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Photograph by Skippy Sanchez/Genesis

Primary concerns

Healthcare | When Arizona and New Mexico became states in 1912, Kansas became the geographic center of the United States. When Alaska and Hawaii became states in 1959 Kansas lost that title, but its largest city is still a place to check the pulse of America, and the condition of primary care physicians who check millions of pulses

Issue: "Medical care circus," Feb. 25, 2012

WICHITA, Kan.-Politicians and policy experts continue to debate Obamacare, but we don't hear enough from frontline family doctors: How difficult is it for them to practice medicine in the current healthcare climate? Six Wichita physicians told me that they struggle to take care of their patients without drowning financially-and they don't have much hope in the government making things better anytime soon. Here's a look at three of them:

Dr. Timothy Wolff opened Rock Ridge Family Medicine four years ago with dreams of running an old-fashioned doctor's office. Inspired by his own boyhood physician in Nebraska's Elkhorn River Valley, Wolff wanted his practice to be a home away from home for his patients. His wife, Christine, manages the practice while their 5-year-old daughter is at school. A poster-sized picture of their daughter in a dance recital outfit hangs behind the reception desk.

Wolff found that owning and managing a medical practice was much more difficult than simply taking care of patients. The meager reimbursement from patients' insurance-especially the government-based programs Medicare and Medicaid-barely covered the business' bills, and he stopped seeing Medicaid patients two years ago. He says, "I didn't realize there was going to be so much governmental involvement-that people were going to tell me how much money I could make. ... I've been forced into a point where we have to see at least 20 patients a day just to break even to cover my expenses."

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In the center of Wichita, Dr. Ronald Ferris has developed a business model that allows him to take care of the Medicaid patients that many doctors refuse to treat. He founded Holy Family Medicine with another doctor right after Ferris completed his medical training. Many physicians seek more stable income in the first few years of their careers, but Ferris believed owning his own practice would give him the freedom to incorporate his Catholic faith into his work. As a fresh graduate of residency, he had to have his parents co-sign his business loan using their home as collateral.

Now, after 11 years of practice, Ferris says God's grace and the sheer volume of patients he sees at the clinic have allowed him to stay in business. About 55 percent of the practice's patients are on Medicaid, and many more are uninsured and pay out of pocket on a sliding scale. He accepts all patients regardless of ability to pay and employs a staff of three nurse practitioners and one physician assistant who, with his supervision, can perform many of the duties of a doctor. Those mid-level providers do not require as high a salary as physicians. Together the staff can treat up to 100 patients a day. They receive between $30 and $60 per patient visit, depending on the patient's insurance.

Ferris' office is decorated with prints of antique icons depicting Mary, Joseph, and a small but not infantile Jesus. Ferris had an opportunity to change locations over a year ago when he decided to purchase a building rather than rent his office space. He moved just a mile and a half north and opened a combination doctor's office and urgent care center. Where some physicians see low-income patients as a burden, Ferris sees them as a gift from God: "I was privileged by these families coming to us and seeing us, and that's what helped as far as my continuing because otherwise I'd be burned out. ... If it was about money, you won't last very long. You'll be disgruntled and bitter."

It's not about the money either for Dr. Scott Bledsoe, another Wichita doctor who left a job managing mergers and acquisitions for the Case Corporation to become a family physician. Bledsoe says he is amused when people he meets assume he is rich because he is a doctor: "In previous careers, I've made more money than I make now." His wife Patricia, who was a high-ranking executive at a medical technology company, is now also a doctor and his only partner in their medical practice. They conceived their dream of a joint practice shortly after their marriage, taking turns going to medical school, and finally started practicing together in 2009.

The Bledsoes treat both Medicare and Medicaid patients, but they are selective about which Medicaid patients they take. The ideal Medicaid patient for them is a child or a young parent who is just starting out and has the potential to get a better job with increasingly better insurance over the years. "We tend to focus more on having good people-people who take care of their families," Scott Bledsoe explains. Patricia Bledsoe works three days a week at the practice, he works four plus one day a week at a local emergency room, and they have two children, ages 11 and 7.

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