Transcript:
Voice over 0:00
This is Health on the Plains, a podcast about rural communities, rural life, and the many factors influencing the health and well-being of rural Kansans. Health on the Plains is a podcast from the Kansas Health Institute, a nonprofit, nonpartisan educational organization committed to informing policy and improving health in Kansas through honest, nuanced conversations with leaders and doers from a variety of backgrounds. The Health on the Plains podcast offers unique insights into rural health challenges in Kansas and shines a light on the people and organizations working to make their communities healthier, more vibrant places to call home.
Dr. Robert Moser 0:42
Welcome back to another episode of Health on the Plains. Today, we’re here in Topeka, Kansas. We’re right outside our office building, in front of the state capitol, and our guest today is Dr. Robert Moser, a former KDHE state health officer and director, and a, a really champion for rural health here in the state of Kansas. He is, he was kind enough to stop by our office today and have a wonderful conversation about his decades-long career doing public health here in Kansas and his current work leading the Kansas Center for Rural Health at the KU Salina campus, and it was a wonderful conversation. We touched on a lot of things. He has a wealth of experience, lots of fun stories. And I hope you enjoy. Welcome back to another episode of Health on the Plains. Today, we are in our studio here at the Kansas Health Institute, and our guest, Dr. Robert Moser, stopped by for this, this conversation. We’re really excited to have you, Dr. Moser. So, Dr. Moser’s list of bio and career accomplishments is really long. I’m going to hit some highlights to set the stage. So, Dr. Moser is a nationally recognized and awarded leader in rural health. He’s a family physician with decades of experience practicing right here in rural Kansas. He served as Secretary of the Kansas Department of Health and Environment, as well as the state health officer from January 2011 until December 2014, he’s the medical director for the University of Kansas Health System Care Collaborative, which works with over 60 rural counties across the state to improve outcomes for critical diagnoses. He was a dean at the Salina KU School of Medicine from June 2019 until January 2023 and is a clinical professor of public health practice with the University of Kansas School of Medicine. Finally, Dr. Moser now serves as the Executive Director for the Kansas Center for Rural Health at the University of Kansas School of Medicine Salina campus. Dr. Moser, thanks so much for stopping by today.
Sure, appreciate it glad to be here.
Wyatt Beckman 2:56
So, I mentioned that you’re a nationally recognized and awarded rural health expert, and you recently were awarded the Louis Goran Award for Outstanding Achievement in Rural Healthcare from the National Rural Health Association. It’s a really prestigious award. Congratulations on that award.
Dr. Robert Moser 3:15
Thank you.
Wyatt Beckman 3:15
And in that video that accompanied the award, one of your colleagues at KU Salina, Dr. Tyler Hughes said you had “lived the life of a rural individual”, not just a doctor, a rural individual. When I heard that, that really stuck out to me, and that rural life for you began about as far west as you can get, in Kansas, in one of our four counties with Mountain Time in Tribune, in Greeley County, where you grew up and then practiced family medicine for 22 years. So tell me, take me back to that, that rural life that you lived, and what, what lessons or insights did you learn from those early years and those 22 years of family medicine that you brought forward into some of the work we’re going to talk about the rest of our conversation.
