This year I was watching the "Oregon Channel" as the legislative health committee conducted business. The sound quality was so poor I couldn't hear the exact nature of the meeting...until 1 male representative (who had better voice projection, asked the male health co. leader "...shouldn't we
(involve/inform?)the Eastern part of the State?(regarding whatever they'd been discussing and deciding).
This "leader", with a dismissive downward /out hand gesture said "nah" in a derisive tone.
When and how will these people (incl. public employees) get the message that they are there to serve a whole state...not just the Salem/Portland corridor.
They've created an US vs THEM environment: people here in Central OR don't think State laws apply to them/us and the metro area prefers not to think about any subject but their own little island.
As the Portland City Club President introduced the OR Chief Justice last year, the 'good ol' boys socialization and the stagnation in this state was blatant. The days of Gov. Tom and Oregon's "innovations in the early 1970's" were the accomplishments they boasted about.
When the gov't/metro Oregon area is stuck in 20th Century (anamolous) achievments, I can see why rural/east of Cascades culture is 19th Century.
Gee, I wonder why the 'new economy companies' aren't flocking here to employ uneducated, unprepared Oregonians!!!!
My wife and I are both rural family physicians in John Day. We have been here for almost three years and thoroughly enjoy the practice, the people, and the community. However, as Dr. Dodson knows because she worked here years ago before joining OHSU and because she continues to come help us with call on occasional weekends, it is very difficult to find rural physicians. Three physicians have left since we arrived and while we have two very competent mid-levels, we need three physicians as they are able to help with hospital and call coverage. It seems there are many, many factors that account for the difficulty recruiting rural physicians: fewer people becoming family physicians (and no one else does ER, OB, adults and kids); fewer family physicians doing ER, hospital, clinic, OB; an increasing need for primary care physicians everywhere; working spouses/partners who would rather not be in a remote rural area; the demands of frequent call with the challenge of working with limited resources far from a major tertiary care center where it is you and a team of nurses (in our case, excellent nurses) to deal with everything that comes through the door; and people always mention finances but that's debatable.
My wife and I are the last physicians that have decided to come to John Day. Until recently we hadn't had any people even come to interview, partly our fault as a hospital as we're only now getting aggressive about recruiting. We are glad to have medical students and residents to teach and supervise and some express an interest but years later when they finally finish training other distractions have often pulled them down a different path. I was a med student in John Day with Dr. Holland, Oregon's Family Physician of the Year this year, he's still here and now I get to work with him as a colleague. But it doesn't happen very often.
We have other needs including mental health and substance abuse treatment. But as a physician committed to the people of Grant County, finding additional providers to improve access to care and limit burnout is among my highest priorities.
I did write an editorial about this to our local paper, The Blue Mountain Eagle, back in February. It summarized our situation at the time and may help people get a better sense of rural medicine.
ARTICLE IN THE BLUE MOUNTAIN EAGLE
February 2, 2008
Thank you for your recent article on the ?health care puzzle? although I am beginning to feel that health care crisis might be a more appropriate term. I have a deep personal, professional, and community interest in the health of Grant County and our providers. The challenges we face as a community are substantial: three high-quality family physicians will have left by April; the public health department has lost its administrator and provider; the health care demands of clinic, hospital, and ER patients continue unabated; only three ER providers will be living in Grant County requiring that we rely more on outside help which is often difficult to find; and, recruiting rural providers is very, very difficult. While the number of mid-levels is stable, over the past year five and a half full time physicians have become two and a half.
It is difficulty to find and recruit rural health care providers. Fewer and fewer medical students have been exposed to rural settings and fewer want to enter family medicine rather than a more popular specialty such as ER, orthopedics, or a sub-specialty. There are fewer people who want to be part of community leadership rather than simply one of many providers in a large city. Fewer providers want to be on call, deliver babies, or be far away from the latest medical high-tech gadgets. Those of us who practice here understand these choices as well as the numerous benefits to living in a setting such as Grant County. But we as a community need to learn how best to ?market? these benefits, not for a short term, for the long haul.
In addition to highlighting our strengths, we also need to address our own weaknesses. Times of trial can help us re-examine our fundamental assumptions, invite constructive criticism, and make healthy changes. This may be a time to examine the broader Grant County health care delivery system and ask what has worked, what has not worked, and how can we as a community move forward into a better model for the future. I do wonder what it says about us as a community that providers have left over the past year. We need to ask ourselves the difficult questions and prepare to make changes.
