Rural Medicine

>> ON “HEALTH MATTERS,” TELEVISION FOR LIFE, HOW RURAL HEALTH CARE IS KEEPING ITS SMALL TOWN FEEL WHILE PROVIDING IMPRESSIVE CARE. >> WHEN YOU PRACTICE IN A RURAL AREA AS A FAMILY PRACTITIONER, YOU STILL DO THE BROAD SCOPE OF MEDICINE, JUST BECAUSE THERE’S NOBODY ELSE TO DO IT. WHEN WE DISCUSS WHAT WE DO UP HERE WITH CERTAIN PHYSICIANS, THEY ARE ALWAYS KIND OF AMAZED. >> TRAVEL TO EASTERN WASHINGTON’S SMALL TOWNS AS “HEALTH MATTERS” EXPLORES THE STATE OF RURAL MEDICINE. RIGHT NOW ON “HEALTH MATTERS.” >> “HEALTH MATTERS” IS MADE POSSIBLE BY VIEWERS LIKE YOU, THE FRIENDS OF KSPS. AND BY THE FOLLOWING: >> I’M ARNIE PETERSON. I’M AN ORTHOPEDIC SURGEON. AND I WORK IN THE SACRED HEART FOR PROVIDENCE MEDICAL GROUP. WHEN I NEEDED MY HIP REPLACED, I CHOSE PROVIDENCE BECAUSE OF THE PROFESSIONALISM AND THE CARE I KNEW I WOULD RECEIVE. I NEVER THOUGHT TWICE ABOUT GOING ANYWHERE ELSE. >> I’M DR. ANDREW BULEAU. I KNEW EVERYTHING WAS AVAILABLE FROM THE EMERGENCY ROOM, TO THE RADIOLOGY, TO THE NURSING STAFF TO THE SPECIALISTS WE NEEDED FOR HER CARE. >> GOOD EVENING AND WELCOME TO “HEALTH MATTERS.” I’M YOUR HOST TERESA LUKENS. ACCORDING TO U.S. CENSUS DATA, ABOUT 20% OF AMERICANS LIVE IN RURAL AREAS, MILES FROM A MAJOR HOSPITAL. BUT THAT DOESN’T NECESSARILY MEAN A LACK OF ACCESS TO QUALITY CARE. TONIGHT, WE’RE TALKING RURAL MEDICINE WITH PROFESSIONALS WHO LIVE IT EVERY DAY. LET’S MEET THEM. ANDY CASTRODALE IS THE CHIEF OF STAFF AT COULEE MEDICAL CENTER. RON REHN IS THE CHIEF EXECUTIVE FOR PROVIDENCE NORTHEAST WASHINGTON MEDICAL GROUP, PROVIDENCE MOUNT CARMEL HOSPITAL, PROVIDENCE ST. JOSEPH’S HOSPITAL AND PROVIDENCE DOMINICARE. ELIZABETH STUHLMILLER IS IN HER THIRD YEAR WITH THE PROVIDENCE SPOKANE FAMILY MEDICINE RESIDENCY PROGRAM. SHE PLANS TO PRACTICE IN TONASKET. ROBERT ST. CLAIR IS A FAMILY PRACTICE PHYSICIAN. HE WORKS AT NORTH BASIN MEDICAL CLINIC AND LINCOLN HOSPITAL WHERE HE ALSO COVERS THE E.R. EDWARD JOHNSON IS A FAMILY MEDICINE PHYSICIAN. HE IS ALSO THE DIRECTOR OF THE EMERGENCY DEPARTMENT AT MOUNT CARMEL HOSPITAL. I WANT TO WELCOME ALL OF YOU HERE TONIGHT AND THANK YOU FOR BRINGING YOUR EXPERTISE. I THINK WE HAVE AN INTERESTING TOPIC. I WANT TO WELCOME YOUR PHONE CALLS THIS EVENING AND YOUR EMAILS, ESPECIALLY IF YOU LIVE IN OUTLYING AREAS AROUND SPOKANE. MAYBE ONE OF THESE HOSPITALS IS YOUR PROVIDER. WE WOULD LOVE TO HEAR FROM YOU TONIGHT. LET’S SORT OF ESTABLISH THE AREA THAT YOU ALL COVER AND TALK ABOUT THE MEDICAL FACILITIES THAT YOU HAVE. DR. REHN, YOU SEEM TO COVER THE MOST AREA WITH THE MOST FACILITIES. SO LET’S BEGIN WITH YOU. >> SO MOUNT CARMEL HOSPITAL, PROVIDENCE MOUNT CARMEL IS IN COLVILLE AND St. JOSEPH’S HOSPITAL IS CHEWELAH. AND THEN WE HAVE DOMINICARE, WHICH IS IN CHEWELAH AND SO IT RUNS FROM CANADA DOWN TO LOON LAKE AND IDAHO AND THE REPUBLIC AREA. >> TALK ABOUT THE LEVEL OF CARE AND THE TYPE OF SERVICES YOU PROVIDE. IS IT ALL INCLUSIVE? >> WE — BOTH ST. JOE AVENUE’S STOPPED DOING OB. AND MOUNT CARMEL IS OUR OB AREA. WE DO ORTHOPEDIC SURGERY AND GENERAL SURGERY, NEUROLOGY. WE ALSO DO PODIATRY AND PRIMARY CARE IS THE BASE OF OUR RURAL AREA. AND SO FAMILY PRACTICE IS KIND OF WHERE WE BUILD OPEN. >> AND DR. JOHN, YOU ARE WITH MOUNT CARMEL. YOU ARE IN THE EMERGENCY ROOM. HOW IS AN EMERGENCY ROOM DIFFERENT THERE THAN SPOKANE. >> USUALLY WE HAVE ONE PROVIDER. IT’S STAFFED 24 HOURS A DAY, SEVEN DAYS A WEEK AND AT TIMES IT CAN GET FAIRLY BUSY. YOU CAN HAVE EIGHT TO TEN PATIENTS AND THE ONE PHYSICIAN IS DEALING WITH. SO THAT CAN BE A LITTLE CHALLENGING AT TIMES. BUT WE DO HAVE GREAT SUPPORT FROM OUR HOSPITAL — THE PROVIDENCE HOSPITAL IN SPOKANE, IF WE NEED TO TRANSFER PATIENTS OR NEED A PHONE CALL TO TALK TO A SPECIALIST OR RUN TESTS OR AN EKG BY. THEN WE HAVE GREAT SUPPORT. >> AND DR. CASTORDALE, TELL US ABOUT COULEE AREA. >> IT’S TOTALS AROUND 5,000 IN THAT AREA. WE ARE NEXT TO AN OVER 1 MILLION ACHE COLVILLE INDIAN RESERVATION AS WELL. ABOUT THREE TO FOUR YEARS AGO WE BUILT A NEW IF A SELLITY, THROUGH A HOT OF WORK THROUGH THE STAFF THAT WAS THERE. WE DO OBSTETRICS BECAUSE IF YOU DON’T, SPOKANE IS ABOUT 100 MILES THIS DIRECTION AND CHALANDISS BUT IN JANUARY, THAT’S A REAL PROBLEM WHEN IT’S SNOWY. WE DO ACUTE CARE, PNEUMONIA, AND SOME GENERAL SURGERY AND VISITING ENDOSCOPY AND SOME OTHER SPECIALISTS AS WELL. WE HAVE MEDICAL STUDENTS THERE ABOUT EIGHT MONTHS A YEAR, WHICH HAS BEEN A REAL JOY TO DO AND TEACH THEM. I THINK IT’S A GOOD LONG-TERM RECRUITING TOOL. >> AND DR. ST. CLAIR, TELL US MORE ABOUT LINCOLN HOSPITAL IN DAVENPORT. >> WELL, LINCOLN HOSPITAL IS ABOUT 30, 35 MILES WEST OF SPOKANE AND OUR CATCHMENT AREA IS PRIMARY LINCOLN COUNTY AND FAIRLY LARGE TERRITORY, PROBABLY 15,000 INDIVIDUALS IN THE AREA. WE DON’T DO OBSTETRICS. WE HAVE AN EMERGENCY ROOM STAFFED BY ONE PHYSICIAN AND 24 HOURS A DAY. WE DO HAVE PHYSICIAN ASSISTANT THERE DURING THE DAY. BUT AT NIGHT, IT’S PRIMARILY A PHYSICIAN. WE DON’T DO OBSTETRICS. WE DID UP UNTIL ABOUT 15 YEARS AGO AND THEN BEING SO CLOSE TO SPOKANE, IT MADE IT DIFFICULT, THAT A LOT OF PEOPLE PREFERRED TO COME TO SPOKANE AND OUR NUMBERS DWINDLED AND THEREFORE WE DECIDED THAT WAS NOT SOMETHING WE COULD RECRUIT TOO WELL. WE DO HAVE GENERAL SURGERY. WE HAVE TRAVELING CARDIOLOGIST AND ORTHOPEDIC SURGERY THAT DO PRIMARILY PROCEDURES THERE. WE DON’T HAVE EXTENSIVE ORTHOPEDICS. WE DO HAVE GENERAL SURGERY, AND WE HAVE TWO OTHER HEALTH CLINICS, ONE IN REARDON AND ONE IN WILBUR THAT WE COVER. >> OKAY. AND DR. STUHLMILLER, YOU ARE AT PROVIDENCE NOW, BUT HAVE CHOSEN TO GO TO TONASKET. DID YOU CHOOSE IT OR DID IT CHOOSE YOU? >> GOOD QUESTION. I PROBABLY WON’T FIGURE THAT OUT FOR A WHILE. CHOOSING TONASKET, WELL IT WAS FUN AND IMPORTANT PART OF MY FINAL YEAR OF RESIDENCY AND BASICALLY BROUGHT TOGETHER ALL OF MY TRAINING, EVERYTHING FROM UNDER GRAD AND EVEN BEFORE TO EVEN NOW MY RESIDENCY PROGRAM AND TRAINING FOR THE RURAL MEDICINE. AND THAT’S AS RURAL AS YOU CAN GET. I MEAN, THESE GUYS ARE COMMENTING ON ALL OF THOSE DIFFERENT — THE DIFFERENT THINGS THAT ARE NEEDED TO RUN, YOU KNOW, A MEDICAL FACILITY UP IN A RURAL AREA