Throughout the Northwest, rural communities are in a constant struggle to attract and keep doctors. To practice in a remote area is to embrace a life of long hours, professional isolation and lower pay.
The region's medical school has a program dedicated to helping students see the upside of rural practice, too.
In Part II of our series on rural health care, correspondent Elizabeth Wynne Johnson chronicles the journey of one medical student as she gets her first real taste of what rural medicine is all about.
It's early spring. A couple dozen first-year medical students from the University of Washington have gathered in North Idaho. They're about to get a preview of what's in store for them this summer.
Corrigan: "Welcome to the RUOP family"
'RUOP' stands for Rural and Underserved Opportunities Program.
Corrigan: "The goals of the RUOP program are to provide you with some understanding of the challenges and rewards of working in rural medicine."
Each of these students will spend a month shadowing a physician in rural practice. So I'm here looking for an aspiring country doc who will let me tag along for the experience.
It turns out, the carrot to get these mostly-urban students in the door is a healthy dose of hands-on clinical work. For some, adjusting to the likes of Laramie, Wyoming or Grangeville, Idaho is going to be a stretch.
Tahir Zaman: "I consider myself to be a minority. In Grangeville, Idaho, I don't know. I looked at the statistics and the Asian population is like, less than like 3%"
Tahir Zaman's home town of Richland, Washington isn't exactly huge, but it's more cosmopolitan than Grangeville. I'm still wondering whose journey I'll be witnessing, when I meet Marisa Bebee. A blond, blue-eyed Seattle native who's going to a place that's about as different as it gets.
Marisa Bebee: "I'm going to be in Plummer, Idaho. And I'm going to be working at…I believe it's called Benewah Medical Center"
Which is the heart of the Coeur d'Alene Indian reservation. My decision is made.
Marisa Bebee: "I've never been to Plummer, Idaho and I don't know what it's going to be like. So I'm probably excited and worried about the same things."
It's an unusually hot day for the beginning of June. Marisa's behind the wheel, driving in for her first glimpse of Plummer, Idaho.
Marisa Bebee: "Kind of bare. Definitely not as many people. Or traffic."
Quick as that, we're on our way out of town.
Marisa Bebee: "Do I need to go back that way? I don't know what the extent of Plummer is here."
Elizabeth Wynne Johnson: "I think you just went through it."
Marisa Bebee: "I'm done. That's amazing [laughs]. So I'm gonna turn around."
The Seattle medical student has done her homework, looking up facts and figures online. The people she'll soon be meeting at the Benewah clinic are overwhelmingly rural and underserved. 70% native, 30% non-native.
Two and a half weeks in, Marisa is doing basic procedures and taking histories.
Marisa Bebee: [Knock] "Hi Beryl, I'm Marisa. How are you doing today?"
Beryl Pielli: "Good. My sugars are kind of high."
Beryl Pielli is a rare sort of patient. She comes to every appointment with a typed, cross referenced list of all her meds and doctor's instructions. On this day she's worried about her blood sugars. Marisa asks questions and takes lots of notes so minutes from now, she can present to the doctor.
Marisa Bebee: "OK, I'll go talk to Mary and we'll be back in."
Mary Barinaga: "My name is Mary Barinaga. I am a family physician at Benewah Medical Center in Plummer, Idaho"
Dr. Barinaga is overseeing Marisa's month-long crash course in rural medicine.
Mary Barinaga: "I think trying to get students to go into family medicine is probably the #1 challenge we're facing right now, especially as family physicians are retiring in rural areas."
Fifteen years ago, Dr. Barinaga did the same month-long rural program.
She grew up in Cambridge, Idaho. Population 350. So she fits the profile of most doctors who end up choosing rural practice. It's about knowing what you're in for. Which is why she believes that RUOP can help even some city-slickers see their way to a country-doc future.
Mary Barinaga: "Even if it causes one person to go into rural family medicine, it's worth it to me."
Marisa Bebee: "I've been surprised by the level of tragedy that's been in the area."
That's Marisa's observation, now that she's past the halfway point of her time here.
Marisa Bebee: "I think part of that's me coming from a privileged kind of life. That I'm seeing more people facing deaths in the family — accidents. It's been interesting to see how open they are with it. I think that really shows something about the connection between the patients and the doctors here."
Marisa Bebee: "This is my last day of my 4-week RUOP experience here. I definitely think there's a lot of qualities of practicing rural med that I would like to have in my practice when I become a doctor. I think it's too early for me to say if I'm going to become a rural family medicine doctor. But it's definitely something that I've enjoyed and may one day do."
In all likelihood, Marisa will go on to a suburban practice somewhere. What she's learned from rural medicine, she can take with her.
Marisa Bebee: "I think they do a lot more than just medicine here. They really help the people in this area to have someone to talk to. And so it's been really great to see that other aspect that they do a lot more than just medical care here."
In another year, this and other rural Northwest towns will get a fresh crop of seedling doctors. Another set of chances for one to take root.