In 1974, Robert W. Brown, M.D., of the University of Kansas Medical Center published a report "Physician Manpower in Kansas". That report documented that rural areas of Kansas were medically underserved to a critical degree. The study called attention to the maldistribution of physicians in Kansas as well as the statewide shortage of physicians. At that time, the four most populated counties in Kansas contained 41 percent of the state's population, but 61 percent of the state's physician manpower. Both primary care physicians and specialists displayed a preference for the more densely populated counties of Kansas. This study estimated that to meet baseline physician need-ratios in 1974, Kansas would have to train or recruit an additional 865 primary care specialists. But in 1974, the training of family physicians in Kansas could not even keep pace with retiring and out migrating generalists, let alone impact upon the need for family physicians in medically underserved Kansas.
Brown's study documented the intuitive knowledge of the people of the State of Kansas that rural Kansas was medically underserved. Acting upon this need, the legislature of the State of Kansas passed Senate Bill Number 472 in 1977 "An Act Concerning Affiliated Family Practice Residency Training Programs". That act stated: "It is the policy of the state to promote family practice residency training programs at locations within the state that do not currently provide such training. It is the purpose of this legislation to encourage such programs through appropriate affiliation agreements between the University of Kansas School of Medicine and qualified medical facilities or nonprofit community organizations".
Pertinent to this bill are three concepts:
Quality educational programs for family practice residents can be decentralized away from major medical centers in Kansas City and Wichita.
A partnership can be developed between the University of Kansas School of Medicine and small local communities to provide family practice residency training.
That the successful implementation of the above would help recharge the rural reservoir of family physicians, help alleviate the troublesome physician maldistribution problems of rural Kansas and decrease the risk of physician migration from Kansas.
It was the feeling of the state citizens, educators, legislators and government officials, that a family practice residency training program in a smaller community of Kansas would be attractive to resident physicians seeking careers in primary care.
Training young physicians in a community setting would encourage them to set up practices in Kansas upon completion of their residency training program. It was felt that the community of Salina, Kansas, would approximate actual practice situations of a community-oriented family practice.
A great deal of planning, organization, dedication and financial commitment on the part of the community, medical staff and hospitals of Salina, Kansas, the Kansas State Legislature and the University of Kansas School of Medicine in Wichita and Kansas City helped to bring these concepts into a program now called the "University of Kansas School of Medicine- Wichita Family Medicine Residency Program Smoky Hill at Salina" (Smoky Hill).
The Salina Health Education Foundation (SHEF) is the official body for all matters pertaining to graduate medical education in Saline. Robert Freelove, M.D. serves as the Executive Director of SHEF. The Salina Regional Health Center and Salina Medical Staff provide support for medical education. The University of Kansas School of Medicine-Wichita is responsible for program administration.
Program funding is from patient care revenues, financial support from Salina Regional Health Center and direct subsidization from the Kansas Legislature. Grants from sources such as the United States Department of Health and Human Services, Kansas Department of Health and Environment, United Methodist Health Ministry Fund and Kansas Health Foundation support the program financially and validate the mission of the program.
The core of the Smoky Hill program is the ongoing continuity of care experience provided by the residents to their patients at the Salina Family Healthcare Center (SFHC). A cognitive base of knowledge and skills are acquired longitudinally and is supported by a helix of required and elective "block" rotations.
Medical and surgical specialists who are all in private practice in the community of Salina provide teaching support. Full-time faculty provide educational instruction to SFHC and in the hospitals. The Residency program is designed around a central framework of the Accreditation Council for Graduate Medical Education's (ACGME) Residency Review Committee for Family Medicine.
Until 1990, Smoky Hill was one of the few "one-two" programs in the nation. The first year was primarily hospital based at St. Joseph Medical Center in Wichita, Kansas. The second and third years of this "1-2" program were provided in Salina, Kansas. In 1989, the American Council for Graduate Medical Education approved moving the first year to Salina beginning July 1990. The infusion of superbly trained medical specialists and the rapid introduction of the latest in medical technology into the Salina medical community made this move possible. The first year in Salina provides in-depth education and training in the major disciplines of specialized care including internal medicine, surgery, pediatrics, obstetrics, gynecology, psychiatry, and emergency medicine.
Smoky Hill is considered a leader in rural family practice residency education. The program has been recognized by numerous publications. In 1992, the legislature of the State of Kansas specifically awarded stipend increases to Smoky Hill resident-physicians, demonstrating its support for Smoky Hill education. In 1996, the National Rural Health Association honored the Smoky Hill Family Practice Residency Program as the Outstanding Rural Health Program in American.
The need for Smoky Hill still remains. Today, over one-half of the counties in Kansas are classified as underserved. The "Governors Task Force on The Future of Rural Communities" published in 1988 and the "Western Kansas Policy Development Board: Regional Agenda for the 1989 Kansas Legislature" both specifically support the concept of rural family practice residency training programs. Of the six 3-year family practice residencies in Kansas, only Smoky Hill qualifies as serving a non-urban area.
Ongoing evaluation and improvement of the program continues. Philosophically, the residency program provides its residents with the knowledge and skills to become clinical problem-solvers for patients and their families. Residents are exposed to medical information, clinical skills and processes necessary to fulfill the role of a family physician in a rapidly changing medical environment and society. The mere acquisition of "subject matter" is not sufficient since it becomes obsolete with discouraging speed. The knowledge and skills of the family physician are those which are not eroded with the passage of time. The family physician is the foundation of the health care