AND BASICALLY FITS IN WITH WHAT THEY SAID. >> SO THE CHALLENGES ACTUALLY APPEALED YOU TO? >> YES. YES. >> THAT’S INTERESTING. >> AND YOU GREW UP IN A SMALL TOWN. >> I DID. I GREW UP ON A FARM BETWEEN REARDON AND EDWALL. SO OUTSIDE OF SPOKANE, ABOUT 45 MINUTES OR SO. >> MM-HMM. TALK A LITTLE BIT ABOUT YOUR TRAINING SPECIFICALLY TO WORK IN A RURAL AREA AS THEY APPROACH — THIS IS A FAIRLY NEW PROGRAM. WITH THE UNIVERSITY OF WASHINGTON THAT YOU ARE IN. >> GOOD QUESTION. SO I DID DO MY FIRST YEAR OF MEDICAL SCHOOL THROUGH UNIVERSITY OF WASHINGTON HERE IN SPOKANE, AND THAT WAS TO HELP KIND OF FOCUS GETTING STUDENTS TO THE EASTERN SIDE OF THE STATE, IN THEIR TRAINING. AS RESEARCH SHOWS, IF YOU TRAIN IN AN AREA, YOU ARE LIKELY GOING TO PRACTICE IN THAT AREA, RIGHT? AND SO WE HAVE A RUAP PROGRAM, A RURAL PROGRAM. I DID SIX WEEKS UP IN TONASKET, AMAZINGLY ENOUGH, AND JUST, YOU KNOW, GRABBED MY ATTENTION WHEN I WENT UP THERE AS A FIRST YEAR MEDICAL STUDENT. THAT WAS WHAT, FIVE YEARS AGO NOW, AND — EIGHT, WHATEVER. LONG TIME AGO! >> A LOT OF TRAINING. >> AND SO NOW AS A RESIDENT IN THE PROVIDENCE FAMILY MEDICINE PROGRAM, SPOKANE FAMILY MEDICINE RESIDENCY IS KNOWN FOR THE RURAL FOCUS AND TO TRAIN PHYSICIANS, NOT ONLY FOR FAMILY MEDICINE IN AN URBAN SETTING BUT ALSO IN A RURAL AREA IF THAT’S WHAT YOU CHOOSE TO DO. SO FULL SCOPE, THAT FAMILY PRACTICE STYLE OF MEDICINE. AND SO I FEEL LIKE I’M VERY WELL PREPARED. I OBVIOUSLY STILL HAVE THINGS TO LEARN FROM MY COLLEAGUES, BUT I’M EXCITED TO GET GOING. >> WHEN WILL YOU START THERE? >> I WILL START THE 1st OF SEPTEMBER. >> SO COMING UP QUICKLY. >> YES. >> SO LET’S TALK ABOUT THE CHALLENGE THAT RURAL MEDICINE POSES, JUST IN HEARING YOUR INTRODUCTIONS IT SOUNDS AS IF YOU HAD TO SCALE BACK ON CERTAIN AREAS BUT THE FOCUS IN OTHER AREAS AND ADAPT TO WHAT YOU HAVE AND WHAT THE NEEDS OF YOUR COMMUNITIES ARE. SO WHAT ARE SOME OF THE CURRENT CHALLENGES THAT YOU ARE FACING? I’M SURE YOU ARE GOING TO SAY BUDGETS ARE PROBABLY THE MAIN THING. JUST HAVING THE MONEY TO PROVIDE? >> I THINK THE THING THAT KEEPS ME UP AT NIGHT IS THE PERSONNEL. WE HAD 27 RESIDENTS THAT GRADUATED AND, AGAIN, YOU KNOW, WITH THAT THOUGHT, YOU ARE GOING TO, YOU KNOW, PRACTICE MORE WHERE YOU TRAIN AND IT’S JUST HARD TO GET — YOU KNOW, EVEN THOUGH IT’S A GREAT PLACE TO LIVE IN RURAL AREAS, IT’S REGARD TO RECRUIT PEOPLE TO COME IN, PHYSICIANS, NURSES, LABORATORY TECHS, X-RAY TECHS. THAT’S PROBABLY — YOU KNOW, THERE’S A BUDGET COMPONENT BUT THERE’S A WORKFORCE COMPONENT THAT IT’S — YEAH. >> SO DO YOU TEND TO HAVE A LOT OF TURNOVER? >> IS IT SORT OF A REVOLVING DOOR? NO I THINK THE BUDGET FOLLOWS THE WORKFORCE. IF YOU HAVE THE WORKFORCE, YOU CAN DO MORE WITH YOUR BUDGET AND IT’S A CERTAIN KIND OF PERSON THAT DOES THIS. WE ARE NOT NORMAL, ALL RIGHT? BECAUSE OF WHAT WE DO AND THE THINGS WE GET INVOLVED IN AND WE HAVE TO BE OKAY WITH I HAVE TO DO THIS TONIGHT BECAUSE THERE’S NOBODY. THERE’S NOBODY. SO, YOU KNOW, WE HAVE — I HAVE BEEN THERE 17 YEARS. THE MIDWIFE I WORKED WITH WAS THERE FOR 20. MY OTHER PARTNER WAS THERE FOR TEN YEARS. I HAVE ANOTHER N.P. THAT HAS BEEN THERE 17 YEARS AND WE ARE BRINGING ON SOME NEW PEOPLE TO EXPAND BUT IT ALSO HAS TO BE REALLY A TRIAD BETWEEN THE BOARD, IN MY EXPERIENCE, BETWEEN THE BOARD, THE PROVIDERS AND YOUR ADMINISTRATION. AND IF THEY ARE NOT FUNCTIONING WELL, YOU WILL HAVE A LOT OF TURNOVER. AND IT’S TOO SMALL TO NOT HAVE THAT KIND OF UNITY, AND A COMMON VISION. >> MM-HMM. >> DR. JOHNSON, YOU ALREADY TALKED ABOUT THE FACT THAT IT’S SLIM STAFFING, ESPECIALLY FOR THE EMERGENCY ROOM. IS THAT THE BIGGEST CHALLENGE FOR YOU? >>> IT CAN BE. STAFFING, IT KIND OF COMES AND GOES. EMERGENCY PHYSICIANS TEND TO BE A LITTLE NOMADIC IN THEIR WAYS. THEY DON’T TEND TO COME INTO A COMMUNITY, MOVE INTO A COMMUNITY AND RAISE THEIR KIDS THERE. THEY ARE SHIFT WORKERS. SO THEY TEND TO BE LESS LIKELY TO LAY DOWN LONG-TERM ROOTS. SO WE DO HAVE SEVERAL PHYSICIANS THAT DO COME UP FROM SPOKANE TO HELP US COVER, SEVERAL PHYSICIANS FROM HOLY FAMILY AND ONE THAT WORKS IN PULLMAN. IN MY RECRUITING TO THE EMERGENCY DEPARTMENT OVER THE YEARS, THE TOUGHEST THING FOR US IS, YOU KNOW, THE DOCS LOVE IT. THEY LOVE THE INDEPENDENCE. THEY LOVE THE HOSPITAL. THEY LOVE THE AREA BUT IT’S GETTING THEIR SPOUSE. THE LACK OF RESTAURANTS AND SHOPPING MALLS AND JOB HUNTS FOR SPOUSES HAS BEEN THE MOST DIFFICULT THING FOR ME IN RECRUITING IN A RURAL AREA. >> AND YOU GREW UP HERE IN THE SPOKANE AREA. SO THIS WAS A BIG CHANGE FOR YOU. WHAT KEPT YOU THERE? WHAT KEEPS YOU THERE? >> WELL, PART OF IT IS I DID THE RURAL RESIDENCY TRAINING IN COLVILLE. SO I DID MY FIRST YEAR HERE AT VALLEY MEDS AND I DID TWO YEARS IN COLVILLE AND I REALLY LIKED IT. I LIKED THE INDEPENDENCE THAT THE PROVIDERS HAVE AND THE OPPORTUNITY TO DO ALL THE THINGS THAT ELIZABETH TALKED ABOUT. YOU GET THIS WIDE EXPERIENCE AS A RESIDENT AND YOU LEARN TO DO ALL OF THESE NEAT THINGS. WHEN YOU ARE IN A RURAL AREA, YOU GET TO DO THEM ALL. THAT WAS GREAT. MY WIFE ALSO GREW UP IN A SMALL TOWN. SHE’S FROM KERLEW WHICH IS A LITTLE ITTY-BITTY TOWN. AND SO COLVILLE IS BASICALLY BETWEEN BOTH GRANDPARENTS. >> DID YOU IT RIGHT. >> YOU CAN’T GET IN TROUBLE THAT WAY. AND DR. ST. CLAIR, YOU HAVE BEEN WITH LINCOLN HOSPITAL FOR A NUMBER OF YEARS. I WOULD GUESS YOU KNOW THIS COMMUNITY VERY WELL AT THIS POINT, THAT YOU KNOW YOUR PATIENTS VERY WELL AND THAT THAT’S PART OF WHAT KEEPS YOU THERE. >> I’M FROM A SMALL TOWN, YOU HAVE NEVER — YOU ARE NEVER REALLY A RESIDENT UNLESS YOU WERE BORN THERE, BUT AFTER 25, 26 YEARS, YOU BECOME AFTER YOU HAVE DELIVERED A FEW PEOPLE AND YOU BECOME A LITTLE MORE OF A RESIDENT. I THINK WE ARE FORTUNATE, IN THAT OUR FAMILY PHYSICIANS COVER THE EMERGENCY ROOMS. SO WE HAVE LESS NOMADIC E.R. COVERAGE. WE STILL HAVE THE SAME CHALLENGES THE OTHER HOSPITALS DO AS FAR AS NURSING STAFF AND OTHER SUPPORT STAFF THAT IS CONSTANTLY DIFFICULT TO RECRUIT TO. >> I DO KNOW THAT THIS IS A COMMUNITY, THE DAVENPORT COMMUNITY THAT RALLY AROUND THIS HOSPITAL, THIS MEDICAL FACILITY. I WAS INVOLVED WITH A FUND-RAISER A FEW YEARS AGO. >> WE