Physician Assistant Relishes Primary Care Practice in Western Kansas

Physician Assistant (PA) Marie McEntee, P.A.-C, loves the role of being the primary care provider for the small town of Leoti (population 1,700) in western Kansas. “It’s what I wanted,” she says. “It’s really practicing medicine.”

McEntee explains, “In a larger town you may work for a doctor in a huge practice and you may assist in surgery, but primarily you are going to do histories and physicals. Here I suture—I delivered a baby the other day—I did a lumbar puncture. I get to do cool things! I really like the scope of practice that a PA gets to do in a smaller town.”

The former NHSC Scholar chose Leoti because she always wanted to do more. McEntee started out as a nurse’s aide in her hometown of Kimball, Nebraska, but decided that she wanted to further her medical career and went on to earn a B.S.N. While working as a nurse, McEntee became friends with a PA who, like her, was married and had children. The friend had trained to become a PA under an NHSC scholarship.

“I liked all the things that PAs are able to do,” McEntee notes, “and I thought applying to PA school with the help of the NHSC sounded like a great idea.” As usual, she wasted little time going back to school and applying for and receiving an NHSC scholarship.

When McEntee was job hunting after graduation, she visited Leoti because of the enthusiasm the site exhibited while recruiting her. “Vicki Burning, the administrator at the Wichita County Health Center, sent me a really nice letter and a little video,” she recalls, “and then the people made me feel so welcome.”

Leoti is located amid the flat prairies on Kansas’ far western border. There’s a single stop sign in the middle of town and the closest McDonald’s is 21 miles away. When McEntee arrived in town in 2001, there was only one doctor. Six months later that doctor left. “By law, I need to have a back-up who can be reached within an hour, and I did—I had a doctor in Garden City which is about 60 miles away,” she notes dryly. “That is pretty cold comfort when you have something come up in the middle of the night.” That situation eventually improved and for the past several years, Leoti has had two doctors who alternate visiting the town every two weeks.

As essentially a solo practitioner, McEntee’s day is packed full. She does hospital rounds at the Wichita County Health Center, and then goes to the clinic that opens at 9:00 a.m. and sees patients until 5:30 or 6:00 p.m. If patients are admitted to the hospital during the day, she will go back to see them at the end of the day. “The health center is one large complex with the state department of health, clinic, hospital, nursing home, and pharmacy attached,” notes McEntee. “So if something comes into the emergency room, I can just walk over and take the case.”

For the really critical cases, McEntee stabilizes the patient and then sends him or her to the nearest trauma center, sometimes by air transport. If the weather is bad and the patient needs to be transported by ground, she often rides along in the ambulance.

Leoti is located in the middle of agricultural and ranching country, so many of the day-to-day health problems McEntee deals with are farm-related, including injuries from taking care of cows, hauling grain, and harvesting crops. The feed and cattle industries also cause a lot of allergy problems from the wheat and corn dust, as well as from cattle dander.

McEntee sees a large number of patients with diabetes, many of them Latino immigrants who work in the local stockyards. These workers experience many of the same agricultural-related health problems as other Leoti residents, but McEntee also finds cases of tuberculosis, poor dental care, and advanced health problems due to the lack of continuity in health care among this population group.

Rather than becoming overwhelmed, McEntee relishes being in the center of her community’s health care system. Her enthusiasm is fueled by the heartfelt response of many of her patients and local residents.

“There’s a real sense of belonging here,” she says. “The community is incredibly supportive.” That support has extended to McEntee’s husband and son, who accompanied her to the windswept Kansas plains.

Her 2-year NHSC scholarship commitment is up, but McEntee has just signed a contract to stay in Leoti another 3 years. “I’ll get more experience here than I ever would in a big town,” she says. “For many patients, I am their primary care person, especially the older people. If I diagnose them with cancer, they usually go to a specialist elsewhere, but eventually they come back here and, boy, am I so attached to them.” And for McEntee, that attachment is for good reason. “People here are so grateful,” she says.