The Bulletin, Bend / Central Oregon News
FEBRUARY 09, 2010 12:47 PM
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more photosRural clinics like Paulina Peak Family Health Care in La Pine are having a hard time recruiting providers, especially primary care doctors. Paulina Peak has turned to hiring more nurse practitioners like Family Nurse Practitioner Joanne Miller, right, to meet the needs of patients like Danny Conatser.
Photo illustration by Anders Ramberg
Wanted: Rural health providers
Geographic isolation and lower pay make it difficult for clinics in rural areas to recruit enough providers to meet patient demand
By Christopher Stollar / The Bulletin
Published: August 24. 2006 4:00AM PSTFor months, Chance Steffey has been trying to hire another doctor and nurse practitioner.
But after each interview, the La Pine Community Clinic manager has received the same answer for the job offers: No.
The responses may be simple, but the reasons vary. They all contribute to a doctor shortage in La Pine and afflict many rural areas in Oregon.
"It's not really easy to get doctors to come to La Pine," Steffey said. "Primary care in general is seeing a shortage of new doctors."
Rural Oregonians have not been as well-served as those who lived in metropolitan areas according to data compiled by Oregon Health & Science University in Portland. Oregon's metro areas, defined as having populations of 50,000 or more, had 259 doctors per 100,000 people in 2004. Rural areas had 161 doctors per 100,000 people.
Doctor shortages have affected all three counties in Central Oregon, according to the university. In La Pine, between 20 percent and 30 percent of the primary care visits needed by the area's residents were not met, though the causes of doctor shortage varied.
"There are so many reasons," said Scott Ekblad, director of the Oregon Office of Rural Health at Oregon Health & Science University. "The larger, overall reason really is that the supply of primary care physicians sort of ebbs and flows. We are currently in a period where medical graduates are choosing primary care less often ... It has a larger impact than one would guess."
Patients can see the impact clearly in La Pine, where Steffey has been forced to turn some people away in recent years simply because he didn't have enough providers, a general medical term that encompasses doctors, nurse practitioners and physician assistants.
The clinic operates with 21 staff, including four full-time providers and two part-time providers, who see about 1,200 patients a month for nonemergency services.
Other rural areas have experienced the same problem.
Ochoco Health Systems, which sees about 8,000 patients through separate clinics in Bend, Madras and Prineville, still needs to hire three additional providers.
So far, Ochoco Executive Director Lynn Martin said she has had no problem enticing doctors to the Bend clinic, but Prineville and Madras remain tougher sells.
The skill factor
One of the main problems, according to Martin, is finding job candidates who are primary care doctors - physicians who know how to do it all, from delivering babies to diagnosing strep throat infections.
"That is harder and harder to find," Martin said. "It's a challenge."
This challenge stems from a switch in teaching emphasis at medical universities, according to Ekblad. Professors used to stress a broad education. Now they emphasize specific skills.
"The bias is to specialized medicine," Ekblad said. "There seems to be more stature in depth of medical knowledge, as opposed to breadth."
Dr. Tina Busby, a physician at the Prineville clinic, agreed with Ekblad, adding that a broad medical education often translates into more time on the job because rural areas typically don't have as many staff members or a plethora of specialized doctors.
While working for a small clinic in Montana years ago, Busby and one other partner saw between 30 and 40 patients a day.
They had one receptionist.
"Even when not in your office, you're in the office," Busby said. "If you do a good job, you really become part of the community ... You're taking care of your friends and your neighbors."
The money factor
On average, rural doctors make $204,000 a year, compared to the $218,000 urban doctors earn annually, according to a 2005 report based on a nationally representative survey of 12,000 doctors selected by the American Medical Association and the American Osteopathic Association.
Such disparities can make it hard for rural, medical graduates, like Brice Stanley, to pay the thousands of dollars in loans taken out for education.
Stanley, a La Pine Community Clinic physician assistant, graduated with a master's degree from Pacific University in 2004 with a total of $280,000 in debt.
He knows some graduates who have $300,000 in loans. The huge debt load makes it so even a low, six-digit salary often doesn't cut it.
"You're asking them to go to medical school and then head out to the middle of nowhere," Stanley said. "You don't take someone from Manhattan and expect them to come to La Pine."
Busby agreed.
"Student loans come due every month, regardless of how much you take in," she said.
The family factor
Even if a rural clinic is able to persuade a doctor that La Pine or Prineville might be a great place to work, the spouse and children must also become convinced.
That is not an easy task, according to Steffey.
He interviewed one candidate who loved the concept of working for the La Pine Community Clinic, but the candidate and his family just didn't like La Pine.
"Even Bend was too small for them," Steffey said. "They needed to have ballet, the arts, a museum, and I don't know what else."
Martin has run into the same problem at the Ochoco Community Clinic in Prineville.
She interviewed a man who looked at all three clinics - Bend, Madras and Prineville - but ended up choosing the one in Bend because of family pressure.
"When you're recruiting, you're not just recruiting the provider," she said. "You're recruiting the wife and children. They need to be happy. It's a challenge."
Some local clinics have taken steps to deal with the problem. Paulina Peak Family Health Care in La Pine, which has 3,500 patients total, has focused more on hiring nurse practitioners because they are more available and have lower salary expectations, according to clinic manager Greg Miller.
There may not even be a long-term solution, according to Steffey. He believes the physician shortage stems primarily from the industrialization of the world - a train of progress that cannot be stopped easily, if at all.
"Today, everybody is moving to urban areas," he said. "Who are going to be the ones going back to the rural areas?"
Christopher Stollar can be reached at 617-7818 or at cstollar@bendbulletin.com.
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