Scott Swanson
The addition of a new physician last week to the Sweet Home Family Medicine staff is the latest step in Samaritan Health Services’ efforts to meet an intensifying demand for medical care locally.
Marty Cahill, chief operations officer of Lebanon Samaritan Community Hospital, said Samaritan Health Services, which operates the Sweet Home clinic, has, along with the rest of the state, experienced a “perfect storm” that is resulting in the shortage of primary care physicians, also known as family doctors or general practitioners.
He said a number of factors are contributing to the shortage: a wave of physician retirements, a massive increase in insured patients via the Oregon Health Plan, and a new “patient-centered primary care home” model for clinics such as Sweet Home Family Medicine that emphasizes a team-based approach aimed at providing more comprehensive and continuous care.
The implementation of that “medical home” concept has required the Sweet Home clinic to hire behavioral psychologist Allegro Johnson late last year and a registered nurse care coordinator among the steps Samaritan has taken to meet the criteria necessary to be a PCMH, said Shiloh Erven, director of primary care clinics.
He and Cahill said Samaritan is being “pressured” by the healthcare reform movement in Oregon to implement the PCMH model.
“This is just the beginning of it,” Cahill said. “As more and more folks get insurance and Obamacare kicks in.”
In Linn, Benton and Lincoln counties, Samaritan Health Services has picked up 16,000 to 18,000 newly insured patients, he said, adding that “disproportionate share” of that number are located in east Linn County.
“Brownsville and the Sweet Home areas have not seen a large influx of new people. The vast majority of that population, we’ve seen them somewhere, whether it’s urgent care or the hospital. We’re just getting insurance, and part of them we’ve probably already seen.”
Erven said the situation is just a small reflection of what’s happening nationally.
“Sweet Home is kind of a microcosm of our larger Samaritan system, which is kind of a microcosm for the state of Oregon, which is sort of a microcosm for what’s going on in the country,” Erven said. “There’s a primary care shortage across the country.”
The good news, he said, is that Samaritan has been “lucky” to find some physicians, one of whom started in Sweet Home Sept. 15 – Dr. Tessa Reff (see accompanying story).
She follows Dr. Corbett Richards, who started at the Park Street Clinic in Lebanon on Sept. 2, and Kathy Chang, who started in Lebanon Aug. 1 – all primary care doctors.
Reff joins physicians Alan Blake, Juliette Asuncion and Nathan Mason. The clinic also has two primary care physician’s assistants, Rick Parrish and Marie Meyers, who started at the clinic last year.
Erven noted that Parrish handles walk-in patients almost exclusively, which is a service “unique” to Sweet Home.
“It’s important for that as a pressure release valve,” Cahill added.
Clinic Manager Kristin Ashcraft said the addition of Reff gives the clinic two family obstetricians, which is “really good.”
“I’m really enthusiastic,” she said.
Another addition for Sweet Home is the on-site dental hygiene services offered by the clinic since August, Ashcraft noted.
“They’ll see anyone, under-insured or non-insured,” she said. A hygienist is available five days a week, while a dentist is available one day a week.
Ashcraft pointed out that clinic offers comprehensive medical services, from physical therapy to pharmaceutical services.
“As much as we can serve Sweet Home patients, we are,” she said.
The Samaritan clinic in Brownsville also has a new staffer: Physician’s Assistant Michael Lounsbury, who started the first week of September, coming from Orofino, Idaho.
“He loves practicing in rural communities,” Erven said. Louns-bury joins longtime Brownsville physician Dr. Diana Barron and Dr. John Hickey, who arrived about a year ago.
“We’re trying to get providers out in that community as well,” Cahill said. “As difficult as it is, we’re trying to embed providers in these communities as much as we can.”
Samaritan, as is standard for medical providers, has a minimum number of patients it expects its doctors to see each day – 16. A well-established Samaritan physician may see 1,500 to 1,800 patients per year, he said.
“Sweet Home’s doctors have already met that,” Cahill said.
He said Samaritan’s intent is to leave some slots open every day for every provider.
“Those providers would rather see their patients than have them go to Urgent Care or go to the walk-in clinic when things pop up. We’re trying to embrace more openly the idea of an open schedule, to get you in to your doctor who knows you and you know your doctor, to create that continunity of care.”
He said Samaritan would like to decrease the wait time for new patients “closer to two to four weeks.”
A real challenge is recruiting new physicians willing to work in rural communities, they said.
Samaritan is competing with other communities, using incentives such as loan forgiveness for newly minted physicians burdened with debt.
“These doctors are coming out with megadebt, crazy numbers,” Erven said.
Cahill said it’s not unusual for a new doctor to have $250,000 to $300,000 in debt. Couple that with the fact that primary care physicians are not paid as well as specialists, and life can be tough. To lesser extents, the same holds true for many physician’s assistants and clinical psychologists.
“If you’re coming out with half a million dollars of debt, you want to be able to make half a million,” Erven said. “It’s tough.”
Samaritan hopes to benefit from its relationship with Western University’s COMP-Northwest medical school, located across the street from SLCH, and it also has a residency program at its Corvallis regional medical center that started the year before the medical school opened.
“The medical school gives us familiarity with those students as they come through as residents or come through as doctors later on,” Cahill said. “We hope it is kind of a working interview for both of us.
“The medical school is more getting them familiar with this rural area, getting them into the community. What we want to give them is exposure to this environment in hopes that some time in the future they’ll come back.”
Through the residency program, which brings in students from a variety of medical schools, Samaritan has established clinics in Corvallis and Albany, and plans to open another next July in Lebanon.
“That should be a pressure release for those folks that are having difficulties,” Cahill said.
The residency program also exposes students from urban backgrounds or schools to rural medicine, and Erven noted that Samaritan has signed Dr. Corbett Richards, the chief family medicine resident in the Corvallis program.
The overall goal is to meet the demand, they said.
“I think we actually have more service, more providers in Sweet Home than two years ago,” Erven said. “We actually have two additional family med providers, plus a psychologist.”
That’s the reason for adding the new providers in Sweet Home and Brownsville, as well as other areas Samaritan serves, Cahill said.
“Then we need to stop and see if the new capacity that we’ve created, does that meet the need or do we need to do more?” he said. “These are subtle changes. Were the changes enough to meet the volume?”
Erven added: “It all comes down to supply and demand.”