APPRECIATED THAT. >> AND I SAW A COMMUNITY SPIRIT AND YOU WILL FIND THAT IN ALL OF THE SMALLER COMMUNITIES. THEY DON’T WANT TO LOSE THIS FACILITY. SO THEY DO RALLY AROUND IT. >> WELL, I THINK WITHIN SMALL COMMUNITIES THROUGHOUT THE COUNTRY, I THINK IT’S SIMILAR. FARMING COMMUNITIES, SMALL COMMUNITIES REALIZE THAT IT’S DIFFICULT TO TRAVEL TO SEE FAMILY MEMBERS IN THE HOSPITAL DISTANCE AWAY, AND IT’S NICE TO BE ABLE TO HAVE SOMETHING LOCAL, A PLACE TO TAKE YOUR CHILDREN, AND A PLACE TO SEE YOUR FAMILY AND A HOSPITAL THAT DOES ADMIT SOME CRITICAL CARE PATIENTS. SO WE HAVE BEEN ABLE TO MAINTAIN THAT, AND I THINK THE COMMUNITIES THROUGHOUT OUR PART OF THE STATE CERTAINLY APPRECIATE THAT. >> MM-HMM. DR. STUHLMILLER, BEING THE YOUNGEST ON THE PANEL AND THE NEWEST OF THE PHYSICIANS HERE, A LOT OF TECHNOLOGY IS COMING TOO PLAY. DO YOU ANTICIPATE USING MORE TECHNOLOGY WHEN YOU GO TO TONASKET AND TELEMEDICINE AND THAT SORT OF THING? DO THEY HAVE THAT AVAILABLE THERE. >> THERE’S TELEMEDICINE AVAILABLE AND ALSO THE PHONE AS DUMB AS THAT SOUNDS. WE USE IT A LOT. AND THAT’S EVEN USED, YOU KNOW, HERE IN SPOKANE, YOU ARE CALLING YOUR SPECIALISTS AND GETTING OPINIONS AND THEIR RECOMMENDATIONS, BUT TELEMEDICINE IS DEFINITELY SOMETHING THAT I PLAN ON USING, ESPECIALLY FOR THOSE LATE NIGHTS WHERE YOU JUST DON’T EXACTLY KNOW WHAT TO DO. >> MM-HMM. EXPLAIN TO OUR VIEWERS WHAT EXACTLY WE ARE TALKING ABOUT. >> YES. SO THERE’S DIFFERENT VARIATIONS OF THIS. BASICALLY I’M A PHYSICIAN OUT IN THE MIDDLE OF NOWHERE AND I HAVE A PATIENT I MAY NOT KNOW QUITE WHAT TO DO WITH AND HOW TO BEST TREAT THIS PATIENT. AND THERE CAN BE SOMEONE ELSE ON THE OTHER SIDE OF — WHETHER IT’S A PHONE CALL OR EVEN A COMPUTER-BASED SYSTEM WHERE YOU CAN SORT OF LIKE — I DON’T KNOW IF I CAN SAY IT, SKYPE, SOMETHING LIKE, THAT WHERE IT’S MORE OF A VIDEO CONFERENCING AND YOU CAN SPEAK WITH THAT SPECIALIST, WHETHER IT’S CARDIOLOGIST, NEUROLOGIST, WHOEVER IT MAY BE THAT YOU MIGHT NEED TO SPEAK WITH. >> SO YOU ARE CONNECTING DIRECTLY WITH SOMEBODY THAT YOU CAN BOUNCE IDEAS OFF OF OR — >> YEAH. >> OR SORT OF WHEN YOU FEEL AT A LOSS FOR THE NEXT STEP IN CARE? >> AND I BELIEVE IT CAN BE USED IN DIFFERENT WAYS. THE PATIENT CAN BE THERE WITH YOU AND THEY CAN SEE THE PATIENT WITH THE VIDEO THAT’S AVAILABLE, AND CAN BE USED IN THE E.R., THE EMERGENCY SETTINGS AND ALSO IN OFFICE-BASED SETTINGS. >> MM-HMM. >> IS THIS SOMETHING — ARE YOU ALL USING SYSTEMS LIKE THIS? >> MAYBE YOU CAN TALK ABOUT THE STROKE PROGRAM. >> YES. IT’S BEEN A REAL SUCCESS. >> WE HAVE WHAT WE CALL THE STROKE ROBOT. IT’S LITERALLY A ROBOT WITH A SCREEN AND IT’S DRIVEN REMOTELY FROM SPOKANE BY THE NEUROLOGIST AND SO WHEN WE HAVE A PATIENT COME IN AND TO OUR EMERGENCY DEPARTMENT WITH AN ACUTE STROKE, WE CALL A NUMBER AND ALL OF A SUDDEN MAGICALLY THE ROBOT COMES TO LIFE AND DRIVES ITSELF INTO THE PATIENT’S ROOM, AND SITS AT THE BOTTOM OF THE PATIENT’S BED AND THEN INTERACTS WITH THE PATIENT. THE PHYSICIAN CAN DO AN EXAM, A NEUROLOGIC EXAM THERE’S A STETHOSCOPE. THEY CAN LISTEN TO HEART, LUNG SOUNDS IF THEY NEED TO. AND SO IT JUST GIVES US AN ACUTE INTERACTION BECAUSE YOU’VE GOT ABOUT A TWO-HOUR WINDOW IF YOU ARE GOING TO TREAT AN ACUTE STROKE. SO WE HAVE A STAT, AND A THEN A NEUROLOGIST WILL COME IN. WE CAN STREET THEIR STROKE AND GET THEM IN A HELICOPTER TO SPOKANE FOR THE TREATMENT. >> I WOULD GUESS YOU WOULD GET SOME INTERESTING REACTIONS. >> THE REACTIONS WERE BETTER. THEY HAVE BEEN PRETTY IMPRESSED AND IT SAVED OUR BACON A FEW DIFFERENT TIMES. IT’S BEEN NICE TO HAVE. MY HOPES IS THAT WE CAN USE THAT ROBOT FOR DIFFERENT THINGS IN THE FUTURE. THE STROKE WAS THE PILOT PROGRAM THAT WE WERE USING IT FOR. HOPEFULLY WE CAN USE IT TORE DERMATOLOGIST OR ENDOCRINOLOGISTS AND DO KIND OF BEDSIDE CONSULTATION WHICH HOPEFULLY COULD AVOID SEEING A LOT OF UNNECESSARY TRANSFERS AND HELP WITH TREATMENT. >> ANYTHING LIKE THAT AT LINCOLN HOSPITAL. >> YES, WE HAVE A ROBOT AS WELL. I THINK THAT’S BEEN REAL HELPFUL. WE INITIATED THAT PROGRAM ABOUT THREE YEARS AGO AND HAVE HAD REAL GOOD SUCCESS, AS FAR AS — AND IT’S VERY ACCEPTED BY THE PATIENTS BECAUSE THEY FEEL THAT THEY ARE GETTING A CONSULT THAT THEY WOULD HAVE HAD TO DRIVE OR BE TRANSPORTED TO SPOKANE. AND THIS HAS BEEN A REAL BENEFIT TO US, TO MAINTAIN PATIENTS THERE THAT OTHERWISE MIGHT HAVE REQUIRED TRANSPORT TO HIGHER LEVEL FACILITY. >> SO YOU WELCOME THIS SORT OF TECHNOLOGY? >> YES, IT’S BEEN EXTREMELY HELPFUL FOR OUR FACILITY AND I THINK OTHER HOSPITALS WILL NOTICE THE SAME BENEFIT FROM IT. >> I KNOW HAVING GROWN UP IN A SMALL TOWN MYSELF, THAT — AND THIS WAS MANY YEARS AGO AND CERTAINLY TECHNOLOGY AND CARE HAS GOTTEN A LOT BETTER IN THOSE YEARS, BUT I KNOW WE DEPENDED HEAVILY ON OUR EMTs AND PROGRAMS LIKE MEDSTAR, FIRST RESPONDERS BECAUSE SOMETIMES THOSE ARE THE CRITICAL LINK BETWEEN — ESPECIALLY IF THERE’S ANY DISTANCE FROM THEN THE HOSPITAL THAT YOU ARE PROVIDING CARE AT. HOW MUCH DO YOU DEPEND ON THE FIRST RESPONDERS IN YOUR COMMUNITY? >> A LOT. BECAUSE THE DISTANCES AND ON TO THE RESERVATION, IT COULD BE — THE MILEAGE MAY BE SHORT BUT THE TIME IS LONG. THESE ARE ALL — EXCEPT FOR THE TRIBAL AMBULANCE. IN THE TOWNS, THEY ARE ALL VOLUNTEERS AND VOLUNTEER GOES DOWN ON EVERYTHING. SO IT’S — YOU KNOW, WE ENCOURAGE THOSE FOLKS. THEY ARE THE LIFE BLOOD FOR US. THEY DON’T GET ENOUGH PRAISE AND — BUT IT IS HARD. IN OUR SITUATION, THEY CAN INTUBATE AND PUT A TUBE DOWN BUT THEY DON’T DO I.V.s. THAT’S A PROBLEM IF YOU ARE A TRAUMA VICTIM OR YOU ARE IN ARREST. THEY DO THE BEST WE CAN. BECAUSE WE ARE SHORT IN THE EMERGENCY ROOM, WE WILL KEEP THEM AND USE THEM AND THEIR HANDS BECAUSE IN RESUSCITATION. >> DO THEY GET EXTRA TRAINING BECAUSE OF SOME OF THE THINGS THEY ARE EXPECTED TO ADDRESS? >> YOU KNOW, THEY DO THEIR EMT TRAINING AND THAT’S WHAT THEY GET. YOU KNOW, I HAVE GONE TO TALK TO THEM ABOUT DELIVERING — HAVING TO DELIVER BABIES AND MOST OF THEM ARE PETRIFIED OF THAT. IF YOU SEE THE EARS, IT’S OKAY. IT’S OVER. I WANT TO DRIVE FASTER. DON’T DO THAT. THEY ARE THE SALT OF THE EARTH AND WE NEED MORE PEOPLE. >> AND HOW CRITICAL IS