Kansas is among the top states in the nation when it comes to placing its medical school students in rural areas and small towns.

Even more impressive are the number of students who remain in those areas after getting their start there.

But the future of medicine in sparsely populated areas of Kansas is somewhat in jeopardy, experts warn, as the state wrestles with Medicaid reimbursements that allow doctors and hospitals to remain solvent.

Michael Kennedy, a family practice doctor and associate dean for rural health education at The University of Kansas School of Medicine in Kansas City, Kan., is the caretaker of a number of programs that have proven highly successful at plugging students into some of the state's least populated areas.

Kennedy noted some of the programs started more than 50 years ago and continue to this day.

The KU Medical School has an enrollment of around 800 students. Students who commit to serving in a rural area or small town after their graduation can benefit from tuition assistance and stipends that can drastically reduce their debt.

Kennedy said the KU Medical School places a high priority on Kansas students filling its slots each year. More than 85 percent of the medical school's 211 incoming students each year are from Kansas.

"We want most of our students to have their homes in Kansas," Kennedy said, "because we know students from Kansas are more like to return to Kansas."

The medical school — which has campuses in Wichita and Salina in addition to its home base in Kansas City, Kan. — divides the state into six regions, said Kennedy, who also serves as assistant dean for student affairs at the medical school.

Those regions are northeast, southeast, north-central, south-central, northwest and southwest. Each one of those areas has its own director from the KU Medical School's faculty, Kennedy said.

Students are plugged into the various regions during their time at the KU Medical School. Some students spend a few weeks in a particular region, while others spend several months.

A key component to the program's success, Kennedy said, is the participation of some 250 rural preceptors who are "spread across Kansas."

The medical school students are assigned a preceptor to serve as a mentor while the students serve in one of the rural areas or small towns of Kansas. Some of the preceptors may take a single student under their wing during a given year, while others may work with as many as 10.

The students take on almost a rock-star status when they serve in one of the practices in a rural area of the state.

"The communities house the students," Kennedy said, "and many will feed the students."

The biggest benefit to the students, Kennedy said, is the opportunity for the medical school students to work one-on-one with the practicing physician. In many cases, those physicians have primary care practices.

"It's an extremely valuable learning experience for the students," Kennedy said.

One of the most successful initiatives sponsored by the KU Medical School's rural health education program is the Scholars in Rural Health program. Kennedy said this program is open to juniors in college who have applied for entrance into the KU Medical School. Students accepted as a Scholar in Rural Health gain 200 or more hours of "shadowing" a doctor in a rural area or small town.

The program started in 1999 with six students, Kennedy said. In the past two years, 16 students have taken part.

The success of the program shows up in the retention rates, Kennedy said. Some 80 percent of the program's graduates remain in Kansas, and two-thirds become primary care doctors. Even more impressive, some 60 percent of graduates elect to serve in rural areas following their graduation from medical school.

Another program that has proven dividends is the Summer Training Option in Rural Medicine — or STORM — which has been in existence for 26 years. It had its 699th participant last year and attracts roughly 30 students per year, Kennedy said.

Students participate in the program in the summer between their first and second years of medical school. The students receive hands-on experience, including everything from working in the emergency department to assisting with surgeries.

Kennedy said 16 students have gone back to practice at the sites where they did their STORM programs, and now are serving as preceptors for KU Medical School students.

Students in their third year of medical school can take part in the Rural Options Clerkships in Kansas — or ROCK — which takes them off-campus to work in a rural setting. The program started in 1997 and has had 490 students participate during its 21-year history. Like some of the other rural programs offered by the KU Medical School, ROCK offers students a chance to take part in family medicine practices, as well as in obstetrics, surgery and pediatrics.

"The students love it," Kennedy said. ""They get a fantastic experience."

The Rural Preceptorship program, targeting rural medicine, was started by Franklin Murphy as part of the Kansas Plan that was signed into law in 1949 by Gov. Frank Carlson. 

Kennedy said The University of Kansas School of Medicine has been one of only two medical schools in the nation to have a required rural preceptorship program lasting at least four weeks. The program has seen more than 17,000 participants since it started 70 years ago.

Kennedy said the intentional efforts of the three-campus system of the KU Medical School to address medical needs in Kansas have paid off in a big way. He noted the KU Medical School is in the 99th percentile of all medical schools in the nation in terms of placing students in family medicine, a vital specialty for rural areas and small towns in Kansas. The KU Medical School also ranks in the 94th percentile of graduates choosing to locate in rural settings.

Speaking for himself as a physician, and not as a representative of the KU Medical School, Kennedy said there are concerns regarding rural hospitals and access to care.

According to America's Health Rankings from the United Health Foundation Report, Kansas has slipped in medical ratings over the past couple decades, listed at 25th in 2017 compared to eighth in 1990, "which disturbs us greatly," Kennedy said.

The most important thing the state of Kansas can do, Kennedy said, is "expand Medicaid."

Such a move not only will lend stability to rural and small-town hospitals — some of which have closed and others on the brink of closure — but also show medical school students they will be able to set up "financially viable" practices in such areas.

"If they don't see a viable practice in rural Kansas," Kennedy said, "we've shot ourselves in the foot."