• Focus on Rural Health

    Full-scope Family Medicine Flourishes in Southwestern Kansas

    July 08, 2019 02:15 pm Sheri Porter Lakin, Kan. – It's 7 p.m. on a warm June evening in this town of 2,200 people near the Colorado border, and family physician Drew Miller, M.D., is tending to a child with a broken arm at the Kearny County Hospital ER, where he is on call. Fortunately, this emergency didn't present until Miller had finished assisting an FP colleague with a C-section.

    After one more ER call, Miller goes home to get some sleep before returning to the hospital the next morning to perform a 7 a.m. esophagogastroduodenoscopy and colonoscopy and check on several inpatients. That done, he crawls into his Jeep -- coffee in hand -- and drives 9 windy miles to the Deerfield clinic site to arrive in time for the first 9 a.m. appointment.

    This crazy schedule is the norm for Miller and the six other family physicians who staff the hospital and Lakin's Family Health Center clinic.

    AAFP News traveled to Lakin recently to see how family medicine is making a profound impact in this rural Kansas community.

    Saving Lives

    Miller came to Lakin in 2010 and has since amassed a lot of stories that illustrate how rural family physicians provide high-quality health care to patients, sometimes saving lives in the process.

    He recalls a local man who walked into the hospital ER a few years back complaining of chest pain. The patient coded, and his heart stopped beating shortly thereafter.

    "We shocked him eight times and did chest compressions for an hour. We gave nine doses of epinephrine and finally got a heart rhythm back with old-fashioned medicine -- lidocaine," says Miller.

    The patient needed immediate transport to the heart catheterization lab in Hays, Kan., 172 miles to the northeast, but a severe thunderstorm in the Lakin area made the usual air transport route impossible. So, Miller implemented an alternate plan.

    The EMS team drove him to Dodge City, Kan., nearly 80 miles away, where an air medical crew took over and flew him to Hays. "The patient underwent a successful heart catheterization and is doing great," says Miller.

    "He brings our family a turkey for Thanksgiving and a ham for Christmas every year just to say thanks.

    "If this facility had not been here, he would not have made it."

    Story Highlights

    Family physician Drew Miller, M.D., is one of seven FPs providing high-quality, full-scope health care, including delivering babies, in Lakin, Kan.

    Miller came to Lakin in 2010 and has delivered more than 500 babies in his tenure there.

    Miller's stories about providing health care in a rural town in southwestern Kansas illustrate how family physicians can keep entire communities healthy.

    Full-scope Practice

    Miller sees patients from 10 or more surrounding counties and provides prenatal to end-of-life care -- and everything in between. Full-scope family medicine is expected here, and all seven family physicians participate in every single part of it -- from delivering babies to performing procedures such as endoscopies, skin procedures, vasectomies, circumcisions and tubal ligations.

    Patients are seen in the main clinic that adjoins the hospital, the "west" clinic -- a repurposed military trailer that was transported from San Antonio and set down across the parking lot -- and the Deerfield clinic.

    Deerfield bustles today with two family physicians, staff and patients. There's an abundance of babies brought in by their proud mamas for 2-month, 4-month and 10-month checkups. Miller has a large pediatric practice -- not surprising for a physician who's delivered more than 500 babies in the past nine years.

    As Miller moves between exam rooms, he provides encouragement to patients and their families, whether he's assessing an infant's growth rate or noting improvement in a patient's HbA1c levels. "This makes me happy," is a phrase he uses often as he finishes up a visit.

    When there's a break between appointments, Miller takes time to talk about what's going on with health care in Lakin.

    The hospital can't handle everything, he explains. It doesn't have an ICU, so physicians transfer critical-care patients and those with acute cardiac events to Garden City, Wichita or Hays. "And we don't do deliveries before 35 weeks' gestation, so if a mom's in preterm labor, we'll try to get her out," says Miller.

    Weather permitting, of course.

    A couple of years ago, just one day after a major blizzard buried the area, a mom pregnant with twins went into labor at 30 weeks. She couldn't be transported, so a neonatal team from Wichita flew in and arrived at the hospital in time to deliver two healthy babies and then transport them back to the Wichita hospital for followup care.