MEDSTAR DR. REHN. >> I DON’T KNOW WHAT THE NUMBER OF TRIPS ARE, BUT MEDSTAR WAS AT MOUNT CARMEL JUST THE OTHER DAY AND BASICALLY, THEY WERE THERE ALL DAY. WE GOT TO TALK TO THE PILOT. AND HE THINKS WE ARE ONE OF THE NUMBER ONE CUSTOMERS AND IT SHORTENS THAT TIME WHEN THERE’S A WINDOW OF OPPORTUNITY, YOU KNOW, WHEN THEY CAN FLY, IT IS REALLY MAKES OUR RURAL AREA SMALLER WHEN WE CAN GET A HELICOPTER? >> WELL, THEY ARE EXACTLY SET UP FOR EXACTLY THAT, FOR OUR OUTLYING AREAS, ANYTHING THAT’S 50 TO 60, 100 MILES AWAY FROM SPOKANE. SO IT’S A PERFECT CONNECTION. IT’S ABSOLUTELY A PERFECT CONNECTION. YOU KNOW, YOU MENTIONED A LITTLE BIT EARLIER THE RESIDENCY PROGRAM. I WANTED TO TALK MORE ABOUT THE RESIDENCY PROGRAM AT MOUNT CARMEL HOSPITAL BECAUSE IT’S EXTREMELY UNIQUE. IN FACT, IT’S ONE OF THE FIRST, IF NOT THE ONLY — IS IT THE ONLY PROGRAM OF ITS KIND? >> THE FIRST IN THE NATION. >> THE FIRST IN THE NATION. SO LET’S FIND OUT MORE ABOUT THE RESIDENCY PROGRAM AT MOUNT CARMEL HOSPITAL. >> MOUNT CARMEL HOSPITAL IN COLVILLE COVERS A LOT OF GROUND. >> OUR SERVICE AREA RUNS FROM CANADA DOWN TO CHEWELAH AND OVER TO IDAHO AND REPUBLIC. >> ROBERT REHN OVERSEES THE HOSPITAL AS THE CHIEF EXECUTIVE. HE SAYS THE HOSPITAL PROVIDES A VITAL LINK TO PEOPLE WHO LIVE HERE. IF THEY WOULDN’T COME HERE, THEY’D HAVE TO TRAVEL 120 MILES DOWN TO SPOKANE, INSTEAD OF 50 MILES TO COLVILLE. >> AND IT’S A BUSY PLACE. >> WE DO ABOUT 250 DELIVERIES A YEAR. WE DO GENERAL SURGERY. WE DO ORTHOPEDICS. >LIKE MANY SMALL HOSPITALS, IT SOMETIMES STRUGGLES TO HIRE SPECIALISTS, BUT MOUNT CARMEL FARES FAR BETTER THANKS TO THE RURAL RESIDENCY PROGRAM. >> WE WERE THE FIRST IN THE NATION HAVE A RURAL RESIDENCY TRACK. THERE WAS AT ONE TIME 40 THAT WERE PATTERNED AFTER US. >> THE SPOTS ARE SO COVETED. MOUNT CARMEL GETS 300 APPLICANTS FOR ONE OPENING. DR. EDWARD JOHNSON DID HIS RESIDENCY HERE. >> THE THING THAT I LIKED ABOUT RURAL RESIDENCY AND THE REASON I WANTED TO PURSE THAT, IS THAT IT’S VERY HANDS ON. IN LARGER RESIDENCIES, THERE ARE THREE CLASSES OF EIGHT TO TEN PEOPLE. THEY’RE ALL COMPETING FOR THE SAME PATIENTS AND THE SAME PROCEDURES. >> IT’S THAT LEVEL OF TRAINING THAT NOT ONLY ATTRACTS DOCTORS, BUT KEEPS THEM. MANY, LIKE DR. JOHNSON, TAKE JOBS AT MOUNT CARMEL AFTER THEIR RESIDENCY IS OVER. AND THEY STAY. TURNOVER IS LOW HERE. >> I PRACTICED TRADITIONAL FAMILY MEDICINE FOR ABOUT THE FIRST 14 YEARS. >> THESE DAYS, HE DOES ENDOSCOPY FOR THE HOSPITAL WHILE PULLING SIX SHIFTS A MONTH IN THE E.R. AS THE DIRECTOR OF EMERGENCY DEPARTMENT. >> WHEN YOU PRACTICE IN A RURAL AREA AS A FAMILY PRACTITIONER, YOU STILL DO THE BROAD SCOPE OF MEDICINE, JUST BECAUSE THERE IS NOBODY ELSE TO DO IT. AND YOU NEVER STOP BEING A PHYSICIAN. >> WHEN YOU’RE A SMALL TOWN DOC, YOU’RE NEVER REALLY OFF CALL, BECAUSE YOU GET PULLED OVER AT THE BASEBALL GAME OR GROCERY STORE OR OTHER PLACES. PEOPLE RUN STUFF BY YOU WHICH IS FINE. I’VE ENJOYED IT. IT’S NOT A BURDEN. >> IMPRESSIVE CARE WITH THE PERSONAL TOUCH. AND WORD’S GETTING OUT. >> WHEN WE DISCUSS WHAT WE DO UP HERE WITH CERTAIN PHYSICIANS, THEY’RE ALWAYS KIND OF AMAZED. >> HELLO. HOW ARE YOU TODAY. >> TALK ABOUT HOW THAT PROGRAM GOT STARTED, BEING THE FIRST IN THE NATION. >> THE PROGRAM REALLY, YOU KNOW, THERE’S A FEW REAL KEY INDIVIDUALS, DR. BOB MAUDLIN AND MIKE SNOOK WAS THE FIRST DIRECTOR. ANY PROGRAM REALLY IS ABOUT, YOU KNOW ARE A KEY GROUP OF PEOPLE THAT PUSH IT ALONG. ALL OF OUR — ALL OF OUR FACULTY, DR. JOHNSON AND I ARE ON THE UNIVERSITY OF WASHINGTON FACULTY FOR THE RESIDENCY. IT’S A VOLUNTEER EFFORT. AND SO IT REALLY DOES TAKE THAT COMMUNITY TO TEACH OUR RESIDENT PHYSICIANS AND I THINK THAT IT REALLY WAS THESE KEY PEOPLE THAT USHERED AND PUSHED IT, YOU KNOW, SOMETIMES IT WAS — YOU KNOW THIS WAS A LITTLE BIT OF KICKING AND SCREAMING BUT WE MADE IT THROUGH THAT, AND IT WAS INDIVIDUALS, AGAIN, LIKE DR. MAUDLIN AND DR. SNOOK THAT REALLY TOOK IT, TOOK IT TO THE NEXT LEVEL. >> 300 APPLICATIONS FOR ONE POSITION. HOW DO YOU CHOOSE? I THINK SOME RESIDENTS WANT TO KNOW. >> MOST OF THE RESIDENTS WILL COME AROUND AND DO INTERVIEWS AND WE WILL BRING THEM TO ALL OF OUR CLINICS. AS A FORMER RESIDENT, I USUALLY TAKE ABOUT A HALF HOUR OUT OF MY DAY AND SIT AND TALK WITH THEM AND ANSWER QUESTIONS. >> WHAT KIND OF THINGS ARE YOU LOOKING FOR? >> THE MAIN THING I TELL THE RESIDENTS IS IF YOU WANT TO COME HERE, INTO OUR RESIDENCY, THAT YOU NEED TO BE INDEPENDENT. IN THE BIGGER RESIDENCIES, IT’S VERY STRUCTURED. YOU ARE A MONTH OF PEDIATRICS AND A MONTH OF INTERNAL MEDICINE AND YOU ARE A MONTH OF E.R. THERE’S STILL THAT STRUCTURE IN COLVILLE, BUT BECAUSE YOU ARE ONLY ONE OF TWO RESIDENTS THERE’S A LOT OF FREEDOM. IF YOU WANT TO LEARN TO DO ENDOSCOPY, THEN YOU HANG OUT IN THE ENDOSCOPY LAB. IF YOU ARE REALLY INTERESTED IN OB, THEN YOU TACK YOUR PHONE NUMBER UP TO THE NURSE’S STATION AND BRING CANDY AND THEY WILL CALL YOU WHEN AN OB COMES IN. SO THERE’S ALSO NOT A LOT OF SUPPORT FOR THE RESIDENTS AND NOT FOR THE MEDICAL STAFF BUT FROM OTHER RESIDENTS. THERE’S NOT 20 OTHER RESIDENTS THAT YOU CAN LEAN ON. SO IF YOU ARE AN INDEPENDENT PERSON AND LIKE TO, YOU KNOW, GET A LARGE AND BROAD EXPERIENCE — >> A LOT OF HANDS ON. A LOT OF HANDS ON. WE HAVE A CALLER CALLING IN. FRANCIS FROM SPOKANE. GOOD EVENING. >> Caller: HI, HOW ARE YOU/. >> I’M VERY WELL. THANKS FOR WAITING. >> Caller: THANK YOU. I JUST — I JUST CANNOT RESIST LETTING YOU KNOW A LITTLE HISTORY ABOUT COLVILLE, BECAUSE MY FATHER WAS A PHYSICIAN IN COLVILLE. HE MOVED THERE IN 1947, BELIEVING THAT IT WAS A GREAT PLACE TO RAISE A FAMILY. AND I AGREE. HE WAS A GENERAL PHYSICIAN WITH A RESIDENCY IN GENERAL SURGERY AND ALSO TRAINING IN OB/GYN AS A RESULT OF HIS MILITARY REQUIREMENTS. AND HE JOINED A PRACTICE WITH DR. WESLEY GRAY, DR. MANZIEL AND DR. KERNING WHICH ARE OLD TIMERS. >> I’M SEEING SOME NODDING HEADS, FRANCIS. >> Caller: SO BASICALLY I GREW UP IN THAT ENVIRONMENT BELIEVING THAT I WOULD BE A PHYSICIAN. AND WATCHING MY FATHER WORK NIGHT AND DAY, 365, SEVEN DAYS A WEEK, AND IN THOSE DAYS EVERYBODY MADE HOUSE CALLS, BECAUSE PATIENTS COULDN’T