A Campus Grows In Wichita
Located in the Sunflower State’s largest city, under the aegis of its flagship university, the University of Kansas School of Medicine-Wichita has been described as a “medical school without walls” and a “model for community-based education.” Established by the Kansas Board of Regents on September 17, 1971, for more than three decades now it has allowed third- and fourth-year KU medical students to receive specialized, hands-on and eminently practical clinical training in patient-rich area hospitals. The result has been the graduation of almost 1,400 physicians as of 2005, nearly half of whom have gone on to set up medical practices in Kansas – exactly as the Wichita campus’ founders had hoped.Indeed, the primary reason for organizing the KU School of Medicine-Wichita was to head off a rapidly worsening, early-1970s doctor-shortage crisis that was particularly affecting rural communities in south-central and western Kansas. The centerpiece of a comprehensive state-funded response – which also included a marked expansion of the KU Medical Center’s original Kansas City, Kansas, campus and its myriad educational capabilities – the new Wichita “branch,” as it was first called, soon enabled the University to annually mint as many as 50 additional MDs: a measureable statistic that has redounded to the immeasurable benefit of untold Kansas residents.
Like any ambitious undertaking, the KU School of Medicine-Wichita has hardly been immune over the years to the occasional jurisdictional squabble or institutional growing pain. Nonetheless, it has arguably enjoyed something of a charmed life, especially when compared to its century-old mother campus in KCK. Whereas the latter’s lot was to endure decades of shoestring budgets, paltry legislative support and facilities awkwardly split between Kansas City and Lawrence before achieving first-class medical school status, the Wichita campus was, in many ways, born full-grown and healthy.
Besides adequate financial backing and minimal overhead, what has further enabled KU’s Wichita campus to succeed “far beyond reasonable expectations,” observed Dr. D. Cramer Reed, its first dean, are the legions of dedicated faculty-physicians, both salaried and volunteer, who gave (and continue to give) unsparingly of their time and expertise. This, coupled with essential support from the city’s public and private hospitals – without which the enterprise might not have succeeded – has resulted in “one of the best community-based clinical medical schools in the country.”The roots of the KU School of Medicine-Wichita trace back to an innovative health care initiative passed by the Kansas legislature in 1949. Known officially as the “Rural Health Program for Kansas” – and in popular parlance the “Murphy Plan,” after KU School of Medicine dean Franklin D. Murphy, who was its leading champion – this $4.3 million measure was aimed at alleviating a worsening doctor-shortage crisis in the rural parts of the state. Among its provisions, the Murphy Plan dramatically enlarged the KU Medical Center’s KCK campus, allowing it to annually graduate 25 percent more physicians and other health care professionals. Additionally, it provided immediate medical student assistance to overworked and understaffed “country doctors” through the Rural Preceptor Program and also devised ways to encourage newly-minted MDs to set up practices in non-urbanized regions. More than anything, the Murphy Plan enlivened the KU Medical Center, enriching it with much needed funding and entrusting it with a long-sought mission of statewide service.
One other key element of the Murphy Plan was a vast expansion of the Medical School’s postgraduate and continuing education capabilities. Through a regular series of seminars and circuit courses, KU physician-educators began traveling in teams throughout Kansas, giving lectures and demonstrations on the latest medical techniques. Playing frequent host to these visiting doctors was the city of Wichita, which, beyond boasting top-notch hospital facilities and hundreds of local practitioners, had, by this time, become the Sunflower State’s largest municipality – thanks to a tremendous World War II-driven period of rapid economic expansion.
By the late 1950s, the educational relationship between the Wichita medical community and the KU School of Medicine had apparently become so close that Dean W. Clarke Wescoe (1952-60), Franklin Murphy’s successor at 39th and Rainbow, began exploring the prospect of forging even firmer ties. Among the ideas he discussed with a number of prominent Wichitans was the feasibility of KU’s Medical School creating a clinical training campus in the city, possibly one connected with the Municipal University of Wichita (present-day Wichita State University). This idea never got off the ground during Wescoe’s tenure, in part because the Murphy Plan was working out so well that there was no immediate need to graduate additional physicians.
This situation began to change, however, as the decade of the 1960s drew to a close. The doctor-shortage problem in Kansas – albeit slowly and unevenly – started to become more and more acute, particularly in terms of the number of general practitioners (or family doctors) serving rural areas. While the Murphy Plan had been remarkably successful in first reversing (then for some two decades holding in check) powerful economic and demographic forces, it could not stem the tide indefinitely. Industrialization and urbanization were not going away. In fact, they were only intensifying. And as they did, according to one contemporary observer, “Political pressure began to build as residents of smaller cities complained to their legislators [about] the lack of health care, or the long journeys required to reach a medical center.”