    "If the babies had come the day before, we wouldn't have gotten the NICU team in, and it would have been a dicey situation," says Miller. It's the kind of situation that illustrates the risks of living in rural America, where health care can be harder to access.

    Embracing Rural Family Medicine

    Miller grew up in Leoti, Kan., which is smaller than Lakin and just 40 miles north. He wanted to be a math teacher, but an astute high school adviser encouraged him to take the premed track.

    Then a rural family physician in Scott City, Kan., invited Miller out for a visit. That shadowing opportunity changed everything. "I loved the relationships he had with his patients. It was a profound experience for me at that time and pushed me to go to medical school," he says.

    Miller concedes he still was not sold on family medicine until an internship in his fourth year of medical school highlighted the full scope the specialty provides. "That sealed the deal," he recalls.

    Learning the ropes while within the safety net of an internship is an important step, but still, all new-to-practice rural FPs face a steep learning curve once thrust into their new communities.

    "Rural family medicine is awesome, but it comes with the hard, heavy truth that you're responsible for a broad scope of things," says Miller. "That first year out of residency is when you learn and grow the most -- and feel the most 'in over your head,'" he adds.

    "That gets better over time, but there still are days I feel stretched beyond my capabilities or what I'm comfortable with. This specialty keeps us all learning all the time."

    Miller recounts an experience just 10 days into his job in Lakin, when he and rest of the ER team did their best to save the life of a young man involved in a horrific car crash.

    "He died. It was super emotional and hard. And then I found out I was also the coroner, and I had to go out to the scene of the accident and pronounce the other person.

    "There were moments early on when I thought, 'This is not for me,'" says Miller.

    But nearly 10 years later, this family doc is thriving, loving family medicine and the wide-open possibilities. "No two days are the same," he says.

    Miller's faith and family, including his wife Rachel, are his anchors. He coaches T-ball, baseball and basketball for his four kids, ages 4, 6, 8 and 11, and, according to those who know him, is a gifted pianist who helps lead worship at church.

    Miller says he prays before commencing surgery and with his patients when the opportunity presents, "especially in really hard situations like end-of-life-care."

    He's traveled to India several times for short-term medical mission trips and spent a month in a rural hospital in Ghana. Remarkably, all the family physicians in Lakin have done overseas mission work.

    "Mission-hearted physicians match up well with rural medicine. If you have a heart for international missions, you have a heart to reach high-need areas in rural America," says Miller. Notably, Kearny County Hospital's recruitment strategy reflects that sentiment.

    Celebrating Success

    In this era of rural hospital closures and loss of obstetrical services, the growth of Kearny County Hospital is unusual.

    The hospital's 60% growth rate in the past five years and the availability of high-quality health care provided by family physicians can be attributed in large part to the vision of hospital CEO Benjamin Anderson, M.B.A.

    Anderson, who also holds a master's degree in health care delivery science, is an outspoken fan of family medicine.

    "I love love LOVE family medicine. I've seen it work firsthand," says Anderson. "All four of our kids were delivered by full-spectrum family physicians."

    Anderson's decision six years ago to grow the hospital's obstetrical service was strategic.

    "Essentially, moms are the key to the health of their families. We focus a disproportionate share of our resources on caring well for mothers -- knowing that they will focus on caring for their families and everyone else around them," says Anderson.

    The strategy is working. Some 20 years ago, the hospital averaged 70 deliveries a year. In 2017, Lakin's family physicians delivered a record 327 babies.

    It's also notable that, with the exception of an ENT surgeon, Anderson recruits only family physicians. "We don't have any pediatricians or internists or OB/Gyns or general surgeons diluting what full-spectrum family medicine does in our rural community," says Anderson.

    Lastly, it's important to note that growth at Lakin's hospital has not come at the expense of surrounding communities. "We look at building systems in a way that supports the existing systems in our area instead of decimating them," says Anderson.

    "We started helping our neighboring hospitals recruit doctors and have helped to bring a couple of dozen family physicians and mid-level providers to southwest Kansas using our proven recipe for success," he adds.