COME IN. THEY HAD POOR TRANSPORTATION. AND SO IT’S FASCINATING FOR ME TO SEE WHAT HAS EVOLVED WITH THE RURAL PROGRAM AND WITH ALL OF THE TRAINING THAT PEOPLE ARE HAVING NOW AND I’M SO GRATEFUL HAVING BEEN A STUDENT AT BOTH WASHINGTON STATE AND ALSO THE UNIVERSITY OF WASHINGTON, THAT EVERYBODY IS GETTING ALONG AND THAT THE RURAL MEDICINE TRAINING PROGRAM IS GOING FULL BORE, BECAUSE IT IS NECESSARY. >> ABSOLUTELY. >> IT’S SOMETHING THAT I FEEL STRONGLY ABOUT AND I SUPPORT WHAT THE DOCTORS THERE PRESENTLY ARE DOING AND I’M SO GRATEFUL FOR THAT. >> AND I’M GUESSING YOUR FATHER WOULD BE VERY PLEASED. >> Caller: I SUPPOSE SO. YES, DR. EDMUND GRAY WAS DR. WESLEY GRAY’S SON AND HE WAS — HE’S QUITE NOTABLE IN THE FACT THAT HE HAS — UNTIL HIS DEATH VERY RECENTLY, HE WAS VERY, VERY PROGRESSIVE IN THE STATE OF WASHINGTON OF ENHANCING AND MAKING AWARE THE NEED FOR RURAL MEDICINE AND MEDICINE AT ALL LEVELS. >> OKAY. >> Caller: AND SO THESE THINGS ARE REALLY INTERESTING HISTORICALLY. >> ABSOLUTELY. WELL, FRANCIS, WE SO APPRECIATE YOUR COMMENTS TONIGHT, HAVING COME FROM COLVILLE. IT REALLY GOES RIGHT TO THE HEART OF WHAT WE ARE TALKING ABOUT TONIGHT. THANK YOU SO MUCH. >> Caller: YOU’RE WELCOME. GOOD NIGHT. >> I THINK SHE SPEAKS FOR A LOT OF PEOPLE, GRATEFUL FOR THE LEVEL OF CARE. WHEN WE HEAR ABOUT — AND THERE WAS A RECENT ARTICLE IN THE NEWSPAPER, THAT CITED 100 HOSPITALS HAD CLOSED SINCE 2010. SO IT’S EXCITING NEWS TO HEAR THAT THERE ARE RESIDENCY PROGRAMS GOING ON THAT ENCOURAGE MORE RURAL MEDICINE AND THAT THE COMMUNITIES ARE SUPPORTING THEM TO THE LEVEL THAT, YOU KNOW ARE HOPEFULLY THAT WE CAN KEEP MOST OF THE ONES WE HAVE IN OUR AREA GOING. IS THAT YOUR HOPE? WHAT ARE YOUR CLASSMATES SAYING? DO THEY — DO YOU HAVE OTHER CLASSMATES THAT ARE HEADED OFF TO RURAL AREAS? IS THIS A TOUGH SELL? >> IT CAN BE A TOUGH SELL. I THINK IT JUST DEPENDS ON, YOU KNOW, THE RESIDENT, THE PERSON AND WHAT YOU HAVE BEEN CALLED TO DO, HONESTLY. YOU KNOW, MEDICINE IS A CALLING WITHIN ITSELF, BUT THEN RURAL MEDICINE IS KIND OF ANOTHER SUBJECT. >> IT TAKES IT TO ANOTHER LEVEL. >> IT DOES. YOU KNOW, ME GROWING UP IN A RURAL AREA, IT FITS. SOME PEOPLE ARE FROM A LARGE CITY AND THEY JUST CAN’T SEE THEMSELVES LIVING IN A SMALL TOWN OR THEIR SPOUSE CAN’T SEE THEMSELVES THERE. SO THERE ARE A LOT OF BARRIERS. YOU KNOW, THE TRAINING IS THERE. SO THEY CAN IF THEY WANT TO. MY COLLEAGUES, YOU KNOW, EVERYWHERE THEY ARE DOING EVERYTHING FROM DOING RURAL LIKE ME, TO, YOU KNOW, URGENT CARE HERE IN SPOKANE AND, YOU KNOW, MOVING TO MONTANA, SMALL TOWN MONTANA, THAT TYPE OF THING. SO A WIDE RANGE OF THEM. >> WE ARE ALSO IN A TIME WHEN IT IS BECOMING CRITICAL DOCTOR SHORTAGE. SO THIS IS JUST GOING TO GET TOUGHER IN THE NEXT FEW YEARS. IS THAT GOING TO AFFECT CARE AND — WELL, WHEN YOU HAVE A RESIDENCY PROGRAM THAT’S ATTRACTING 300 APPLICANTS, IT DOESN’T APPEAR TO BE A PROBLEM RIGHT NOW. >> YEAH, WE NEED TO TRAIN MORE RESIDENTS. WE NEED MORE RESIDENCY PROGRAMS. WE NEED SOME MORE MEDICAL STUDENTS FROM EASTERN WASHINGTON WHO WANT TO GO INTO MEDICINE AND STAY HERE. AND RECRUITING IS HARD. THERE’S A NATIONAL SHORTAGE EVERYWHERE. WE’VE HAD CERTAIN POSITIONS OPEN IN OUR FACILITY FOR OVER A YEAR NOW THAT WE CANNOT FILL, DESPITE BEING A WONDERFUL PLACE TO LIVE AND A BEAUTIFUL NEW HOSPITAL. SO, YOU KNOW, WE ARE GETTING TO THAT POINT WHERE A LOT OF THE AGING PHYSICIANS ARE GOING TO START RETIRING AND IN MY OPINION, WE ARE NOT TRAINING ENOUGH TO TAKE THEIR PLACE. >> WE ALSO HAVE AN AGING POPULATION WHEN IT COMES TO THE PATIENTS. IS THAT BECOMING MORE OF A CHALLENGE? IS IT HAVING TO CHANGE THE WAY YOU APPROACH CARE? >> YOU KNOW, I DON’T THINK SO. IT JUST CHANGES THE PERCENTAGES. THE THINGS THAT ARE HARD FOR US IS THAT EXTRA SUPPORT, YOU KNOW. NURSING HOMES, THEY DON’T MAKE MONEY AND THEY GO UNDER FAST. WE DON’T HEAR A LOT ABOUT THAT. SO HOW DO YOU DO THAT? HOW DO YOU SUPPORT THOSE FAMILIES WITH AGING PARENTS AND CHRONIC ILLNESS? THAT’S REALLY HARD. THAT’S A VERY HARD THING TO DO. YOU KNOW, I THINK AS FAR AS THE RECRUITING, YOU JUST — I THINK YOU HAVE TO TEACH IF YOU ARE A LITTLE TOWN, IF YOU ARE NOT TEACHING STUDENTS OR RESIDENTS AND SHOWING THEM THAT THERE’S THIS WIDE SPECTRUM, YOU ARE GOING TO FADE. IT’S HARD TO RECRUIT TO A SMALLER, SMALLER SET OF SKILLS THAT ARE BEING USED. >> HOW DO YOU MAKE THIS ATTRACTIVE? >> WELL, I THINK WE ARE MOVING INTO A LITTLE DIFFERENT AREA OF MORE PREVENTATIVE MEDICINE. IN-HOME CARE HAS BECOME A REAL ISSUE AND WE ARE VERY THANKFUL FOR EMPIRE HEALTH FOR THEIR SUPPORT TO HELP DEVELOP THIS PROGRAM, BECAUSE AS ANDY MENTIONED, NURSING HOMES ARE VERY DIFFICULT TO MAINTAIN AND SUBSIDIZE. IT’S, I THINK MOVING MORE TOWARDS CARE WITHIN THE HOME, WITH SUPPORT OF FAMILIES AND I THINK THAT’S VERY ATTRACTIVE TO A LOT OF OUR POPULATION, HAVING THAT TYPE OF SUPPORT AND MOVING — WE ARE MORE CONSOLIDATING NOT ONLY MEDICAL BUT BEHAVIORAL HEALTH AND WE HAVE HAD SOME REAL STRIDES IN DEVELOPING A MORE COMPREHENSIVE HEALTHCARE SYSTEM. >> PREVENTATIVE MEDICINE IS HUGE RIGHT NOW, MAKING SURE PEOPLE ARE HEALTHY, TAKING CARE OF THEMSELVES. DO YOU HAVE THOSE SORT OF PROGRAMS IN PLACE WHEN IT COMES TO RURAL MEDICINE OR IS IT JUST SOMETHING YOU CAN’T APPROACH WITH LIMITED STAFF? >> WELL, BACK UP A LITTLE BIT, JUST TO SAY THAT WE HAVE GOT A — WITH PROVIDENCE HEALTHCARE’S SUPPORT, YOU KNOW, WE WOULDN’T BE — LIKE, IT WOULDN’T LOOK LIKE WHAT WE LOOK LIKE WITHOUT PROVIDENCE’S SUPPORT AND WE HAVE A 40-BED NURSING HOME IN CHEWELAH THAT IS CONNECTED WITH St. JOSEPH’S HOSPITAL. EVEN THOUGH WE ARE TALKING ABOUT TECHNOLOGY, IT’S HIGH TOUCH. YOU KNOW, AND THOSE FOLKS, YOU KNOW, COUNT ON US TO BE THEIR FAMILY, AND WITH THAT SUPPORT, WE HAVE BEEN ABLE TO DO THAT. THE, YOU KNOW, WELLNESS CARE OR WELL CARE OR PREVENTATIVE CARE, THERE’S A LITTLE BIT OF A GAP BETWEEN HOW WE ARE PAID FOR MEDICINE NOW, AND HOW WE MAY BE PAID FOR MEDICINE IN THE FUTURE. YOU KNOW, WELL CARE IS NOT, UNFORTUNATELY — IT’S NOT HOW WE ARE PAID. WE ARE PAID EPISODICALLY AND IT’S CHANGING, AND WE ARE THINKING IT’S GOING TO BE CHANGING. THERE’S — >> PUSHING A ROCK. PUSHING