardiologist, and chiropractor on staff; hospital consists of 12 beds, 35-bed long-term care unit, and a rural health clinic; hospital services: PT, lab, x-ray, ER, acute care, home health; salary is negotiable and competitive; full benefits KRC C Pharmacist solo position available in a 45-bed county owned, not-forprofit, rural hospital; experience preferred but new grads encouraged to apply; PharmD required and must be KS licensed or eligible; hospital is currently contracting with a local pharmacist; hospital services include radiology, lab, OB, ER, MRI, CT, acute care, general surgery, pediatric care, RT, ICU, home health and PT; salary is $75,000-$110,000; full benefits KRC C Family Physician for growing multi-specialty group practice; family medicine, general surgery, OB/GYN; position is w/o OB, but if there is a strong interest, there may be flexibility; currently 3 physicians and 1 mid-level on staff; call is 1:3 (no ER); caseload primarily outpatient; 100-bed hospital is 1 block away and is a full service acute care center; salary is $135,000+; full benefits; H-1B and J-1 opportunity KRC C Medicine-Pediatrics position at growing multi-specialty group practice; group specialties: family medicine, general surgery, OB/GYN; currently 3 physicians and 1 mid-level on staff; call is 1:3 (no ER); caseload primarily outpatient; 100-bed hospital is 1 block away and is a full service acute care center; salary is $135,000+; full benefits; H-1B and J-1 opportunity KRC Endocrinologist for multispecialty group housing 25 physicians with 11 specialties; serves the endocrine needs of 24 counties; 2 satellite facilities; proud of their highly complex lab and radiology/nuclear medicine depts; call is 1:6; 100-bed hospital is 3 blocks away and includes ER, lab, x-ray, CT, MRI, OB, peds, new cardio and ICU services; salary is $180,000 depending on experience; full benefits; KRC Rheumatologist for multispecialty group housing 25 physicians with 11 specialties; large service area w/ many referrals; 2 satellite facilities; proud of their highly complex lab and radiology/nuclear medicine depts; call is 1:6; 100-bed hospital is 3 blocks away and includes ER, lab, x-ray, CT, MRI, OB, peds, new cardio and ICU services; salary is $180,000 depending on experience; full benefits; KRC Pulmonologist for multispecialty group housing 25 physicians with 11 specialties; large service area w/ many referrals; 2 satellite facilities; proud of their highly complex lab and radiology/nuclear medicine depts; call is 1:6; 100-bed hospital is 3 blocks away and includes ER, lab, x-ray, CT, MRI, OB, peds, new cardio and ICU services; salary is $180,000 depending on experience; full benefits; KRC Gastroenterologist for multi-specialty group housing 25 physicians with 11 specialties; large service area w/ many referrals; 2 satellite facilities; proud of their highly complex lab and radiology/nuclear medicine depts; call is 1:6; 100-bed hospital is 3 blocks away and includes ER, lab, x-ray, CT, MRI, OB, peds, new cardio and ICU services; salary is $180,000 depending on experience; full benefits; KRC Medicine-Pediatrics to treat patients in inpatient and outpatient setting; currently 2PA s and 2 part-time physicians on staff at hospital; call is 1:5; outpatient clinics have a Podiatrist, Cardiologist, and Chiropractor on staff; hospital services include PT, lab, x-ray, ER, acute care, swing bed, home health and independent living apts; salary is negotiable and competitive; full benefits KRC Physical Therapist for 45-bed county owned, not-for-profit- rural hospital; dept. treats 5-10 patients/day; candidates should have at least 1 year of experience and preferably hold KS licensure; hospital services include radiology, lab, OB, ER, MRI, CT, swing bed, acute care, general surgery, pediatric care, RT, ICU, home health, and PT; salary is negotiable KRC Family Physician with or w/o OB for multi-specialty group w/ 23 physicians and 11 specialties; currently 2 physicians and 1 NP; call is 1:3; local 100-bed hospital is 3 blocks away and includes ER, lab, x-ray, CT, MRI, OB, Peds, new cardio and ICU services; salary is competitive and negotiable, full benefits; KRC C Obstetrician/Gynecologist for growing multi-specialty group practice with the following specialties: family medicine, general surgery, and OB/GYN; currently 3 physicians and 1 mid-level on staff; call is 1:3 (no ER); caseload is primarily outpatient, but physicians follow their admitted patients at the local hospital; the 100-bed admitting hospital is 1 block away; salary is $135,000+; full benefits; KRC C Internist for growing multi-specialty group practice with the following specialties: family medicine, general surgery, and OB/GYN; currently 3 physicians and 1 mid-level on staff; call is 1:3 (no ER); caseload is primarily outpatient, but physicians follow their admitted patients at the local hospital; the 100-bed admitting hospital is 1 block away; salary is $135,000+; full benefits; H-1B and J-1 opportunity KRC Physician Assistant for family physician w/o OB; currently 2 Pas and 2 part-time physicians (contracted) on staff; hospital consists of 12 acute/swing beds, 35-bed long term care unit, and a rural health clinic; hospital services include PT, lab, x-ray, ER, acute care, home health, and independent living apartments; contracted services: speech therapy, sonograms, and bone densitometry; salary is $75,000; benefits Candidates looking for job opportunities in Kansas can access those listed by the KRC by visiting ruralhealth.kumc.edu on the Web.