Dr. Robert Moser 4:03
Sure. No, it. You know, growing up rural and particularly out there on the Kansas/Colorado border, it was a great opportunity to really appreciate, you know, the community values and the connections. And I think I was fortunate because, you know, my father ran a garage and body shop, and at 10 o’clock every morning during the weekday and even on Saturdays, locals, the farmers whatnot, would kind of gather around. There’d be 10, 12, 15, folks sitting around on old bus benches, you know, and just drinking coffee, eating donuts, and talking about everything from local politics to state/national to, you name it. And it was a great experience, because you develop relationships, you know, with a complete age spectrum. And so I really appreciated that. So I knew when I was, you know, attending medical school, you know. To take the opportunity to take the Kansas Medical Student Loan, which required me to pick a critically underserved rural community to apply my skills and pay off my tuition. But we weren’t necessarily thinking about returning to hometown, because you know, you grew up in a small town, you know everybody and to come back as the, you know, the professional, the medical doctor, and to now take care of that population, well, that might be strange. It could be a hardship, not only for me, but for my patients. But I was fortunate, and during my clinical rotations at KU to spend a couple of months in rural communities where family doctors had actually gone back to their hometown, like up in Seneca, and talking with Dr. Roger Tobias, who was in Lyons at the time, and and they said, you know, made a great point. You know, it doesn’t matter where you go if you’re going rural, in no time, 2, 3, 4, years, it’s going to be like you’ve lived there your entire life. You’re going to get to know everybody. You’ll know who’s related to whom, and, and such. And I thought, you know, that’s a good point. And so, we kept it open, thinking about it, my wife and I. My wife grew up in Tribune as well, and her father ran the grocery store, so we were townies, but we had a lot of great experiences. But as we were finishing up residency in Salina at Smoky Hill Family Medicine Program, we were expecting our first child, and so we thought, you know, this might be an opportunity, because my wife certainly wanted to work with her degree in Respiratory Therapy. She wanted to be a busy health professional as well. We had built in grandparents, you know, ready to help with babysitting. So, it made it a lot easier to make that jump to go back home. But, took no time at all to be really, you know, ingrained back into the community and, and providing healthcare. But also, you know, participating in number of other community activities. And what a great experience. But, in no time, you know, I found myself, you know, as the sole provider for that community for a period of time. But, that was when I became, you know, the county health officer, really got to appreciate, I think, a little bit more of the public health side of things, although Family Medicine tends to stress that perhaps a little bit more than some other specialties, but, but there were some great experiences that I think I learned from that and caring for community. And, in rural health, one of the nice things that I appreciated was when we decided as a practice that we were going to start focusing on a particular health issue or develop a new program, or how we were managing a particular condition. We could implement that fairly quickly, because there’s a small number of people to make decisions and implement, a great support staff to help with doing that, but you could quickly see the impact of what you were doing, rather than waiting months and years and whatnot. So, as we really appreciated that. So, when we, you know, moved most of our vaccinations to the health department instead of doing it in the clinic, and I started that when I was the only provider, because you could imagine, you know, covering the ER, and delivering babies, and covering long-term care, and doing that 24/7 365, I was seeing, you know, upwards of 40 patients a day in the clinic, and I couldn’t have delays, you know, like trying to convince a two year old they’re not there to get a shot. You know, they’re there to see me, and I’m not a mean guy and whatnot. So that was kind of why we decided to use the public health department as our primary source for the vaccinations. And it worked out great, because when we set it up, we would do well-child visits in the morning and refer them directly over to county health for the vaccinations, WIC, whatever you know they needed. And so, we found a great opportunity for that cooperation between public health and the clinical care. So, I think a lot of those experiences over 20 years in public health and rural practice, I got to bring you know into my experience at the Department of Health and Environment.
Wyatt Beckman 9:18
Absolutely, and what a, what a great insight into that. Know that there’s a really small community when you are the only provider, they’re covering everything then. You’re on call, whether you want to be or not, you’re pretty much on call 24/7, but being really strategic about the other folks in your community that can help support and provide services, and the local health department or, or other organizations to where as a, as a medical provider, you can have more space to focus on the things that only, only you can provide, or be more intentional about providing a range of services to the community. And that, you brought it up, and I’m sure that was great insight, and started getting you thinking about, how does our public health system, local, state level, work well with our health care system, and after your time in Greeley County, you briefly were the Director of Rural Health and Outreach at KU in Wichita, but then you came here to Topeka, and you were appointed the Secretary for Kansas Department of Health and Environment. When you got to KDHE, so you’ve spent 20 plus years doing this work, collaborating, did you learn anything that that surprised you, or was unexpected about our state health system when you, when you got here?