A ROCK, TRYING TO GET THAT MOVING. >> I THINK TRADITIONALLY, MEDICINE HAS BEEN KIND OF CRISIS MANAGEMENT, AND IT MUST MOVE TOWARDS MORE PREVENTATIVE MEDICINE, BECAUSE THE DOLLARS ARE JUST NOT THERE FOR THAT, AND WE KNOW THAT IF WE SPEND TIME AND EFFORT AND DOLLARS WITH YOUNGER, HEALTHIER PEOPLE AND MORE PREVENTATIVE PROGRAMS, I THINK THAT OVERALL, THAT’S GOING TO BE THE GOAL, AND THE FUTURE OF MEDICINE. >> MORE HELP IN THE LONG RUN. >> RIGHT. >> WE HAVE ANOTHER PHONE CALL, DAN FROM SPOKANE. GOOD EVENING, DAN. >> Caller: GOOD EVENING. >> DO YOU HAVE A QUESTION FOR THE PANEL? >> WELL, IT’S ACTUALLY, YES, PERTAINING TO WHAT THEY WERE JUST TALKING ABOUT. WE’RE SURROUNDED BY ASTRONOMICAL HEALTHCARE COSTS AND, YOU KNOW, THERE’S A UNIQUE OPPORTUNITY WITH THE STUDENTS COMING IN AND ONE GENTLEMAN THERE MENTIONED THAT IT’S A PLEASURE TO HAVE THEM AND DO SOME TRAINING. I KIND OF WANTED TO ASK, WHAT IS BEING DONE TO ADDRESS THE HIGHER HEALTH COSTS AS IT PERTAINED TO THE MODALITY OF THE PHYSICIANS COMING IN THE FIELD. I HEARD OF A DOCTOR WOULD CAME ACROSS A DIAGNOSIS AND DIDN’T REVIEW IT AS A PERSONAL DECISION BECAUSE THE PATIENT WOULD BE UNABLE TO FINANCIAL HISTORICALLY COPE WITH IT. AND SO THE DIAGNOSIS WAS MISSED AND, YOU KNOW, THAT HAPPENS, I’M SURE, A FEW TIMES A YEAR AROUND THE COUNTRY. AND SO THERE IS A STIGMA REGARDING THE HEALTH COSTS AMONG THE PHYSICIANS AND AMONG THE PATIENTS AND WHAT ARE WE DOING FOR THE NEW PEOPLE COMING INTO THE FIELD TO ADDRESS THAT AND CHANGE THAT. >> DAN, THANK YOU SO MUCH FOR YOUR QUESTION. WHO WOULD LIKE TO ADDRESS THAT? THAT’S A BIG KETTLE OF FISH. >> WELL, I THINK THAT HEALTH CARE IS BECOMING A REAL ISSUE AND I THINK OBVIOUSLY CONGRESS IS TRYING TO STRUGGLE WITH AN EVENTUAL HEALTHCARE SYSTEM THAT MAY ADDRESS THESE KINDS OF ISSUES. WE’RE NOT SURE WHAT THAT SYSTEM IS GOING TO LOOK LIKE, BUT OBVIOUSLY THERE’S GOT TO BE CHANGES TO THE WAY WE PRACTICE AND THE WAY THE HEALTHCARE SYSTEM IS SET UP. WE OBVIOUSLY WANT TO PROVIDE HEALTHCARE AND SHOULD BE ABLE TO PROVIDE HEALTH CARE TO MORE PEOPLE. THERE’S EVIDENTLY MORE ACCESS TO SOME TYPE OF COVERAGE. THE ISSUE IS AS THE CALLER BROUGHT UP, HAS TO DO WITH COST AND THE NEW SYSTEM HAS ADDRESSED THE HEALTHCARE FOR EVERYONE, BUT THERE’S A TIERED SYSTEM AND A COPAY SYSTEM AND IN A WAY, IT’S HELPED THE RURAL HOSPITALS BE ABLE TO HAVE PATIENTS WITH SOME TYPE OF INSURANCE, UNFORTUNATELY, THE DOWNSIDE IS MANY OF THOSE COVERAGES COME WITH A HIGHER COPAY, AND THAT TRANSLATES TO BAD DEBT FOR THOSE FACILITIES. BUT OBVIOUSLY, WE CAN’T OVERLOOK PROPER TREATMENT FOR OUR POPULATION AND IT’S UNFORTUNATE IF DIAGNOSES DON’T GET ADDRESSED OR DELL WITH. AND I SUPPOSE — DELL WITH, AND A SUPPOSE IN A LARGE SYSTEM, THERE CAN BE ISSUES SIMILAR TO THAT. I DON’T THINK THAT’S SOMETHING WE EXPECT TO HAPPEN AND IT’S CERTAINLY SOMETHING THAT WE — WE WANT THE PROPER CARE FOR OUR PATIENTS AND WE WANT TO OFFER THE BEST CARE WE CAN AND THE BEST REFERRALS BASED ON WHAT THEIR DIAGNOSES ARE. SO I DOUBT THAT THAT’S AN INTENTIONAL. >> DR. REHN, IS IT A BIGGER CHALLENGE FOR OUR RURAL MEDICAL CENTER OR HOSPITAL THAN IT IS, SAY, FOR SPOKANE OR SEATTLE? >> AGAIN, I THINK IT’S PART OF OUR PROVIDENCE DNA, TO CARE. >> THAT YOU ARE UNDER THAT UMBRELLA. >> WE OKAY FOR THE POOR AND THE VULNERABLE. — WE CARE FOR THE POOR AND THE VULNERABLE. WE CARE FOR PEOPLE REGARDLESS OF THEIR ABILITY TO PAY. SO HOPEFULLY, YOU SNOW, IT’S NOT LIKE THERE’S A LITTLE BIT OF AN ETHICAL QUESTION. I DON’T THINK THAT THAT WOULD PROBABLY OCCUR IN — YOU KNOW, IN A NONPROFIT COMPANY, MINISTRY IS WHAT WE WOULD SAY, IS THAT YOU WOULD HAVE KIND OF THAT — THERE PROBABLY WOULDN’T BE THAT QUESTION. >> ANYONE ELSE LIKE TO ADDRESS THAT? >> A COUPLE OF ISSUES THERE, I THINK. SO WE ARE A CRITICAL ACCESS HOSPITAL, AND WE’RE ONLY ALLOWED 25 BEDS. WE GET PAID A LITTLE BY DIFFERENTLY, BUT TO THE QUESTION, WE’RE ALSO NONPROFIT, AND WE RUN INTO THOSE SITUATIONS EVERY MONTH. YOU KNOW, FOR OUR SMALLER BUDGET, TENS OF THOUSANDS OF DOLLARS FOR WHAT WE CALL CHARITY CARE WHEN WE CAN’T DO THAT. THOSE ARE HARD QUESTIONS. AND WHEN I HAVE THE STUDENTS TO STAY INTEGRATED, BECAUSE I HAVE TO, I SAY, LOOK, OUR MAIN JOB IS TO RELIEVE SUFFERING. WE TRY TO DO THAT THE BEST WE CAN AND THE BUSINESS PART IS IMPORTANT, AND WE HAVE TO WORK THROUGH THAT, BUT THAT’S WHY YOU DID THIS VOCATION. BECAUSE THAT ALL CAN BE OVERWHELMING. YOU KNOW, WE HAVE TO BE THE PATIENT ADVOCATE AND TRY TO RELIEVE THEIR SUFFERING, NOT FIX THEM EVERY TIME. SOMETIMES YOU CAN’T. BUT YOU HAVE TO BE HONEST WITH THE PATIENT. >> ABSOLUTELY. WE HAVE AN EMAIL TO ADDRESS THIS EVENING. THE EMAIL READS: >> IS IT, SAY, LARGER THAN IT IS IN LARGER COMMUNITIES. >> I’M NOT SURE IF IT’S A LARGER, SMALLER OR THE SAME, BUT IT IS A PROBLEM. WORKING IN THE EMERGENCY DEPARTMENT, WE DO RUN TO A LOT OF PATIENTS WHO, YOU KNOW, DRIVE CLEAR FROM PULLMAN OR MOSCOW OR OTHER PLACES IN ORDER TO, YOU KNOW, TRY TO GET PRESCRIPTION MEDICATIONS FROM THE EMERGENCY DEPARTMENT. LUCKILY NOW, MOST OF THE HOSPITALS ARE INTEGRATED WITHIN THE SAME MEDICAL RECORDS AND THERE’S ALSO A STATEWIDE DATABASE AND SO I THINK THAT’S GETTING — IT’S GETTING BETTER AND IT’S GETTING HARDER FOR THOSE PATIENTS TO GET THOSE MEDICATIONS FROM OUR EMERGENCY DEPARTMENT, WHICH HAS BEEN A BLESSING. >> DOES THAT POSE CERTAIN SECURITY ISSUES IN A SPALLER HOSPITAL, THAT MAY — YOU KNOW, YOU MAY NOT NORMALLY ADDRESS, THAT YOU HAVE PEOPLE DRIVING FROM OUTLYING AREA. >> SECURITY AS FAR AS VIOLENCE AND THAT? >> YES, EXACTLY. >> THERE ARE PEOPLE WHO ARE UNHAPPY, BUT YOU HAVE TO BE PROFESSIONAL AND MEET THEIR NEEDS. ALL THE TIME THAT BEHAVIOR IS AN ISSUE. THEY MAY WANT TO TALK ABOUT THEN OR NOT AND SOMETIMES YOU HAVE TO CALL THE POLICE IF IT GETS ACCELERATED. >> DR. STUHLMILLER, I’M WONDERING WHAT YOUR PLANS. YOUR LONG-TERM PLAN, DO YOU PLAN TO STAY IN TONASKET LONG TERM? >> AT THIS POINT IN TIME, YEAH. YEAH. YOU CAN’T NECESSARILY PLAN ALL OF LIFE AT ONCE, BUT MY PLAN IS TO BECOME A PART OF THE COMMUNITY AND I THINK THAT’S WHAT THESE GENTLEMEN HAVE COMMENTED ON IS YOU KNOW YOU ARE THERE FOR 20 YEARS IF THAT