I believe that through adversity we can explore opportunities. There are opportunities for closer collaboration between providers, between the county and the hospital district, and among ourselves as a community of health care users. I have wondered if we can?t even dream bigger and take more control of our collective health care destiny. While it is a topic for another time, we could ask ourselves why we tolerate the ongoing injustice of limited access to health care that the current expensive health insurance system perpetuates rather than developing a better way to provide services for all our friends and neighbors here in Grant County.
The current health care crisis is an opportunity. It is an opportunity to understand the past, build relationships between people and between providers in the present, and collectively work towards a better, sustainable health care model for Grant County.
Union, Oregon's Health Center as well as Elgins is transititioning from coverage from coverage with Nurse Practitioners from OHSU School of Nursing at Eastern Oregon University in LaGrande.
We, Cove-Union-North Powder Medical Association (CUP) feel it is important to have local coverage and will be persuing a health district that eventually will employ up to a couple Nurse Practitioners and at least parttime services of a physician offering primary care, home visits, wellness clinics, school clinics, classes related to health to the communities.
Attracting health care personnel to rural communities is a hugh problem. In the long run, I suggest we try to "grow" our health care providers by providing excellent incentives to send our promising youth to train to return to us. If raised rurally they will come back.
For short term I wonder if there could be incentives to physicians who want to retire to rural areas to work parttime, and that we aggressively work with Medical and nursing schools to allow practicum rotation to our clinic and the community participate by embracing them while here. Hopefully they will be "hooked" to our quality of life.
I live in Pendleton (rural but not remote) with hemophilia. Hemophilia affects about one male in about 7,000. That means that few physicians, particularly in rural communities see the condition.
I have been very happy with the medical care I've received over the past 30 years in Pendleton. My physicians, hospital, and dentist have been willing to learn about and accommodate my condition. The hospital stocks the specialized medications I need. I'm on a first-name basis with most of my care team. They all receive good support from the hemophilia treatment center at Oregon Health and Sciences Univ.
(typing is irregular today due to an injured index finger due to a cut that was treated well on Saturday.
I live in Halfway. We are an hour east of Baker, about an hour and 45 minutes from LaGrande. We have been struggling for several years to keep our local clinic open. The nonprofit Pine Eagle Clinic is the only healthcare available in over 50 miles. (We consider Elgin to be close to the city in comparison to us!) This spring a local health taxing district failed by 7 votes out of 900 cast. Now we are faced with supporting the clinic through donations and attempting to reorganize and cut costs even further to keep a PA working here.
Medicare (and Medicaid) reimbursement rates are a large part of our problem. Since Oregon has had historically lower health care costs, Medicare pays even lower rates here than in other states. Medicare pays below costs and this amounts to a back door tax on the medical system and the state as a whole, and particularly on health care in areas like ours with a high proportion of Medicare patients.
Ironically the care provided by family practice doctors and primary clinics like our are the most efficient and cost effective ways to keep people healthy and provide health care. The current payment system however prioritizes (and pays for) specialists, hospitals, and devices (e.g. CT scans) over primary care.
My name is Alison Clemens and I'm a physician assistant working in Woodburn OR at a community health center serving medicare, medicaid and uninsured patients primarily, many who are migrant farm workers. So far I haven't heard you address the role of mid-level providers in rural health care. I'm a graduate of OHSU Physician Assistant program who actually has a focus and commitment of preparing graduates to provide underserved communities with care. Mid-level practicioners such as PAs and nurse practicioners are an alternative health care provider where physician's aren't available or in adjunct with physician's to increase the availabilty and quality of care.
My husband is a family physician who trained at OHSU (with the wonderful Lisa Dodson!!) and has practiced for six years in Vancouver and Portland. In about a month we are moving to the small Wyoming town of Jackson Hole where he grew up, so he can help to build a hospital-owned multispecialty primary care clinic there. Most of the primary care doctors who are there now arrived in 70s and hung up a shingle to practice independently. Now they are all ready to retire, but can't find young doctors willing to take over their practices. Even though the town is a desirable place to live, the combination of high cost of living there, med school debt load and growing liability costs associated with rural practice make it financially unrealistic for young primary care doctors to practice there under the old independent clinic model.
