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more photosDr. Lisa Steffey talks with longtime La Pine Community Clinic patient Renee McTague during her checkup. The rural clinic has seen its patient load more than double since 2003.
Nicole Barker / The Bulletin
Expanding clinic races to keep up
Patient load at La Pine facility has risen by 6,000 in three years
By Christopher Stollar / The Bulletin
Published: August 07. 2006 4:00AM PSTLA PINE - An ancient song from King David of Israel rests on a shelf in Chance and Lisa Steffey's office, a reminder of the rough, 16-hour days they were working to keep their La Pine Community Clinic from dying.
"He brought me up out of the pit of destruction, out of the miry clay," the words read in praise of Yahweh. "And he set my feet upon a rock, making my footsteps firm."
But the struggle remains.
The 39-year-old Steffeys still work 12-hour days to keep pace with their patient load that has almost tripled in size since 2003, said Chance Steffey, who manages the clinic. It has grown from 4,000 patients three years ago to 10,000 today.
Regional health providers attribute the clinic's patient spike to La Pine's increasing population.
Chance Steffey said the patient boom has made it hard for them to find enough staff members to keep pace with that growth because many simply don't want to live in La Pine, a rural, unincorporated community of about 6,000 people 30 miles south of Bend.
The clinic, at 51600 Huntington Road, currently has 27 staff and four full-time providers, who help see about 1,200 patients a month.
The Steffeys have been trying to hire another provider for months, but have received few responses.
"A lot of docs don't want to live in a rural area," Chance Steffey said. "They want to stay in a more urban area like Bend, Portland or Salem."
La Pine's staff shortage has directly affected patient care, according to Chance Steffey. The Steffeys said they have had to turn some people away in recent years simply because there weren't enough providers.
"It's definitely created challenges," he said. "You try to provide good customer service, but when you're short on providers and keep getting more and more patients, it does make it harder to have that service that everybody wants."
Jack Holland, a patient of the clinic, agreed with Chance Steffey. He said the increase has made it harder to book appointments, and Chance Steffey confirmed that it can take up to a couple days.
But Holland also praised Lisa Steffey's work.
"Dr. Steffey is running a tight ship," he said. "It's just right for a small town. If it wasn't for that, we'd really be screwed."
At this point, the Steffeys said they have no specific solutions to the patient growth problem other than continuing to work 12-hour days and maybe hiring another provider.
"We see this as our mission," Lisa Steffey said. "We don't stay here because we're making a lot of money. We stay here because people wouldn't have this if we weren't here."
Chance Steffey agreed.
"We're still struggling," he said. "But we have faith. It's why we do what we do."
Staff shortage is not unique to La Pine, according to Kim Barnes, director of marketing and business development for Bend Memorial Clinic, which owned the La Pine clinic for 15 years before turning it over to the Steffeys.
"It's difficult for everybody to provide staffers," Barnes said, "just to find people."
An uphill battle
After a rocky start, the Steffeys say they came to the surface financially when Chance Steffey applied to become a federal rural health clinic in 2003. It is a program started in 1977 that provides Medicare and Medicaid reimbursements to about 3,000 rural clinics throughout the United States, according to the National Association of Rural Health Clinics.
"We're still struggling," he said. "At least our heads are above water now."
Before becoming a rural health clinic, Chance Steffey said he and his wife were spending about $10,000 each month on their credit cards to pay for bills and staff.
"I was just pulling my hair out," Chance Steffey said. "We turned it over to God and said, 'If you want this to work, make it.' Right after that, things started to get better."
La Pine's $1.5 million clinic provides physicals, drug screening and other nonemergency services. It got $140,000 extra last year from the rural health program for expense reimbursements of patients.
About 65 percent of the patients are enrolled in Medicare or Medicaid, according to Chance Steffey.
The clinic receives $100 per visit for every patient enrolled in Medicaid, a federal and state program that helps pay health care for elderly and disabled people and low-income families with children.
It also gets $58 per visit for every patient enrolled in Medicare, a federal health care insurance program for the disabled and people ages 65 and over.
"Without that, I don't think we would be here," said Lisa Steffey, who runs the medical side of the clinic. "That has been what's turned us around."
Patients say the clinic remains vital to the health of La Pine since it offers services that other places don't provide.
Gas prices and the 30-minute drive to Bend would make medical visits hard if the La Pine clinic wasn't around, according to Shirley Hoover, another patient.
"It's great not having to drive to Bend," she said, adding that her husband just had knee surgery. "It's convenient for us."
Despite the convenience, other problems remain.
The clinic has no emergency room, leaving only two options for people in critical condition: Call 911, or drive to Bend.
"A lot of people think we're a hospital," Chance said. "But we're not. We're not set up to be an emergency room. We're just a doctor's office. If you're having chest pain that shoots down the arm, we can't treat you."
At the same time, said Brice Stanley, a physician assistant at the clinic, it remains the only place in La Pine that offers labs and X-ray machines for patients.
"It's a big community with a lot of people with complex medical situations," he said. "Older folks don't want to drive to Bend, so they would sit at their home with pneumonia, get transported - or worse."
Christopher Stollar can be reached at 617-7818 or at cstollar@bendbulletin.com.
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