LONG, AND YOU ARE DELIVERING BABIES OF PEOPLE WHO YOU DELIVER BABIES OF AND YOU ARE TREATING A WHOLE FAMILY AND THAT’S TRULY FAMILY MEDICINE. THAT IS THE PRACTICE THAT I DESIRE. >> AND, AGAIN, THAT GOES TO YOUR ROOTS. THAT GOES TO HAVING GROWN UP IN A SMALL COMMUNITY. SO YOU UNDERSTAND THAT GOING IN, IT COULD BE A LITTLE TOUGH, BECAUSE AS ONE OF OUR DOCTORS MENTIONED, YOU KNOW, SOMETIMES IF YOU WEREN’T BORN THERE, YOU ARE NOT PART OF THE COMMUNITY. YOU REALLY HAVE TO JUMP IN AND BECOME PART OF THAT COMMUNITY. >> YES, YOU DEFINITELY DO. >> GROWING UP IN A SMALL COMMUNITY, YOU KNOW THE INS AND THE OUTS AND YOU KNOW WHERE YOU GET THE SPEEDING TICKETS, THOSE TYPES OF THINGS. >> SURE. >> AND SO IT’S A MATTER OF, YEAH, BECOMING A PART OF THAT COMMUNITY AND IN SMALL COMMUNITIES, YOU KNOW, ARE VERY FRIENDLY, AND, YOU KNOW, AT LEAST THE ONES THAT I HAVE BEEN A PART OF, OPEN ARMS AND UP TO THIS POINT, YOU KNOW, MOVING TO THIS AREA WILL BE NOT ONLY ADVENTURE BUT JUST AN EXCITING PART OF GETTING TO KNOW OTHER PEOPLE AND, YOU KNOW, THEM BEING A PART OF MY LIFE BUT ALSO ME SERVING THEM. >> HOW LARGE OF A FACILITY IS THAT IN TONASKET. >> SO IT’S THE SAME CRITICAL CARE ACCESS HOSPITAL AND TONASKET ITSELF IS ABOUT 900 PEOPLE, AND THEN THEY ALSO — WE ALSO SERVE ORVILLE, WHICH IS JUST NORTH OF THERE. AND SO ABOUT 1200 PEOPLE. >> WHAT DOES THE FUTURE LOOK LIKE FOR YOUR FACILITIES AND YOUR MEDICAL CENTERS? HOW ARE WE LOOKING IN FIVE OR TEN YEARS? >> WELL, I’M OPTIMISTIC THAT RURAL MEDICINE AND SMALL RURAL HOSPITALS ARE HERE TO STAY. I THINK THE POPULATION OF OUR PATIENTS WANT THAT. I THINK THAT IN MANY WAYS, MULTIPLE TIMES WE HAVE DEMONSTRATED WHERE WE ARE NOT ONLY MORE CONVENIENT BUT WE ARE MORE COST EFFECTIVE. THERE HAVE BEEN MULTIPLE STUDIES THAT HAVE LOOKED AT COSTS TO TREAT CERTAIN CONDITIONS, AND OVERWHELMINGLY SMALL COMMUNITY HOSPITALS TREAT THOSE CONDITIONS AT A LOWER PRICE, LOWER COST TO THE SYSTEM, AND LARGER HOSPITALS. SO I THINK WE ARE A VIABLE COMMODITY AND I THINK THAT WE’RE HERE TO STAY. THE POPULATION WANTS IT. YOU CAN’T ARGUE THAT WE ARE AN OUTLANDISH EXPENSE BECAUSE OF THOSE STUDIES. >> DR. REHN? >> YOU KNOW, WE DON’T KNOW WHAT TOMORROW IS GOING TO BRING. YOU KNOW, I’M OPTIMISTIC TOO. YOU KNOW, WE HAVE 20% OF THE U.S. POPULATION LIVES IF RURAL AREA — LIVES IN RURAL AREAS. JUST LIKE YOU GROWING UP IN A RURAL AREA, YOU ARE FIVE TIMES MORE LIKELY TO PRACTICE IN A RURAL AREA, IF YOU GREW UP IN A RURAL AREA. AND SO FOR ME, I’M NOT SURE EXACTLY WHAT HEALTH CARE WILL LOOK LIKE IN THE NEXT 20 YEARS, BUT WE — YOU KNOW, HEALTHCARE IS DONE LOCALLY. WE PRACTICE LOCALLY. AND SO, YOU KNOW, WHAT IT’S GOING TO LOOK LIKE, YOU KNOW, I’M NOT SURE. WILL IT BE EXACTLY THE SAME AS IT IS TODAY? PROBABLY NOT. BUT AS FAR AS DELIVERING CARE IN THE RURAL AREAS, YOU KNOW, I THINK THAT WE, YOU KNOW — WE WILL BE THERE IN SOME FORM, TAKING CARE OF OUR NEIGHBORS AND ENTREPRENEURS AND FAMILIAR HISTORICALLY. >> I’M HEARING A LOT THAT IT’S ABOUT PEOPLE MOSTLY, THOSE CONNECTIONS. BUT TECHNOLOGY DOES PLAY A ROLE AND WE ARE SEEING SOME REALLY COOL TOOLS COMING INTO PLAY. DO YOU ANTICIPATE MORE OF THAT? >> I DO. WE USE THE STROKE ROBOT TOO. I WANT TO SEE IT AS THE TECHNOLOGY GOES FORWARD AUGMENT WHAT WE DO LOCALLY AS OPPOSED TO REMOVING FROM OUR ENVIRONMENTS, BECAUSE EVERY PATIENT WE CAN KEEP IS BETTER CARE FOR THAT FAMILY, BUT IT ALSO IS ABOUT THE ECONOMY OF THAT SMALL TOWN, THE STABILITY OF THAT TOWN, AND IF YOU ARE EXTRACTING OUT THINGS THAT WE WERE TAKING CARE OF, THE ECONOMY SUFFERS. BUT MY HOPE IS THAT THE TECHNOLOGY WILL AUGMENT OUR CARE OF OR PATIENTS, SO THAT THEY DON’T HAVE TO, YOU KNOW, PAY THOUSANDS OF DOLLARS TO BE TRANSFERRED. >> ARE YOU CURRENTLY USING — ARE ANY OF YOU USING THE — THERE ARE SOME APPS THAT HAVE BEEN PUT TOO PLACE FOR iPHONES AND CELL PHONES THAT ARE HELPING CONNECT PATIENTS WITH DOCTORS AND PROGRAMS. ARE YOU CURRENTLY USING ANY OF THOSE PROGRAMS? NONE OF THE APPS. >> WELL, FOR PROVIDENCE WE HAVE JUST ROLLED OUT A CARE PROGRAM THAT YOU CAN SEE A PROVIDER USUALLY IN AN ADVANCED PRACTICE, LIKE A NURSE PRACTITIONER OVER YOUR MOBILE PHONE, YOUR COMPUTER, I THINK IT’S A — >> YOUR HOME? >> YEAH. OR IN YOUR CAR. WHEREVER YOU ARE — WHATEVER YOU MAY NEED, IT’S — AND I THINK THAT IT’S A $39 CHARGE FOR THAT, BUT, YOU KNOW, YOU ARE GOING TO BE ABLE TO GET CARE FOR PROBABLY MORE LIKE ADVICE, YOU KNOW, AND COULD GET A PRESCRIPTION FOR, YOU KNOW, URINARY TRACT INFECTION, IT WOULD BE THAT FIRST LINE OF DEFENSE AND PROVIDENCE JUST ROLLED THAT OUT IN SPOKANE. IT WAS IN PORTLAND EARLIER. SO ARE WE DOING, YOU KNOW, BASED IN OUR COMMUNITIES, PROBABLY NOT, BUT WE ARE SEEING IT BASED IN SYSTEMS THAT ARE, YOU KNOW, OFFERING IT TO THE RESIDENTS. >> AND DR. JOHNSON, AS WE TALK ABOUT RECRUITING, THIS SORT OF HITS CLOSE TO HOME FOR YOU. YOU HAVE A SON WHO JUST STARTED COLLEGE AND HE WOULD LIKE TO BECOME A PHYSICIAN. HE WILL ACTUALLY SPEND SOME TIME WITH YOU THIS SUMMER? >> YES. >> TALK MORE ABOUT THAT. >> WELL, MY SON TYLER JUST FINISHED HIS LAST FINAL TODAY. HE’S AHAPPY. HE’S OVER AT PACIFIC LUTHERAN. HE HAS BIOLOGY. HE WOULD LOVE TO GO INTO MEDICINE AND THIS SUMMER WHEN HE COMES HOME, WE’RE GOING TO HAVE HIM DO SOME SHADOWING IN OUR HOSPITAL. KIND OF FOLLOW AROUND IN THE EMERGENCY DEPARTMENT, IN OTHER DEPARTMENTS AND JUST KIND OF TEST THE WATERS A LITTLE BIT. >> NOW, IF YOU WERE AT SACRED HEART OR DEACON THAT’S HERE LOCALLY, THAT WOULDN’T BE HAPPENING. NOT AT THE LEVEL THAT HE’S AT RIGHT NOW. >> PROBABLY NOT. YEAH. THEY HAVE A LOT OF RESIDENTS AND STUDENT, MEDICAL STUDENTS, BUT, YOU KNOW, AS FAR AS PREMED STUDENTS THIS IS A PILOT PROGRAM FOR US THIS SUMMER. THERE WILL BE TWO STUDENTS, ANOTHER YOUNG MAN WHO IS IN HIS FIRST YEAR AT UNIVERSITY OF IDAHO AND HE’S ALSO GOING TO BE DOING SOME SHADOWING. SO WE WILL HAVE TWO PREMED STUDENTS WHO WILL BE HANGING AROUND THE HOSPITAL AND GETTING SOME EXPERIENCE AND JUST TRYING TO FIGURE OUT WHAT THEY WANT TO DO WHEN THEY GO TO MEDICINE. >> WERE YOU SURPRISED THAT YOUR SON WAS TAKING THIS TRACT? >> NO. MY DAUGHTER HAS NO INTEREST WHATSOEVER, AND MY SON IS FROM — FROM