15 Stories from Greensburg: Greensburg health department carries on Mitzi Hesser, health department administrator, talks with Gov. Kathleen Sebelius. When Mitzi Hesser, RN and administrator of the Kiowa County Health Department, came up out of her family s underground safe room 45 minutes after the tornado had passed, it was pitch black so she had only a vague idea of the devastation that surrounded her. Mitzi s family began walking toward Highway 54 and were astounded by the solid mass of flashing red lights from ambulances, fire trucks and highway patrol cars coming at them. Not until she went into triage mode and saw people she knew from all parts of town did she realize what a large area had been devastated. Normally, the tendency is to think things will look better in the morning, but they didn t, they looked much worse, she recalled. The fact her house was destroyed didn t deter her from setting up a tent in its front yard, rolling up her sleeves and attempting to carry out public health duties. As she helped people who d lost their medications and directed volunteer nurses, she answered her own family s questions as they went in and out of their house trying to salvage items. Their house was across the street from the health department, which was located in the basement of the county courthouse. While the courthouse was still standing, the computers and records in the basement were badly damaged. Volunteer nurses showed up to help and they pushed grocery carts through the ruins giving tetanus shots to workers and passing out gloves, masks and hand sanitizers. They eventually gave 4,500 shots, a challenge without refrigeration for the vaccine. At the tent workers fielded a constant stream of questions from people about various health concerns, including water quality and disposing of rotting food. Even though they were operating out of makeshift quarters, Hesser instructed her staff that they were not allowed to tell anyone they could not help them. If you can t answer their question -- whether it s about housing, health or finances -- you have to find someone who can even if it means literally walking them over to the city building, she said. The health department operated out of the tent for several days and then a camper for three weeks. The mobile unit had a generator but I had to learn how to run a generator, she said, laughing. They didn t cover pitching a tent or running a generator in nursing school. I learned all kinds of stuff in those first two weeks. After the health department moved into a modular home they got phone service and internet back, and a company in Wichita was able to restore much of the computer data. But much of the rest was either wet or blown away, she aid. It took several weeks before we got up and running. For the most part we were doing almost everything we normally did and providing all the services, but it wasn t as easy. She expects to operate out of three modular homes for the next year and a half until the courthouse can be repaired and they can move back in. As for her own home, it s now in a FEMA trailer south of town. Hesser has been with the health department since 1979 and administrator since Prior to the tornado the department had four staff members; all lost their homes and one has since moved away. We take one day at a time, she said. We don t know where we ll rebuild. There s been no time to think about that. The Kiowa County Memorial Hospital also doesn t know yet what its rebuilding plans are. Since May 11 the hospital has operated out of a field hospital deployed and set up by the Kansas National Guard s Expeditionary Medical Support System. Twelve trucks transported the pre-packaged units from Continued on page 17 15