Dr. Robert Moser 10:55
That’s a great question, and you know, as a county health officer. And you, you, you got a lot of exposure to the Department of Health and Environment, particularly the health side of things. And so, you know, I knew a lot of those names, so to speak. I knew a little bit about them. I knew the work they did, and all great people. And so, you know, I felt I was kind of fortunate, you know, because I was coming into something, I felt I had a little bit of background in but I knew I had a lot to learn. And great staff there that really made, you know, the first six months, first year, which was indeed like drinking from a fire hose of learning. You know how the system operates, how it operates within the state, you know government, governmental structure. And it didn’t surprise me, though, that, you know, I always kind of looked at agencies as really being the ones who implement policy. Don’t necessarily make the policy, but they have lots of information that can help guide that. And so, you know, the staff I thought did just a fantastic job to make my transition into that type of work, that volume of work, you know, much, much easier than it could have been. So I was fortunate, because I had a little bit of knowledge of kind of how it operated, but not to the depth that I needed, which was pretty obvious within the first week.
Wyatt Beckman 12:25
Yeah, that makes sense and I imagine that they also learned a lot from, from your experience doing work in really rural community, and providing care in that way, and being a local health officer that you were able to bring to the state health department?
Dr. Robert Moser 12:45
Yeah, I think, you know, wherever I’ve gone, perhaps it’s because it’s my passion, you know, but I think they really did appreciate that, you know, I had that strong passion about rural health and the challenges of providing services in resource limited environments, which by definition, is public health to some degree. You know, in Kansas, we don’t put a lot of dollars in into the public health services, and there’s still a lot of, you know, question of, what value do they provide, until they really stop and sit back and think about it and, and so it’s under appreciated until its needed.
Wyatt Beckman 13:21
Yeah, that’s the story of public health, typically. And you mentioned your passion for rural health, and that’s been clear all along through your career. And I imagine that what you’re doing now really is a great opportunity to lean into that work. And so we talked about where you started Tribune, and talked about time, some time in KDHE, but I want to bring us all the way to now and spend the rest of time talking about the great work you and your colleagues are doing at the Kansas Center for Rural Health. So it’s at the KU campus, School of Medicine campus there in Salina. It began in 2022 and has a mission to improve the health of rural Kansans through focus education, relevant research, collaborative services and health policy leadership. As I mentioned before, you serve as the executive director. Can you tell us about the development of the center? It’s a pretty big investment of resources, of time, of professionals. Why did, KU School of Medicine and the partners that have supported it, why’d they make such a big investment to build this new center focused specifically on rural health?
Dr. Robert Moser 14:37
Yeah, great question, and it started long ago, if you would. You know, it actually came up in conversation back in the early 2000s when we were looking at the Kansas physician workforce and serving on that committee. You know, one of the recommendations that came out of that was, as the federal government was forming these centers for rural health research, why isn’t Kansas you know looking to become one of those sites, if you would? And out of that conversation was also the recommendation that KU needed to expand their number of slots for medical students so we could graduate more physicians, and hopefully with that more that would, you know, distribute where needed. But that was where the recommendation to expand to four years in Wichita, to create that medical school, four-year campus down there, as well as to start one in Salina and, so, yeah, you know, you’re looking at 20 years of, you know, some history in conversations that have been ongoing. So I was kind of fortunate in that when I was interviewing for the dean’s job in Salina the founding dean, Dr. Cathcart-Rake, who had been an instructor of mine back when I was a resident, he and Dr. Mike Kennedy, who was the head of rural health education, Dean of Rural Health there on the Kansas City campus, had also had the conversation again about establishing that center and doing it in Salina, and as a matter of fact, in the building that they moved into for the School of Medicine and with the School of Nursing joining us in Salina, they didn’t finish out the south end of that building, but they had some rough architectural drawings that included a space for the center. So I came into that, you know, knowing that existed, knowing that we were starting on looking to build out that south part of the building, and I wanted to make sure we protected and maintained a space. But we didn’t have a center authorized or approved yet. So, at the same time that I was, you know, coming in as the dean, they were recruiting a new executive dean for the KU School of Medicine in Kansas City, and fortunately, Dr. Akinlolu Ojo was named that dean, and after some conversations with him about the work that I’d been doing, along with Jodi Schmidt and others, through the health system with the Care Collaborative, working with those 70-plus counties now, in helping them move evidence-based guidelines into actual practice a little quicker than what happens naturally. He really had a passion