In response, state legislators – in conjunction with county medical societies, university administrators and members of the Kansas Board of Regents – began entertaining a number of potential solutions. These included forming a second four-year, publicly funded medical school at Wichita State University; shortening the KU School of Medicine’s curriculum to three years to graduate more physicians; and expanding the KU Med Center’s campus and capabilities, enabling it to accept 30 percent more medical students – from 125 to 175 annually.
In the end, the proposal most favored – and ultimately approved – was an amalgam of the class-enlargement scheme and Dean Wescoe’s late-1950s idea to establish a clinical campus of the KU School of Medicine in Wichita. Agreed upon at the September 17, 1971, meeting of the Board of Regents, the ambitious plan sought “to expand medical education massively in Kansas and to emphasize a new concept of community based training.” According to Dr. William O. Reike, vice chancellor for health affairs at the KU Medical Center, the Regents’ action promised to be “the most significant development in medical education in Kansas in the last fifty years.”
Setting up a clinical campus in hospital- and patient-rich Wichita, where KU medical students would complete the final two years of their four-year education, had many obvious attractions. For one, it would be cost-effective in that there’d be no need to build new structures to accommodate first- and second-year basic science classes, since those could still be taught in existing Kansas City campus facilities by already employed Medical School professors. Second, since all clinical training could be given in Wichita hospitals themselves, the only conceivable physical plant need would be a single administrative building. And third, aside from hiring a complement of physicians to serve as full-time department heads – in fields such as surgery, internal medicine and pediatrics – the bulk of the Wichita campus’ faculty members could be recruited from the populous local medical community on a part-time, volunteer basis. Indeed, based on preliminary polling of the 300-member Sedgwick County Medical Society, most were eager to serve and relished the prospect of bringing an “educational component” to Wichita.
Over the next several months, this new venture – known initially as the Wichita State University Branch of the University of Kansas School of Medicine – was given more corporeal form. The reason for including WSU in this double-barreled appellation was, primarily, in recognition of the fact that its original administrative home was located on the Wichita State University campus. Moreover, a number of WSU people figured prominently in its early organization, none more so than Dr. D. Cramer Reed who, in addition to serving as dean of WSU’s College of Health Related Professions, was also an associate dean in the KU School of Medicine. Beginning in September 1971, Reed put on yet a third hat when he agreed to serve as the first dean of KU’s Wichita clinical campus, too. (To disabuse anyone of the misconception, however, that this was a WSU-controlled institution or that the KU Medical Center was not calling all the shots, the entity’s name was later changed to the University of Kansas School of Medicine-Wichita, abbreviated KUSM-W.)
In his 2005 book titled History of the University of Kansas School of Medicine-Wichita, historian Craig Miner described D. Cramer Reed (a native Wichitan) as an “unselfish builder, a tireless worker, and a charismatic, though quiet leader.” Known for his “leadership, vision, drive, and commitment,” he seemed to be “the right person to pull all the disparate factions together.” As one WSU colleague put it, Reed was “the perfect guy for the job.”
At the outset, among Reed’s chief duties was to forge the crucial arrangements with Wichita-area hospitals that would become the core of the Sunflower State’s “medical school without walls.” In close consultation with fellow administrators on the Med Center’s KCK campus, including his immediate superior, Vice Chancellor Reike, Reed convinced four hospitals – the Via Christi Regional Medical Center-St. Francis Campus, the Via Christi Regional Medical Center-St. Joseph Campus, Wesley Medical Center, and the Department of Veterans Affairs Medical Center – to partner up. These institutions agreed to provide third- and fourth-year KU medical students (set to arrive in January 1974) access to their more than 2,000 patient beds and allow them to receive clinical training in hospital facilities.
For those concerned about the state’s worsening doctor-shortage crisis, this educational concept offered a seemingly ideal solution. The KU School of Medicine could conceivably provide 50 additional medical students with first-rate clinical instruction each year. (If so enlarged, roughly a third of KU’s clinical students would go to Wichita; the remaining two-thirds would continue to take their clinical training at 39th and Rainbow.)