16 16 Kansas c o n n e c t i o n s Study Finds Rural Physicians Satisfied but Numbers Declining Arecently published paper by the National Rural Health Association concludes that rural physicians still have increasing levels of satisfaction because they feel their services are essential and deeply appreciated by their communities. In addition, rural physicians derive satisfaction from the ability to practice a broader range of primary care and the fact they get to know their patients over time, unlike urban physicians. However, the paper, Recruitment and Retention of a Quality Workforce in Rural Areas, noted the number of medical school graduates going into family medicine continues to decline, which exacerbates the problem of attracting physicians to rural communities. Family medicine graduates compose 90 percent of current rural primary care physicians. This artical is intended to be the first in a series of policy papers on the rural health career pipeline. This first issue focuses specifically on primary care medicine. The paper highlighted the results of a recent physician survey and included a series of recommendations on methods to enhance the pipeline of students choosing primary care. There has been a 30-year decline in interest in family medicine related to U.S. medical students being less rural and less connected to state and local areas, according to the paper. While 25 percent of the U.S. population lives in rural communities, only 10 percent of physicians in primary care work in these rural communities. As physicians are becoming increasingly specialized, they are less likely to practice in a rural community. While the NRHA paper concluded that overall there seemed to be no improvement in the downward trend for medical students to choose primary care, the University of Kansas School of Medicine s efforts to reverse this trend were recently recognized by the American Academy of Family Physicians, which named the school as one of the nation s leading educators of family physicians. KU s three-year average of 21.7 percent of graduates going into family medicine residency programs made it the No. 1 medical school in the country for producing family medicine physicians, and the only school with a threeyear average greater than 20 percent. The award was particularly satisfying given the national trend of fewer family physicians, said Joshua Freeman, MD, professor and chair of the Department of Family Medicine, who sees family physicians as representing the first face of health care. Family physicians are also among the most versatile of health care providers, he said, which is of particular importance in Kansas where many smaller communities can only support one or two physicians, rarely being specialists. It has also been shown that primary care results in higher quality health care at lower costs than specialty care, he said. Kansas long tradition of family doctors has been supported by the legislature which has recognized the importance of educating primary care physicians, according to Freeman. One example is the state s Kansas Medical Student Loan Program, which is offered each year to 30 students who agree to practice in rural areas in exchange for forgiveness on their student loans. For primary care residents, the state offers the Kansas Bridging Plan which includes a stipend with an agreement to practice in a rural health setting. Training doctors to serve Kansas rural and urban communities has always been a primary mission of the KU School of Medicine, Freeman said. One of the reasons family medicine has continued to be one of the school s major programs, he said, is by drawing students from these very communities. The NRHA study concurred that attracting students from rural communities was one of the best ways to increase the odds of a medical student deciding to practice in a rural area. The paper reported 47 percent fewer rural-born medical students over the last 25 years and a decline of rural background admissions from 27 to 11 percent. Rural training tracts have the best record for Continued on next page

17 Study continued from page 16 placement of residents in rural areas, according to the NRHA research, which found that of the 474 family medicine training programs in the country, 143 had rural fellowships and 29 had rural training tracts. Rural training tracts have 76 percent of their graduates remaining in rural locations and 61 percent are in shortage areas. These physicians remain near their residency 45 percent of the time and 39 percent of them are near their hometowns. Other facts cited in the paper included: Medical school graduates sometimes choose specialty areas because of the large debt load they have upon graduation. Another disincentive to rural practice is that those areas tend to have a higher percentage of Medicaid and Medicare patients. Currently, over half of family medicine residency positions are occupied by students educated in other countries. In 2004 only 36 percent of the 936,000 physicians in the U.S. were in primary care. Ninety-seven percent of medical school education occurs in metropolitan areas and 90 percent of medical students are from urban areas. So it s no surprise that 90 percent of physicians choose to practice in urban areas. Improvement in rural health care is dependent on recruiting primary care and other providers, and recruitment is dependent on improving rural interest among medical students, the paper concluded. The authors recommended that medical schools select more students who are inclined to choose rural careers and that health careers programs in rural primary and secondary schools be emphasized. For a copy of the physician recruitment and retention article, visit org/advocacy/sub/issuepapers/physician-1.pdf. Greensburg continued from page 15 Topeka where they were housed at the 190th Air Refueling Wing. The Expeditionary Medical Support System will replace the hospital in Greensburg until a new facility can be constructed, according to Brig. Gen. Deborah Rose, director of Joint Forces Headquarters Kansas. The hospital lost virtually everything. The Expeditionary Medical Support System has equipment and space for just about any service a regular hospital provides surgery, dental care, laboratory services, pharmacy, supply and in-patient care. Some days are harder than others, Hesser admitted. Since we re shortstaffed we ve all had to pick up and do more than we had to before. It s a personal struggle as well. It takes its tolls some days but we ve held on. Each of us knows there are good days and bad days, and we try to be upfront with each other. We just have kind of accepted that s how it s going to be. Following the tornado, the Kiowa County Health Department operated out of a tent and then a camper. 17

18 2007 Rural Kansas Photo T he 2007 Rural Kansas Photography Contest, presented by the University on Kansas Medical Center, Rural Health Education and Services, had a number of wonderful entires. Photographs were submitted from across the state to create a collection of images that reflect why Kansas is a great place to live, work, and play. To view winning photographs and horable mention photos in color, visit Rural Landscape Community 1st Place Amanda Botterweck The House Ole Doc Jones Built, Chase County, Kan. 1st Place Lori Beikman, CCMC at Piotique Parade, Clay Center, Kan. 2nd Place Theresa Bedigrew Marching Band, Lawrence, Kan. 18 Kansas connections 2nd Place Rachael Barr Red Bud Reflection, Southern Morris County, Kan.

19 graphy Contest Winners Health Care 3rd Place Nancy Stucky Double Rainbows, Farm East of Kingman, Kan. 1st Place Marcia Newell Teddy Bear Clinic, Clay County Medical Center Recreation 1st Place Kenny Titus Fishing, Big Hill Lake 2nd Place Marcia Newell Student Nurse, Clay County Medical Center 2nd Place Evelyn E. Parker Hunting Dove, Ellsworth County, Kan. 19