about the underserved nature of rural health, the fact that we have disparities in health status and health outcomes in rural Kansas. And so he actually recommended that we form a rural health task force for the School of Medicine. And so that started right at the end of 2019, and as you can imagine, you know, within a few months, we were moving from, you know, having about 90 people meeting and talking about, you know, what’s the role of the School of Medicine in addressing rural health disparities in Kansas. It became virtual meetings. And so out of that, we broke out into areas of focus. And one of the committees that we formed was to study, you know, the creation of creating a Kansas Center for Rural Health. And so we had, you know, several folks from a variety of disciplines and areas of experience to come together and basically help in creating the business plan, the business model for the center. So then we were fortunate to get funding that came from the Patterson Family Foundation that actually helped us to kind of kick start this. And so then we gave it to the senior leadership at KUMC and got approval to get started. And so, in March of 2022, we formally announced the Kansas Center for Rural Health, which meant at that time, I was kind of serving as dean and also trying to head up the center as the executive director. So that didn’t look to make a lot of sense. So I was fortunate to be able to step out of the dean’s role to take on the executive director, and that started a year ago, January. So we hit the ground running with a number of projects. It’s nice being the medical director for the Care Collaborative, because we’re already engaged, as I mentioned, with over 70 counties. So we get a lot of feedback, and we hear from everybody, from the nursing staff, the physicians, the administrators, as well as hospital board members, in some cases, about what are some of their challenges, and what could we do, as a health system and as a academic, you know, medical center in maybe addressing that, maybe expanding some of the work that we’ve been doing as a care collaborative. So we see the center as you know, not just solely focused on the research side, you know, in writing papers and whatnot, but also in kind of studying and developing new models of care. Or looking at the best practices. How did you know this community solve this particular problem, and is this something that’s replicable in other rural counties and whatnot? So we’re busy, we’re probably not staffed yet at the level you know, where we want to be, but I’m very, very, you know, fortunate to have the commitment of KUMC and a number of external stakeholders that you know have been very supportive of what we’re trying to do.
Wyatt Beckman 20:17
You mentioned the Care Collaborative a couple times, and I know that’s something that you, personally, have worked on for many years, and probably a lot of insights that inform the work you’re doing now come from that work as well. Can you tell us a little bit more about what that Care Collaborative is, and what you’re trying to do? When you say, “make those evidence-based approaches be adopted faster and more efficiently.”
Dr. Robert Moser 20:47
Yeah, yeah. I was very fortunate, I think, to be in the right place at the right time in many instances throughout my career. But one was, you know, looking at finishing almost four years as secretary and state health officer, KDHE. And in October of 2014, I was asked by the KU Health System, hey, you know, we were getting this CMS Innovation Award grant, creating this Kansas Heart and Stroke Collaborative. And our goal is, you know, we want to improve outcomes for heart attack and stroke patients in rural Kansas. And of course, you know, I knew from data that KDHE had done in a report on, you know, the Kansas Heart Stroke Collaborative paper actually, that came out, I think, in 2012, that you know, we had indeed, higher mortality rates in rural Kansas for heart attack and stroke. We had higher readmission rates and we knew from the data as well that less than 3% of patients that were eligible for a clot-busting drug when they had a stroke were actually getting it in rural Kansas. So there was great opportunity for improvement. And so they had asked me to come out and talk to this group in Hays about population health. How would you approach, you know, a system-wide approach to addressing this issue? And so it was great to go out and talk with them. And I stayed around listening to the various breakout groups. And I got really excited about it, because this was actually taking, you know, some public health and clinical science and actually moving it out into practice and supporting those providers out there, and I certainly appreciated the challenges of taking new information and putting it into actual practice, and knowing that the literature said, you know, on average, it takes about 17 years for new evidence-based guidelines to become the standard of care. Well, when you think about 17 years, that’s literally a generation. So that means it’s, you know, the old docs, you kind of do what you’ve been doing all along, and then the new docs come out. And maybe you change, you know, because they’ve been trained, you know, in newer techniques, newer theories. So we wanted to see if we couldn’t move that. And the other thing that Jodi Schmidt, who I was again, very fortunate, that when I found out that she was also looking, you know, to come into the health system and participate in the work and the KU Health System, I thought had a great model in many of their projects. They create a clinical and administrative dyad. And so having me as a clinician, and Jodi Schmidt with her experience in rural health and administration, in Hays and Labette County. I thought, boy, this would be great opportunity, and it certainly was.
