By Allison Perry
University of Kentucky
In 2013, the Commonwealth of Kentucky Health Care Workforce Capacity Report announced a grim statistic: by 2025, Kentucky would be facing an estimated shortage of 960 primary-care physicians, the third-greatest shortfall in the U.S.
The physician shortage is not limited to primary care. The greatest physician shortages in the state include surgical subspecialties, psychiatry, and pediatric primary and specialty care. Rural areas have long had physician shortages, and 61 percent of the greatest physician needs in Kentucky are in rural areas.
In the past two decades, the UK College of Medicine has gradually increased enrollment, boosting class size from 100 per year in the early 2000s to 136 graduating physicians by the year 2013.
The goal is to increase the number of physicians who will stay in Kentucky to practice medicine, expresed as “training Kentuckians in Kentucky to practice in Kentucky,”
This year, across all four sites of the UK College of Medicine – Lexington, Morehead, Bowling Green, and Northern Kentucky – a record-setting class of 190 medical students are set to graduate and begin practicing medicine.
A banner Match Day for Kentucky
Match Day is a longstanding medical-school tradition, a nationwide event where medical students learn where they have matched for their residencies following graduation. The national initial match rate for medical students is roughly 92%, and UK’s rate has historically been higher. This year’s rate, with the largest-ever class of graduating medical students, is 97%.
With UK’s largest graduating class matching in Kentucky at the school’s highest rate, this bodes well for reducing the physician gap.
“The biggest factor for a physician practicing in Kentucky is both going to medical school and doing a residency in Kentucky,” Griffith said. “Nearly nine of 10 physicians who do both will remain in state to practice when residency is finished.”
With this in mind, UK has placed more emphasis on enrolling in-state students – in recent decades, roughly 70-75% of medical students were from Kentucky, and the goal now is for 85% of each medical class to be a Kentuckian or have a tie to the state.
UK’s regional approach began with the Rural Physician Leadership Program, developed with Morehead State University and the Morehead hospital, St. Claire HealthCare. The program was developed to train students who are interested in practicing rural medicine after graduating, and the program has capacity for up to 12 students per year.
The program began in 2009. With this year’s class, the RPLP will have graduated 110 physicians well-versed in rural medicine, with their top three residency choices being areas of primary care.
Two of every three RPLP alums are practicing in the state, and 92% of the participants from Kentucky now practice in rural Kentucky.
“The premise behind this program works,” said Dr. Rebecca Todd, associate dean for the RPLP and an obstetrician-gynecologist at the UK HealthCare Morehead Women’s Health Clinic at St. Claire. “It’s hard to transplant someone who is used to – and who loves – an urban area into a rural area. But if you take students from rural communities and train them to be physicians, they want to go back and practice in those rural communities.”
Having the opportunity to live and train in a smaller community allows RPLP students to have more one-on-one time with the physicians they’re learning from, almost like an apprenticeship, Todd says. Students get the advantage of closer mentorship coupled with UK’s rigorous curriculum to prepare them for their careers in medicine.
“When you work with regional campuses, you get both the resources from the larger institution, like UK, but you also have that smaller, close-knit feel,” Todd said. “I think this program really brings out the best in all medical training.”
The UK College of Medicine-Bowling Green campus
In 2018, UK took another huge step in growing its class size by partnering with Western Kentucky University and Med Center Health of Bowling Green, which operates six hospitals and more than 30 clinics in Southern Kentucky. Students complete their classwork and clinical experience in Bowling Green, primarily at The Medical Center at Bowling Green, the system’s main hospital.
“We’re meeting the mission,” said Dr. Todd Cheever, a UK associate professor of psychiatry and the associate dean of the Bowling Green campus. “Having students from this region, where they can train close to their families and support systems, is very important.”
Adding this regional campus has enabled UK to train up to 30 more future doctors each year. This year, the Bowling Green campus will graduate its second class, and seven graduates will stay in Bowling Green for residency.
Nearly half of the Bowling Green campus’s two graduating classes matched into primary-care residencies, and 27 matched into Kentucky health systems.
UK’s most recent regional campus, a partnership with Northern Kentucky University and St. Elizabeth Healthcare, will graduate its first class next month.
This campus has an annual capacity of 35 students, who complete coursework and clinical experience in Northern Kentucky. More than 90% of the students are from Kentucky or nearby counties in southwestern Ohio.
Seven of this year’s inaugural class of 30 graduates will remain in Kentucky for residency, while eight will be working at health-care facilities just across the river in Ohio. Five graduates from across all UK College of Medicine sites will go into residency at St. Elizabeth Healthcare.
Looking toward future growth
Griffith offers some simple math to demonstrate the importance of graduating new doctors: If UK graduates 65 more doctors a year than in the recent past, history shows that roughly half – around 33 – will eventually practice in Kentucky. And if the average physician takes care of roughly 5,000 patients in their lifetime, that could be an additional 165,000 patients in Kentucky each year that now have access to a physician compared to past years, he says.
The regional campuses have room for growth, and UK’s Lexington medical campus is growing, too. A Health Education Building now being designed, combined with expansion of UK HealthCare’s clinical services, means that the College of Medicine could add 50 to 65 new students per class in Lexington. By the end of the decade, UK could be graduating nearly 280 new doctors each year – more than double the number who graduated in 2021.
“A lot of these physicians didn’t plan on being teaching physicians, but they’ve found that it’s invigorating,” Griffith said. “They really enjoy it, and they’re ready to have more students.”