Dermatologists hard to find in southwest Kansas




Despite a need for dermatologists in the area, many patients diagnosed with various types of skin cancer have access to the kinds of treatment needed through either their primary care physicians or surgeons, according to Scott Taylor, president and CEO of St. Catherine Hospital.

Taylor said that while attempts to recruit dermatologists to the area are consistently being made by the hospital, many patients diagnosed with skin cancer can get the type of treatment they need in Garden City.

"I would say that the vast majority of skin cancer patients are actually treated locally, unless they choose to go somewhere else and the majority of those cases, and this is nationally, are treated by surgeons. Surgeons and primary care physicians," Taylor said.

He said local primary care physicians at Plaza Medical Center and Siena Medical Clinic are very attuned to skin cancer and include it in their patients' annual physical exams.

"They are very skilled at recognizing the potential skin cancers," Taylor said. "They are also very diligent about when they do recognize a potential skin cancer, having it either confirmed through a pathologist or referring it to a surgeon for further evaluation."

One of the physicians who skin cancer patients are referred to is Dr. Restituto Tibayan, oncologist and hematologist at the Central Care Center, 410 E. Spruce St., particularly if someone has melanoma, the deadliest form of the disease.

"There are certain features in the cancer, if they are diagnosed to have cancer, that are high risk of recurrence or high risk for spreading, so the surgeons or the dermatologists send the patients to us for evaluation, to determine if they need more treatment and if it has spread, chemotherapy would be the course of treatment," Tibayan said.

He said in the past year that he has practiced at the cancer center, he has seen three cases of melanoma, but none of those patients had indications for chemotherapy.

Tibayan said in those cases, the melanoma was resected, or surgically removed, so he only monitored the patients afterward to make certain none of the cancer had remained in the area or spread.

There are two other types of skin cancer: basal-cell carcinoma is the least serious type and can usually be surgically removed or frozen off by either a primary care physician or a surgeon; squamos-cell carcinoma is more aggressive, must be treated aggressively and is typically removed by a surgeon.

Tibayan said that with melanoma in particular, early detection is the key in terms of preventing further progression and spreading of the disease. He said that melanoma is an area in which dermatologists can play a critical role.

"The time line is really variable, but I should say within a few months (of discovering a spot), a person should get a dermatologist to see (him or her) because there are certain features that the dermatologist could recognize as being suspicious for cancer or not. Some people would say, 'Oh this is OK,' but to a dermatologist, to an expert eye, it could be different — there are certain features in the skin, lesions for example, the intensity of the color, the irregularity of the shape, the increasing of the size — those are the characteristics that can vary over a period of one or two months. Unfortunately, since we only have four dermatologists in the area, to get an appointment with them is really difficult, so I think there is really a need for more dermatologists in the area," Tibayan said.

The four dermatologists in the area are located in Liberal, Ulysses, Dodge City and Hays.

Taylor said dermatology has been a recruitment avenue for St. Catherine Hospital for several years, and despite the fact that demand in the area is great enough to guarantee a steady stream of income for a dermatologist, other factors get in the way.

"It's not because Garden City is not an attractive opportunity for a dermatologist — they would be very busy, very quickly, if we were able to get one. The problem for us is they can be equally busy in Wichita, Kansas City, Colorado Springs, Denver and they have the advantages of bigger cities and probably have partners to cover on vacation and those types of things," Taylor said. "So, when I recruit a dermatologist and tell that dermatologist, 'You will be very busy, just come out. We will provide start-up financial support for you and assure you that you'll make the type of living that dermatologists make,' nine times out of 10, the answer is 'Wichita or one of these larger communities is aggressively recruiting me as well, and they're telling me the same thing.'"

For that reason, Taylor said he actively seeks those who are interested in living in a rural setting and are interested in having a very busy practice.

"From time to time every couple of years, a candidate crosses our desk that we do aggressively pursue, but to date, we just haven't been able to secure one," he said.

Taylor said, as with other positions at Siena that have recently been filled by homegrown physicians, he hopes at some point to find a homegrown dermatologist.

"If there was someone from western Kansas who had finished up their general medical practice and was interested and went into a dermatology fellowship when they got out, that would help us immensely in the recruitment," he said.

Victor Hawkins, executive director of marketing and development at St. Catherine Hospital, said they talk to most of the candidates from southwest Kansas who go to medical school.

"The problem is that the standards are so high for dermatology that not many slots are available, and there is just a shortage of dermatology nationwide, so they can go anywhere they want," Hawkins said.

Taylor said dermatology is an excellent career for someone who wants to set their own hours and be as busy as they want to be.

"If they're going to come to this community and be a part of the medical community, St. Catherine is more than willing to help financially with their first year start-up expenses, as a community service, but dermatology has been one we have not been able to recruit yet," he said.

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