But we were able to quickly take on that role when I was appointed as the Executive Director for the Kansas Heart and Stroke Collaborative to work with our original 13 counties, 11 critical access hospitals. And so the first thing we did was, you know, what are your order sets for heart attack and stroke patients? And they varied. And so what we were doing is comparing them to the evidence-based guidelines and then making recommendations, you know, here’s where your, you know, need to improve, and setting up time metrics to see how good they were meeting those measures of trying to get the clot-busting drug on board within 30 minutes, or for heart attack, or 60 minutes for stroke, et cetera. The practices gave us great feedback. You know, hey, when you know our providers are on call, they don’t have to be in the hospital. They might be at home, they might be at the local basketball game. So we have a heart attack patient come in, you know, we get an EKG, we’ve got to wait for them to come to the hospital. So how about we just take a picture of it and send it to them by phone. And, you know, we can do that, but we’ve got to protect, you know, the HIPAA privacy issues, and so we work with developing how to do that, and those practices took that up, and so they could quickly get a, yes, that’s an acute MI, or no, that’s not. And I’m coming in, they’ll be there in a minute. But if it was an acute MI, then they could start their order sets. So we learned a lot from our practices. You know, without them, we would have no success. But what they appreciated was we used, I think, my 20 some years as rural provider to take the evidence-based guidelines and make sure that when the protocols were written up that they reflected the local realities, that no, we don’t have ambulances that are staffed by paramedics everywhere. Very few of our ambulances had EKGs in the back that, so the patient wasn’t going to get that until they got to the hospital. And the other thing that we found that hasn’t improved a lot, but it’s kind of a public health issue, but we still have about 75 to 80% of heart attack or chest pain patients that show up by private car to the local ER, and sometimes that’s due to the rural nature, right? It’s, you know, I don’t want to bother anybody. It’s quicker for me to just load up and get them in than it is to wait on the ambulance, and about 60% of stroke patients show up by private car. And again, perhaps that number is lower because it’s harder to get somebody in a vehicle if they are paralyzed on one side. But even though we do a lot of public health messaging, you know what signs and symptoms are for heart attack and stroke, getting them to call and activate 911, so trained professionals could be there to, you know, collect appropriate history, maybe do an early intervention that might be beneficial. So we did find that we still have a lot of public health messaging, you know, to work on, on for this, but we quickly expanded into other conditions, which is why eventually, after the end of that original three year grant with one year no cost extension, we changed our name to the Care Collaborative. We just didn’t think we wanted to keep adding conditions that we were addressing to that name.