The OHSU Library and other librarian's across the state are working on a project funded by the Oregon State Library and the National Library of Medicine called Oregon Health Go Local. This free web-based database will allow individuals to identify health service providers in their communities and adjacent communities who can treat specific conditions. One will be able to enter their zip code and specify the the number of of miles they are willing to travel to get care. Oregon Health Go Local will not address physicican shortages but as care becomes more patchy, this project may help lead people to providers who can provide the care they need. The project is expected to be available in late 2008.
Oregon Health & Science Library
Oregon Health Go Local
Someone mentioned trying to get retired physicians to practice part-time in rural communities. I am a retired pediatrician and can see several problems with this.
One is the malpractice problem. Even if funding could provide the money to buy malpractice insurance, the physician is still liable to malpractice suits. A malpractice suit can devastate a physician and his/her family for many years. I would not like to spend my retirement under the threat of a possible malpractice suit.
A second problem is keeping current. You might be practicing part-time, but you need to keep current on all the developments in medicine. This is a full-time job and not something I would want to do in retirement.
A third problem is night and weekend call. A retired doctor would not be interested in being on call nights and weekends. Even if you are not officially on call, you can't live in a small community, get close to your patients and ignore their around-the-clock needs.
Joining the discussion late, but I'm pleased that the role of physician assistants in delivering health care to rural Oregonians has been raised. As the founding director of the first PA program in the state in 1995, I think it is vital that the role of PAs and nurse practitioners be considered when looking at longterm solutions to the anticipated physician shortage on the horizon.
Ted J. Ruback, M.S., PA-C
Director, OHSU Physician Assistant Program
Doctors need to stop pretending to be powerless. No country's population can pay for the huge offensive war capability that the U.S. has and at the same time take care of social needs. Doctors must unite and be proactive advocates of world unity agreements so that the world can agree to reduce armaments and sign peace treaties. They must lobby for legislation that makes rural health care reasonably attractive. We can subsidize 2 to 4 year stints and motivate medical schools to operate around the clock so that twice and many physicians can be trained. More funding should be requested for training nurse practitioners and physician assistants. The founder of the Baha'i Faith, Baha'u'llah, advised that the countries must hold a world tribunal. Each country must choose a representative to attend. All countries must agree that if one country takes up arms against another, all the other countries must arise to stop that country. With this agreement, each country will need only as many armaments to keep peace within its borders.
The amount we spend on the war machine is mind boggling and underpublicized.
I wonder if you could set up a couple of railroad train cars as a traveling hospital/clinic with some very well appointed living cars for the staff and send it around on a regular schedule to each town. I think that most of those towns have railroad access as they were logging, mining, or cattle towns. Then each town would share a part of the cost but not have to bear the entire cost of the temporarily local hospital.
At the estimated three trillion dollar cost for the Bush/Cheney War against Iraq, Bush has spent over 134,000 American Dollars on each and very one of the original 23 million Iraqi people, and rural Americans have trouble raising the money for doctors and healthcare?
Its an Alice in Wonderland world!
Sadly, the state of medical care in this country is more a reflection of a lack of creditable leadership than a lack of resources. Access to medical care is a right not a previlege. We have universal telephone service because it is profitable for all the interest groups. There must be more than 50 ways to establish adequate rural health care which would involve some of the same principles as universal telephone service. People who make a decision to live in a rural environment must be willing to share a greater burden of providing medical care than those who live in urban environment. Since rural environments are critial to the health of our country those who live in urban areas must be willing to support health services in these areas. The question which needs to be answered is: What does it take to provide adequate health care in rural areas ? The requirements may be different for different geographical areas, but there is an answer. What do medical personnel need to dedicate their career or a portion of their career to a rural area ? If we had effective leadership with primary loyalty to the voters instead of special interest groups and concerns about their next election we would not be having this particular conversation. If we had enough voters who were more than one or two issue voters and who held interest of the country as a whole as their primary concern and elected officials accountable, perhaps we would have better leadership. I grieve for my city, my state, my geographical region, my country, and my planet. I still have hope we can somehow turn things around.
Maybe Cuba would help out, they train and send doctors to needy places all around the world. I understand that Cuban people are very healthy in general because of their health care system.
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