With a shortage of family practice doctors, especially in rural areas, recruitment of doctors is important to patients and hospitals alike.
Three rural doctors discussed these topics with a group of health care professionals at the June 11 Rural Health Policy Summit, sponsored by the Oregon Office of Rural Health.
During the summit, Dr. Evan Saulino said to increase primary care from 40 to 50 percent of the physician workforce, Oregon would need to add 1,355 new primary care physicians over the next 10 years.
One of the ways to increase Oregon physicians is to increase opportunities for medical students through graduate medical education programs both during the third and fourth years of medical school, and by increasing residencies.
Saulino said graduate medical education is an expensive business: $1 million to help start an education program.
Just 50 family-medicine residency slots are in Oregon, Saulino said, suggesting 25 more are needed.
Why are Oregon residencies important?
When it comes to doctors, two-thirds of residents stay and practice medicine where they were residents, said Alissa Craft, DO, director of medical education at Samaritan Health Sciences.
This can become a problem when most residencies have been done in Portland or other states, taking away doctors from more rural areas.
“Portland has plenty of doctors because they train there and stay there,” Craft said. “We want doctors in Corvallis, Lebanon, Newport, so we’ll have doctors for those communities.”
SHS has been working with Western University of Health Sciences since 2007, Craft said, and, in 2009, initiated the first American Osteopathic Association graduate medical education programs in Oregon since 2004.
A total of 27 residents are in SHS facilities, from hospitals to clinics, with a goal to grow the program to accommodate 80 residents, Craft said.
That will help, but to fill the needs of each of the 100 expected graduates from the College of Osteopathic Medicine of the Pacific Northwest (COMP-NW), Craft said help from other hospitals and clinics will be needed.
“We have until 2015,” she said, which is when the first graduating class is scheduled at COMP-NW.
School officials are working with other Oregon hospitals to help support the efforts, Craft added.
She would not reveal exactly how much money is invested in the SHS graduate medical education program.
“It’s a commitment,” Craft said. “It’s a financial commitment and an organizational commitment. You change the culture.”
Both doctors and patients were used to doctors going and taking care of patients.
“Now we add residents to that,” she said. “Each one of our community members who come to our hospitals are helping train physicians for the next generation.”
Residents are doctors and should be treated as a normal doctor, Craft said.
“They have gone to medical school and have their license to practice under supervision,” she said.
Seeing a resident is “the greatest deal on the planet,” Craft said, because patients essentially get to see two doctors instead of one: the resident and the training doctor. Visits are often an hour long, rather than the average 15 minutes, she added.
The chance of keeping a medical student in the area as a physician is 80 to 90 percent if they’ve done a residency in the area, said Dirk Foley, executive director of COMP-NW.
Other ways to attract rural doctors
At the health summit Saulino said, in addition to graduate medical education programs, rural scholarships are incentives that will help increase and encourage doctors to choose rural areas.
COMP-NW does not have any rural scholarships, but students have the same opportunities to apply for what’s available, Foley said.
He said the college does not dictate where students should practice medicine, but that osteopathic education produces more family practitioners: 45 to 50 percent going into family care, internal medicine, pediatrics and family practice.
One summit attendee said if a medical student would commit to coming back to his town to practice for five years, businesses in his community could get together and pay the student’s education costs.
Foley said COMP-NW would be open to such an idea.
The National Health Services Core has a similar scholarship program in place, Foley said.
“They pay for a year of tuition; you repay those monies by working a year where they place you, usually in a rural area,” Foley said.
Should a program like that be installed at COMP-NW, businesses would pay the tuition to the college and sign a legally-binding contract with the student that he or she will serve for a paritulcar amount of time, Foley said.
“I’m thinking that would be attractive to some of our students,” he added. “I think they would jump at the chance to do that.”
Medicine as a business
A challenge facing rural doctors is trying to serve patients and keep the doors open, Dr. Janet Patin said at the summit.
Medical school is already packed with information doctors need to know, Foley said, and, though it is important, business practices are not included in the curriculum.
Instead, graduate medical education and residencies is the place for aspiring doctors to learn business practices.
“We are trying to teach some business skills to our residents,” Craft said.
The family practice residents working in clinics help manage finances, scheduling, medical coding and other aspects of the business-side of running a clinic.
“It’s on-the-job training for running a practice,” Craft said.
Patient's personal benefit summary
When you make an appointment at a Samaritan Health Services hospital or clinic, you may be seen by a resident.
This decreases your cost while increasing your overall visit time from an average of 15 minutes to closer to an hour.
Secondly, you will be seen by your attending physician as well, meaning essentially two doctors for the price of one.
Thirdly, you will be helping to train the next generation of physicians.