Wyatt Beckman 26:37
Yeah, the that makes makes sense. I was curious where the name shift comes from. But if you’ve expanded into new areas, and it’s impressive that, you know, I said 60 counties earlier, you’re now up to 70, and that’s shows the growth of the work. What stands out as you’re talking about that, is this idea and this intentionality, to marry these evidence-based practices. So we want to close that 17 year gap. We don’t want it to be 17 years until we have a new approach that can have better outcomes. We want those to be adopted sooner, but the way you go about doing that is really being intentional about saying, what are those, as you said, local realities that shape what this looks like, and how this is feasible or not feasible? And you brought your experience as a provider in those contexts to that work, but it sounds like, in the collaborative as well, it’s a two-way street where you’re listening to them as much as they’re listening to you. And that phrase of “local realities” really sticks with me, because I think that’s the crucial part of a lot of our successes in rural communities is finding ways to lean into the strengths of our local realities and address those challenges that are maybe working against us in those local realities. So maybe broadening out to the center as a whole, what does that look like for the center to incorporate those local realities into your research or your education work or your training?
Dr. Robert Moser 28:26
Yeah, that’s a great question in that we know that one of the common sayings that I always heard when I started at KDHE, particularly as we were looking at changing the Medicaid program, was when you went to each state and you wanted to compare notes, was every Medicaid program is unique, and that was always kind of consistent with what I was taught was, health is local, and so every community, every jurisdiction, has its own unique challenges, whether it’s social determinants of health, health care access, what services are available, etc. So, we kind of knew we needed to address that. And then we also knew, you know, and part of that was from my experience as well, but Jodi always mentions a Dartmouth study that shows that, you know, if you take a professional and you send them to a remote location to train them on something, and maybe it’s on new evidence-based guidelines that they need to, you know, implement, about 10% of the time, that’ll actually happen. They will take it back, the new information, they’ll work with their partners, their system, and they’ll implement these new changes. So it’s not very successful, but if you take the training to them, and you surround, you know the support staff, and you know EMS, you name it, lab, PT, everybody hears the evidence. You know, why this is the way we approach these things. And you train them on the protocol, then everyone’s hearing the same message. They all kind of understand why you’re going down this road, and the likelihood of it being implemented goes up. And so, that was part of our, as Jodi says, our secret sauce, you know, why we think we’ve been successful. A part of it is, I also had more appreciation for people that took the time to come to me, you know, because they could see what I was talking about, rather than just hearing it. And so, that built a lot of credibility with our partners. And so, that’s why, you know, even though we continue to expand the number of communities that have joined the Care Collaborative, we’ve not lost a single one that started with us. They obviously see value in what we do. And I think the other is we don’t come in as the 800-pound gorilla. You know, “we’re the academic medical center. We know what’s best.” Well, yeah, you might, you know how to really treat some bizarre, strange things that we would have no idea how to approach, but you don’t necessarily know how to approach it from our perspective and our resource limitations. And so, let’s work together to figure that out. And so that’s that’s been our secret, I think. So, you know, the Care Collaborative has expanded from heart attacks, chest pain, stroke, to sepsis, which, fortunately, we kind of started that in 2015, 2016 so, that made it, you know, very handy to kind of transition when COVID hit, to help with developing, you know, how do we triage our patients with COVID in the small community and a number of other things that we’re able to, you know, cooperate with Kansas Hospital Association and others, including KDHE, to help provide support for rural Kansas during that. But we’ve added, you know, acute decompensated heart failure, diabetes, we’re doing remote patient monitoring with that. And so the center, you know, we can take some of these new models that we’re actually kind of demonstrating a little bit with the Care Collaborative and research those, write those up and look at what would be the feasibility of expanding that out to others. And so, as we look at our maternity deserts that are increasing across Kansas, and patients having further for obstetrical care and delivery is, does remote patient monitoring have a role in that? And so we’re using some of our health coaches that have been doing chronic care management by telephone with a number of rural communities, and they’re trained to kind of become health coaches, care coordinators. Take one of those, or a couple of those, and train them up on you know, how to manage more high risk OB issues and and using remote patient monitoring, setting up the parameters. Can we help that delivering physician who’s you know, now, taking care of a larger area and a larger population? Can we help them feel a little bit more at ease that the patient’s not just disappearing between visits, that somebody’s monitoring kind of what’s going on, how are they doing and whatnot. So is that an answer, you know, for Kansas, in these increasing maternity deserts? So the center, I think, fits very nicely, you know, with what the Care Collaborative’s been doing, but I think can also expand on that, maybe move some of the focus in some different areas that the Care Collaborative just doesn’t have the bandwidth for right now. But we have to be very careful speaking about bandwidth, because I think that’s the other thing that’s not always appreciated by the academic medical center and others, is that these folks, you know, like I was at one time, running as fast as they can, trying to just keep up with the workload that they’ve got. So adding one more thing can sometimes be overwhelming, so we’ve got to be willing to wait until they’re ready, and but when they’re ready, jump on it and work with them to implement whatever it is that they’re interested in taking on.