In Kansas Governor Robert Docking’s estimation, the community-based “Wichita plan” was “one that would encourage doctors to stay in Kansas and train them ‘in one of the most inexpensive methods known.’” For KU Chancellor Archie Dykes, it was a means by which the Medical School could become “more deeply imbedded in the state” while simultaneously enhancing the “one medical school-one University” concept, of which he was a steadfast proponent.
Above all, noted Dr. Robert P. Hudson, the Med School’s longtime chairman of the History of Medicine Department, since the Wichita campus would highly emphasize hands-on, community-based patient-care experience, the enterprise would most effectively “prepare physicians for family practice” – the very kind of practitioners most needed in 1970s Kansas.
As to how a 30 percent increase in KU’s medical student body could be accommodated – after all, before they could become third- and fourth-years in Wichita, there had to be room for them as first- and second-years in KCK – this was resolved thanks to some $65 million in legislative appropriations that enlarged the Med Center’s Kansas City, Kansas, campus dramatically over the next five years. Indeed, from 1971-76, no less than nine new buildings of varying sizes were erected.
As its originators had hoped, from the beginning KUSM-W enjoyed considerable support from the Wichita medical community. Local doctors signed up in droves, some in a salaried professorial capacity, the vast majority on a strictly voluntary basis. Among the most prominent included Dr. Richard Guthrie, a nationally renowned specialist on diabetes; Dr. William Eckart, an internationally respected expert in the field of forensic pathology; and Dr. Ernest Crow, an accomplished veteran internist who was widely regarded as the “conscience of Wichita medicine.” Among these esteemed physicians and scores (later hundreds) of others, “The response … was overwhelmingly positive,” noted Miner. Indeed, their enthusiastic, often selfless, cooperation – coupled with that from the four area hospitals – allowed the KU School of Medicine to send its first crop of 15 fourth-year clinical students to Wichita in surprisingly short order. Classes began on January 2, 1974, and that same year, KUSM-W earned its official medical school accreditation.
Regarding the specific program Wichita-based medical students followed, each was assigned to rotating assignments at the four participating hospitals, during which they were closely supervised and mentored by faculty physicians. These assignments varied in length. For example, those in surgery and internal medicine lasted 10-12 weeks; both pediatrics and obstetrics/gynecology were eight weeks in duration; and six weeks were devoted to psychiatry. Specialized training in such subjects as dermatology, radiology and plastic surgery was also available.
Beyond this, each student was matched with a local Wichita physician and spent a half-day each week in his or her office, acquiring additional “real-world” patient-care experience. And as was the case for medical students at the KCK campus, attainment of fourth-year status at Wichita required these future MDs to enter the Rural Preceptor Program, where they would spend roughly four weeks in the field assisting mainly rural practitioners in communities throughout Kansas. Daily rounds and periodic seminars and conferences were integral as well.
The first group to complete this well-rounded medical education consisted of 14 KUSM-W students who received their MD degrees in May 1975. In so doing, incidentally, they became the first Wichita-trained physicians in the city’s 105-year history.
It took until 1981 before the KU School of Medicine-Wichita began receiving its intended full complement of 100 third- and fourth-year medical students. Nonetheless, progress in the interim was steady. For example, starting from a 1971 outlay of $153,000 – enough to hire nine full-time faculty members – within 10 years KUSM-W was able to boast a $13 million annual budget, a more than 80-fold surge.
Similarly remarkable was its journey from being headquartered in a “small cottage” on the WSU campus to (in 1975) an extensively renovated, modernized facility that once housed Wichita’s E.B. Allen Memorial Hospital. According to Dean D. Cramer Reed, “The move was symbolic of an attitude involving the Wichita health care community,” one reflecting “an extremely cooperative environment” that dispelled “the doubts and uncertainties which clouded the school’s earliest days.”
Moreover, Reed added, within a few short years the new campus “had such acceptance by the students that a lottery was devised to select those who would come to Wichita from among all who applied in a given year.” The main reason, it seems, that so many were vying so energetically to undergo their clinical training in Wichita was the chance to gain extensive hands-on experience, particularly in obstetrics.
Additionally, as Miner put it, those eager to complete their education at KUSM-W “wanted to see how medicine was practiced outside a university-based medical center, as they felt that was more likely to parallel their own eventual practices.” What’s more, noted Miner, many aspiring MDs “viewed Wichita as a source of tranquility, a sort of peaceful kingdom…where they could pay attention to their career goals without distraction.” Still others, he suggested, saw the Wichita campus as “less hierarchic” than Kansas City’s and the educational environment there as “more collegial between residents, students and faculty.”
