The Oregon country doctor 
(From The Oregon magazine)

Oregon 's country doctors, as well as the nurses, dentists, physician assistants and other medical professionals who work in rural communities, are some of the finest health care providers in the state. They serve a large, diverse population with relatively few resources. Although most specialize in general and family practice, country doctors are adept at wearing many different hats and using a wide range of skills to give their patients the best possible care. And because there are so few doctors in small towns, a bad one tends to stick out like a sore thumb and usually doesn't last very long.

Getting doctors and keeping them is a constant challenge for rural communities. Working in a small town isn't for everyone. The pace and need for flexibility, in addition to fiscal and lifestyle issues, drive many doctors back to the city. "Some physicians find it undesirable to work in a rural setting-it's not 'big-hospital' enough," says Sue Fahey, a certified nurse midwife in Grants Pass. "Some physicians thrive on [having] a crisis going on all the time."

Economic disincentives are also a factor. Rural physicians tend to get paid less and have a harder time maintaining their practices, which doesn't always jibe with the tens of thousands of dollars in student loans that the average new doctor has to repay. It may be difficult for a physician's spouse to find work in a small town that supports their own careers. The facility in which they work may not be able to afford the newest, most technologically sophisticated equipment. The rural clinic or hospital may have a "tired" appearance-no budget for a remodel.

In some communities, mid-level practitioners such as nurse practitioners and physician's assistants are embracing rural practice and picking up where physicians have been leaving off. "Mid-levels," as they are called, have a similar education as physicians, just less of it. A nurse practitioner is a registered nurse who independently provides health care in an expanded specialty role, such as family practice or mental health. A physician assistant works under the direction, supervision and responsibility of a doctor.

Kate Kossler, a family nurse practitioner, was interviewed recently for the Hell's Canyon Journal, which is published in Halfway. She says that, in some ways, an experienced, rural, mid-level practitioner can have a broader range of skills and be more effective than a new or urban doctor. "A doctor has more training, but a lot depends on experience," she says. "In one day, I could see a car-accident victim, do a well-child exam, treat an elderly patient with diabetes and see someone with a mental health issue. If a doctor came here and most of his or her prior patient load was kids or just adults, they wouldn't have the same breadth of experience. … In a rural clinic, you have to do it all."

  (3/6/04)