Wyatt Beckman 34:01
Absolutely, and I’m glad you mentioned the sort of bandwidth, workload, number. I often talk about it in terms of the number of hats that folks wear. And in our rural communities, you often end up with a handful of folks where, the number of hats they wear gets pretty high, and I’ve shared before, one of my parents is head of EMS in Ness County, and she also was a full-time teacher for a long time. She also was the county coroner. She also helps with the emergency preparedness, and also, and also, and that’s often pretty typical for a lot of our, our health care professionals. And so having the, knowing that reality, as a center, allows you to go into those conversations, with the right level of understanding and appreciation for, why maybe something isn’t changing right away, because it’s not feasible right now. And I imagine that builds trust too with your partners, where you can see that there’s genuine understanding and appreciation,
Dr. Robert Moser 35:20
Yes,
Wyatt Beckman 35:21
-from both sides.
Dr. Robert Moser 35:22
-yeah, absolutely. I think you have to approach it that way, or you’ll, you’ll lose folks that, just, you know, feel pushed rather than supported.
Wyatt Beckman 35:34
Absolutely. And one of the common challenges, and you mentioned maternity deserts, which is a specific part of this. But in general, we know many of our rural communities, there simply aren’t enough health care providers. We have a lot of health care provider shortages, mental health provider shortages, primary care provider shortages, and the KU Salina campus has a particular focus on supporting future physicians that have an interest in rural medicine and potentially help fill some of those those gaps that it’s a smaller program, eight students admitted each year. It’s actually the smallest four-year medical education site in the country, which I think is phenomenal. But you’re having, you’re bringing students to Salina, to a rural community, and getting them closer to even more rural communities where they can practice. And I think that is an amazing opportunity for them. But I imagine it also comes with some challenges. You know, you’ve mentioned before, some of the challenges that come with being the only doc in town. So when you think about medical education, for those future physicians that have an expressed interest in rural communities, what are some of the challenges and opportunities you face on the education side, trying to prepare them to go into that sort of practice?
Dr. Robert Moser 37:04
Yeah, no, that’s great, great question. It is challenging, because I think that’s the biggest fear, you know, even if a student starts out, you know, like I did, thinking, you know, I want to do primary care. I’d love to go back rural, because that’s my roots. But yeah, most all of them worry about the two most dreaded words in rural health, which is “solo practice,” you know, that they’ll be left alone. And sometimes it’s, you know, gosh, will I know enough? Will I be skilled enough, you know, to manage what comes in the door? Because I won’t have somebody just down the hall to back me up or support me or whatnot. So we have to, kind of, you know, be able to start addressing that. You know, almost from day one, you know that you will, you know, have the knowledge, you will have the skills, you will understand your limitations and where you need to have continued training and whatnot, but you’ll get enough clinical experience, you know, in these larger training sites to be well prepared. And a lot of them come in undifferentiated as far as what kind of a specialist do I want to be? And so they want to make sure they get a good enough broad exposure to number of specialties and opportunities so that they’re good candidates. You know, when they apply for a residency that they’ll be selected. So our approach, you know, when we were looking at creating this kind of distance learning medical school, if you would, it was easy. I mean, even when I went to medical school back in the old days of, you know, the early 80s, we had note taking service, you know, so we didn’t have to, we weren’t required to be at every lecture. So a lot of times, you know, the lecture rooms got, you know, where they weren’t as filled with bodies, and yet, you know, folks that are taking the, you know, notes from the lecture and going to the audio/visual center and looking at slides or whatever. So they were already doing distance learning, learning by podcast and, you know, recording, you know, video or whatever, didn’t seem like a far stretch. And these students, you know, were more and more accustomed to that anyway. So that model, you know, turned out to work Salina was, you