Rural Kansas struggles to attract psychiatrists
“Fewer and fewer individuals are going into these professions."
TOPEKA, Kan. – Psychiatrists are so hard to come by in some rural parts of Kansas that out-of-state doctors now commonly treat patients through video conference.
Kansas, like the rest of the U.S., is seeing an increase in patients seeking mental health treatment. The state can’t find enough doctors, nurses and therapists to treat them, and providers say the problem is worse in the state’s least-populated rural areas.
The Kansas News Service reported that the High Plains Mental Health Center in northwestern Kansas has long struggled to attract psychiatrists for patients in its 20-county coverage area. Executive Director Walt Hill stopped even trying because it typically took him more than a year to fill a position. Attracting psychiatric nurses is hard, too.
So Hill turned to providers who conference in from Kansas City, Missouri, Texas and Oklahoma.
“Fewer and fewer individuals are going into these professions,” Hill said. “We’re seeing a demographic challenge, a crisis coming.”
One measure from the federal government suggests only nine of the counties in Kansas have enough psychiatrists, and they’re mostly in or near populated areas like Kansas City, Wichita and Topeka.
Community mental health centers, like the one Hill manages, face an even greater challenge because they treat people regardless of their ability to pay. And as reimbursement rates from insurance companies have stagnated, Hill’s center has had to raise its base fees to cover costs.
The center sees 6,000 patients a year, about half of whom need medication. Some wait six weeks for an initial appointment.
Greg Hennen, executive director of the Four County Mental Health Center in Independence, said his center has been trying to recruit a psychiatrist to serve as medical director for two years. One of the two applicants couldn’t get his license. The other decided he didn’t want to live in southeast Kansas.
“They just want to be a little closer to the cultural offerings of a big city,” Hennen said.
Pay is another issue. Neighboring Nebraska and Colorado can afford to pay medical staff and therapists partly because they expanded Medicaid coverage. Oklahoma and Missouri have federal funding from the Excellence in Mental Health Act, a program Kansas never applied for.
Hiring nurses is the challenge for Lisa Southern, executive director of Compass Behavioral Health in Garden City. The center paid a recruiter $20,000 to find a qualified nurse. But in 18 months, just two applied, and neither decided to take the job.
Kansas passed a law in 2017 adding psychiatry to the state’s medical student loan program. The program helps pay for tuition and other expenses in exchange for the student practicing primary medicine in the less-populated counties after graduation.
It’s too early to tell how well it’s working, said Dr. William Gabrielli, head of psychiatry at the University of Kansas School of Medicine. But as attitudes toward mental health treatment change, Gabrielli is optimistic more students will feel encouraged to do psychiatry residencies in rural areas.
“Most of the people that pursue psychiatry as their medical specialty are not focused on maximizing their incomes,” he said. “They’re focused on taking care of the people.”