That’s not to say, though, that the formation of KUSM-W was somehow seamless, that it was in any way utopian, or that it did not have to suffer its share of hardships. Indeed, for those tempted to conclude that “the Wichita saga was an easy and rollicking success, [going] from its concept to birth in five smooth gestational years,” KUMC’s Dr. Robert Hudson hastened to remind them that “things were not that simple.”
Beyond the basic mechanics of establishing a new medical campus 160 miles away from the original, there were myriad, often thorny, political and jurisdictional realities to contend with, as well as the occasional intra-institutional feud. These almost exclusively revolved around how much curricular and budgetary independence Wichita would have – or, more accurately, how much Kansas City and Lawrence were willing to tolerate. For several years, in fact, frustrations ran high among senior administrators on all three campuses.
For their part, some Wichita-based officials and faculty early on chafed under their original “branch” status designation, often feeling their counterparts at 39th and Rainbow did not treat them as full partners.
Another sore spot for some associated with KUSM-W was KU Chancellor Archie Dykes’ tendency to keep the campus on a tight administrative leash. Described by Miner as an executive with “enormous energy and tolerance for detail,” Dykes devoted an unprecedented amount of attention to KU medical education during his seven-year tenure (1973-80) and was determined, at all times and on all issues, to ensure the Med School remained a “unified whole.” Although occasionally thought of as a “micro-manager,” especially where KUSM-W was concerned, Dykes was undoubtedly a tireless advocate of the “synergism that [he felt] should exist between the academic and medical world.” But as Miner has also pointed out, “whether he was a benevolent dictator or not depended on one’s location in the system and one’s point of view.”
As it turned out, a number of KUSM-W officials – particularly during the first few years – ultimately found the view northeast from Wichita not pleasant in the least. As such, the institution had to endure its share of high-profile resignations including, most prominently, Dean D. Cramer Reed’s in 1978. Yet despite this, he and many other KUSM-W pioneers, regardless of the lengths of their service or the circumstances of their departure, deserve credit for laying the solid foundation upon which considerable future successes could be built. Indeed, looking back from a vantage point of more than three decades, it seems apparent that KU’s “medical school without walls” needed little else.
As of 2005, for instance, the University of Kansas School of Medicine-Wichita could claim 10 different medical departments, 110 paid faculty members, over 900 volunteer educators, and two full clinical classes (one comprised of third-year students, the other of fourth-years) numbering approximately 55 prospective MDs each. It has repeatedly been named a local “economic driver” and, since its inception, has graduated 1,400 physicians, roughly half of whom have gone into primary care fields such as family medicine, pediatrics, internal medicine, and obstetrics/gynecology.
Moreover, though its Wichita Center for Graduate Medical Education, KUSM-W supervises a dozen residency programs and more than 260 resident physicians. Perhaps the most impressive statistic here is that, historically, some 60 percent of KU physicians who serve out their residencies in Wichita hospitals have gone on establish medical practices in Kansas. Not enough, unfortunately, to ever single-handedly solve the Sunflower State’s persistent rural doctor-shortage problems, but certainly enough to justify its founders’ belief that a Wichita campus would be an estimable investment in service of a noble cause.
John H. McCool
Department of History
University of Kansas
[Source Notes: The documents and materials consulted for this article can be found in the University of Kansas Medical Center Archives. They include the following: Craig Miner, History of the University of Kansas School of Medicine-Wichita, 1970-2003, (Mennonite Press, 2005), passim; William J. Reals, MD and Joseph C. Meek, MD, “University of Kansas School of Medicine-Wichita: Twenty Years and Beyond,” Kansas Medicine 96:3 (Fall 1995), pp. 117-120; Ernest W. Crow, MD, “The Early History of the University of Kansas School of Medicine-Wichita: Department of Internal Medicine,” pp. 1-16; Jack D. Walker, MD, “A Proposed College of Health Related Professions: Wichita State University Feasibility Study” (August 1969), pp. 1-51; Lawrence H. Larsen and Nancy J. Hulston, The University of Kansas Medical Center: A Pictorial History, (University Press of Kansas, 1992), pp. 139-216; Stanley R. Friesen, MD, and Robert P. Hudson, MD, The Kansas School of Medicine: Eyewitness Reflections on its Formative Years, (University of Kansas Medical Center, 1996), pp. 170-182.]