know, great proof of that. And and the fact that it was a collaborative learning environment, because you had eight students, so if you were going to create a study group, they’re, pretty much was it, you know. So that became kind of the model as to what led to KU School of Medicine changing the curriculum to the ACE curriculum, they call it now, and so that collaborative learning model, the close connection between the student and the community providers, who are often those who are coming in to facilitate their collaborative learning groups, and their problem-based learning groups as well. So, you know, we have to make sure we nurture, provide them with the experience, provide them with the resource. And we know that was kind of why, you know, the thought between moving out of the big, large Kansas City metropolitan area to do medical education was based on a lot of studies done back in the 70s and 80s by Rabinowitz and others that, showed the more time a student spends in a rural environment, the more likely they’ll go to primary care, they’ll go rural. So we also have to recognize that not every student, even if they come from rural, has dreams of becoming a rural family physician or pediatrician or internal medicine, and so, you know, we have to make sure that they have a good experience and whatnot. And some of the students, you know, listening to them in the surveys and feedback and whatnot, they sometimes feel like, you know, because Salina is, you know, a kind of a rural development model, hoping that we get graduates that go rural and stay in Kansas and practice primary care, they feel like they’re being pressured, you know, a little bit to go that route, and that’s never come out of the mouths of any of the faculty or staff. You know that you’ve got to do this. You know, you’re gonna let us down if you don’t, that’s not at all. We want to hear what you want to do. We want to support you. Want to make sure you have great experience, so you’re a great candidate as a resident. But one of the things that we also look at is interviewing residency program directors, where our students go to, you know, to kind of get some feedback as to how good of a, you know, intern did this individual turn out to be? And we get great reports back. And then we hear from students who sometimes, you know, it’s kind of like, well, I don’t know if I really want to go to Salina and miss out on all the great things that I could see in Kansas City or Wichita, but they often report back that they were better prepared and skilled in the initial patient assessment, differential diagnosis, how to manage patients, because I had that hands on experience at Salina without two or three other students and residents and fellows blocking their way so they were better prepared. But unfortunately, they didn’t appreciate that until after they left. And so we have to, I think, you know, continue to identify the right students for the right campus. We’ve been fortunate that every year, you know, we’ve had eight that have requested the Salina campus as a minimum, and filled those slots. One year we had, you know, 10, and we took that although we had to prove to the accrediting body that they weren’t diluting the other’s experience by adding two more students. But we hope, you know, as a medical community and specialist grow and develop in Salina that we can both expand the Smoky Hill Residency to, you know, from five to maybe six or more residents, and expand the School of Medicine maybe up to 12 students a year.
Wyatt Beckman 37:04
Yeah, the something you mentioned in there that I I think, is, as you said, is a dreaded fear, the solo practice. And in a lot of ways, it sounds like, while maybe there’s a hope that situation changes in a lot of communities. If it doesn’t, how can we prepare future physicians to where they can be as successful as possible in that sort of setting where they’re on their own, so that a breadth of experiences, knowing what they can do, what they need support for? Well, that wraps up part one of our conversation with Dr. Robert Moser, I really enjoyed our conversation, and I’m excited for the second half, where we’re gonna keep talking about the Center for Rural Health, and we’re gonna talk a little bit more about telehealth and the challenges and opportunities that that technology presents. We invite you to come back for part two, and thanks for tuning in to part one.
Voice over 42:41
You just heard Health on the Plains. Look for new episodes twice per month. Follow us on social media and continue to listen to the latest episodes wherever you regularly listen to podcasts. Learn more at khi.org/podcast. Thanks for listening.
Transcribed by https://otter.ai
