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OHSU president bemoans lack of rural doctors
By ED MERRIMAN
Baker City Herald
Training enough new doctors to replace their retiring baby-boomer predecessors in rural communities across Northeastern Oregon, and then convincing those new doctors to stay, is an uphill battle, especially when the Oregon Legislature keeps cutting funding for the state's only medical school.
Joseph Robertson, president of Oregon Health Science University, and other OHSU officials delivered that message during a tour of rural communities this week that included a Wednesday stop in Baker City.
"Over the past two decades state funding has progressively diminished," Robertson said.
That funding decline included a 40-percent reduction in state funds for OHSU imposed by the 2005 Legislature, a cut which Robertson said the 2007 Legislature failed to restore despite the growing shortage of doctors across rural Oregon.
He's hoping the 2009 Legislature will be more supportive of a cooperative strategy OHSU is preparing this year to address what he describes as Oregon's "rural health care provider crisis."
"The recruitment and retention of doctors in rural areas is a major issue," Robertson said, adding that OHSU is working with two Oregon universities with pre-med programs, hospital associations, the Oregon Medical Association and the Oregon Board of Medical Examiners to devise strategies to attract more OHSU graduates to practice medicine in rural communities such as Baker City.
Robertson said this week's swing through Northeastern Oregon is a followup to a tour he took 18 months ago during his first 100 days as OHSU president.
"When we toured the state last time, I knew the healthcare crisis was bad, but I didn't know how bad," Robertson said.
With 1.39 physicians per 1,000 population, Baker County ranked 23rd among Oregon's 36 counties in per-capita physicians at the time of Robertson's visit 18 months ago. On Thursday he said the situation has gotten worse here and in other rural areas of the state.
Out of 9,773 active medical doctors licensed statewide, Baker County had 20 when the county numbers were last updated in May of 2005. While that is a far cry from Multnomah County with 3,709 active licensed medical doctors, Washington County with 912, Lane County with 747, Clackamas County with 663 and Marion County with 566, Baker County has more doctors than Jefferson County with 19, Columbia with 17, Crook with 16, Wallowa with seven, Lake with six, Morrow and Harney counties with five, Grant with three, Sherman with one, and Wheeler and Gilliam counties with none.
"As you get out on the road, you see that the crisis has not abated," Robinson said.
While there's a current need for 200 to 250 new doctors a year across Oregon, the lack of state funds limited class enrollment to 96 when Robertson took the helm at OHSU in 2006.
By adopting an aggressive strategy of pursuing federal research grants and funding from the National Institute of Health, Robertson said OHSU has managed to offset some of the state funding cuts and has boosted enrollment to 115.
"You will not find another state institution in the country that leverages federal money like OHSU does, with the possible exception of the University of Colorado," Robertson said.
Those federal research grants have helped OHSU somewhat, he said.
But with medical school graduates carrying an average debt of $140,000 when they complete their training, Robertson said many new doctors feel compelled to practice in Portland and other urban areas where the customer base and doctor incomes are considerably larger than in rural communities.
To alleviate some of that financial pressure on medical school students, Robertson said OHSU has entered into agreements with the University of Oregon and Portland State University to allow students to complete their first year of medical training, accredited by OHSU, during their fourth year at those universities.
That trims a year off of medical school, from eight to seven years, Robertson said.
A loan forgiveness program for medical school graduates who opt to practice in rural communities is also under consideration, as well as a proposal to give applicants in rural areas priority in scheduling of medical license examinations by the Oregon Board of Medical Examiners..
In addition, Robertson said OHSU will propose a rural residency program in which more graduate medical students will have a chance to serve their residencies in rural hospitals and clinics.
"We have a prototype program like this right now in Klamath Falls, and nearly 80 percent of them go on to practice in rural areas," Robertson said.
Based on the results of the Klamath Falls program, Robertson thinks setting up residency programs in other rural communities would be an effective way to get medical school graduates adapted to a rural lifestyle during their residency, so they'll be less inclined to leave for the big city when it's time to start their medical practice.
Actively recruiting students from rural towns to attend medical school is another approach that Robertson said "increases the odds by a factor of six that the student will return to his or her rural roots" to practice medicine.
To fill a gap in professional affiliations and desires by some doctors to do research or teach in addition to working in a medical clinic or hospital, OHSU is looking at allowing pairs of doctors to rotate so each spends half of the year serving in a rural medical clinic or hospital, and the other half doing research or teaching at OHSU.
Robertson said those kinds of rotations, along with the opportunity to join organizations such as the Oregon Rural Practitioners Network of 146 doctors in 36 communities (currently), gives rural physicians an opportunity for "stimulation beyond the one-on-one with patients."
While the wheels are already in motion on some of the strategies Robertson discussed during his stop in Baker City, he said other proposals require legislative approval and will be included in a package OHSU will submit to the 2009 Oregon Legislature, along with requests for additional state money.