THE TIME HE WAS YOUNG, HE USED TO COME WITH ME TO THE HOSPITAL WHEN HE WAS 5 OR 6, WHEN I WAS DOING MY ROUNDING IN THE MORNINGS. AND HE WOULD FOLLOW ME AROUND AND GO INTO THE PATIENT ROOMS. I’M SURE THAT’S GOING TO BE A VIOLATION OF ALL KINDS OF THINGS NOWADAYS BUT BACK THEN, IT WAS GREAT. HE USED TO COME TO THE HOSPITAL WITH ME AND HE WOULD SPEND THE NIGHT WHEN I WAS ON CALL. >> HE KNOWS WHAT HE’S IN FOR. >> HE KNOWS. AND I THINK THAT’S ONE THING HE DOES. HE KNOWS WHAT THE HOURS ARE AND THE COMMITMENT IS. I’M PROUD OF HIM. HE’S A GOOD KID. >> THAT’S GREAT. LET’S TAKE ANOTHER PHONE CALL. WE HAVE BOB CALLING IN FROM NORTH PORT, ONE OF OUR OUTLYING AREAS. HI, BOB. >> Caller: HI. >> YOU HAVE A QUESTION FOR OUR PANEL THIS EVENING? >> YES, I DO. >> Caller: I THINK NORTHERN STEVENS COUNTY IS LADIES AND LAN URGENT CARE FACILITY. WOULD THE DOCTORS ADDRESS THAT, PLEASE? >> DR. REHN, CAN YOU ADDRESS THAT, PLEASE? >> YES. URGENT CARE IN THE — URGENT CARE IS USUALLY MANNED BY PHYSICIANS AND SO WHETHER WE HAVE URGENT CARE OR WHETHER WE HAVE, YOU KNOW, ACCESS IN OUR, YOU KNOW, OPEN SCHEDULES AND OUR AMBULATORY SITES AND OUR CLINICS, YOU KNOW, IT’S ALL — I THINK IT’S ABOUT ACCESS. AND SO I THINK THE QUESTION THERE IS REALLY ABOUT, YOU KNOW, HAVING TO WAIT FOR DAYS OR WEEKS TO GET IN TO SEE YOUR DOCTOR BECAUSE WE DON’T HAVE ENOUGH HEALTH CARE PROVIDERS IN OUR AREA, IN OUR COMMUNITY. SO I THINK THAT’S THE SYMPTOM IS, YOU KNOW, JUST NOT BEING ABLE TO SEE PATIENTS IN A TIMELY MANNER, AND SOMETIMES THE — YOU KNOW, THE — WHAT THE CURE MIGHT BE IS URGENT CARE AND THAT’S WHAT WE ARE SEEING IN SPOKANE. WE ARE GETTING A LOT OF URGENT CARE. BUT I THINK IT’S REALLY ABOUT BEING ABLE TO GET IN AND SEE A PROVIDER. I THINK WE ARE GOING TO COME UP WITH THE SAME PROBLEMS. WE ARE GOING TO HAVE TO FIND SOMEBODY TO WORK AT APRIL URGENT CARE CENTER — AN URGENT CARE CENTER AND LIKE DR. JOHNSON WAS SAYING, WE HAVE HAD POSITIONS OPEN. IT WASN’T JUST ONE YEAR, IT’S BEEN TWO AND A HALF YEARS THAT WE HAVEN’T BEEN ABLE TO GET A REGULAR INTERNAL MEDICINE PHYSICIAN IN COLVILLE. AND SO YOU KNOW, THAT’S — WHEN I WAS TALKING ABOUT STAYING AWAKE AT NIGHT, IT’S ABOUT WORKFORCE. I THINK WE ARE HEARING WORKFORCE HERE. >> WOULD IT HELP TO HAVE MORE, SAY, PHYSICIANS ASSISTANTS, SUPPORT STAFF, NURSING STAFF, WOULD THAT HELP OR IS IT DOCTORS WE NEED IN THESE POSITIONS? >> I MEAN, I — MY PARTNER AND I OF TEN YEARS, THE TWO OF US WOULD SPLIT CALL OWN THE BACKUP CALL AND WE HAD — WE WERE BACKING UP ABOUT 12 LEVELS. SO THAT’S HARD. TRADITIONALLY, THE MIDLEVEL WAS ALWAYS CALLED THE PHYSICIAN EXTENDER BUT WE WERE EXTENDING, ACTUALLY, THEIR PRACTICES AND THEY GOT TO DO AND DO A LOT AND DO IT VERY WELL, BUT IT’S HARD, BECAUSE AT SOME POINT, YOU HAVE TO SIGN THE LINE AS A PHYSICIAN. YOU HAVE TO BE AVAILABLE AS THE PHYSICIAN, AND SO IT’S VERY HELPFUL, AND WE COULDN’T DO IT IN OUR SYSTEM WITHOUT VERY GOOD HIGH LEVEL MIDLEVELS BUT YOU NEED MORE DOCTORS. >> WELL, WHAT WOULD YOU — WHAT DO YOU SAY TO STUDENTS NOW? HOW DO YOU ENCOURAGE MORE PEOPLE TO GET INTO THIS FIELD? WE HAVE A CRITICAL NEED RIGHT NOW. HOW DO YOU ENCOURAGE THAT? >> WELL, I THINK IT’S DIFFICULT. I THINK THAT THERE ARE INDIVIDUALS, STUDENTS THAT VIEW MEDICINE AS A CAREER. I THINK THAT THERE ARE A LOT OF THINGS THAT COME INTO PLAY THAT DISSUADE THEM FROM THAT. I THINK THAT AT TIMES THE EXTENSIVE SCHOOLING, I THINK THE COST, AND I THINK THAT — I THINK IDEALLY, YOU GENERATE AN INTEREST AND HELP TO PERPETUATE THAT WITH YOUNG PEOPLE TO BRING THEM INTO THE SYSTEM, AND THAT’S — THAT’S ONE THING THE RURAL COMMUNITIES, IT’S EASIER TO DO TO BRING THEM INTO THE OFFICE, AND BRING THEM INTO THE HOSPITAL, THAT’S VERY DIFFICULT IN A LARGE HOSPITAL. I KNOW THAT MY CHILDREN ASSISTED ME IN VARIOUS WAYS IN THE HOSPITAL EMERGENCY ROOM, AND ONE NIGHT MY SON HELPED ME SUTURE UP A BIKER THAT ENDED UP — I THINK HE — I DON’T KNOW, WE WERE THREE HOURS SEWING HIM UP. BUT I THINK GETTING THAT EXPERIENCE IS HELPFUL FOR YOUNG PEOPLE AND TO SEE IT AS SOMETHING THAT THEY ENVISION THEMSELVES DOING. IT’S GOING TO BE A PROBLEM AND IT’S ALWAYS A PROBLEM TO GENERATE THAT INTEREST AND THEN PROVIDE THE ECONOMICS FOR THOSE KIDS TO GET THROUGH TRAINING. >> YEAH. >> ONE OF THINGS WE ARE INVOLVED IN IS WHAT’S CALLED THE TRUST PROGRAM, THROUGH THE UNIVERSITY OF WASHINGTON. AND SO THESE STUDENTS ARE COMING INTO THE MEDICAL SCHOOL AT THE UNIVERSITY OF WASHINGTON BUT THEY ARE ALSO APPLYING SEPARATELY AS A TRUST STUDENT. AND IF THEY ARE CHOSEN, THEN THEY ARE ASSIGNED TO A RURAL COMMUNITY. AND SO THAT STUDENT IS ASSIGNED TO ME AND OVER THE FOUR YEARS OF MEDICAL SCHOOL, THEY COME BACK TO MY COMMUNITY AND THEN IN THEIR THIRD YEAR, THEY SPEND FIVE MONTHS THERE WITH US. I JUST FINISHED A ROTATION BEING A FIVE MONTHS ROTATION. THE IDEA IS THAT NOT ONLY WILL THEY WANT TO DO RURAL MEDICINE BUT HOPEFULLY COME BACK TO OUR AREA. >> THAT YOU GET THEM ATTRACTED TO THE AREA. YOU GET THEM ENBRAINED IN THEBR- ENGRAINED IN THE COMMUNITY, LIKE WE TALKED ABOUT. >> WHEN WE BECAME A SITE AND THEY SAID, WHY SHOULD WE CHOOSE YOU? YOU WOULD BE THE SMALLEST SITE THAT WE EVER USED. AND I LOOKED AT MY PARTNER AND I THOUGHT MAYBE I SHOULDN’T SAY. THIS I LOOKED AT THE GAL AND SAID, IF YOU WANT PEOPLE TO PRACTICE IN TOWNS THIS SIZE, THEN WHY WOULDN’T YOU TRAIN THEM IN TOWNS THIS SIZE? >> THERE’S A NOVELTY. WE GOT SELECTED. >> IT MAKES PERFECT SENSE TO ME. >> DR. STUHLMILLER, ARE WE STARTING YOUNG ENOUGH? SHOULD WE START ENCOURAGING KIDS IN MIDDLE SCHOOL AND HIGH SCHOOL THAT THERE’S A NEED FOR DOCTORS AND GIVE THEM ATTRACTIVE INCENTIVES TOWARDS THAT? >> I DON’T KNOW IF KIDS REALLY KNOW THAT YOUNG. I MEAN, MAYBE SOME DO. MAYBE YOU ARE 5 YEARS OLD AND YOU KNOW YOU WILL BE A DOCTOR BUT I THINK IT’S A PROCESS. AND DO YOU REALLY KNOW WHAT YOU WANT TO BE WHEN YOU GROW UP? AND GETTING TO THAT POINT AND THEN STICKING WITH IT AND ACTUALLY KNOWING WHAT YOU ARE GETTING INTO, I THINK THAT’S A, YOU KNOW, CHALLENGE. AND ALSO A BIG PART OF THAT RETENTION AS WELL, KEEPING THAT STUDENT ON THAT TRACK TO BECOME A PHYSICIAN TO BECOME A RURAL PHYSICIAN. IF YOU DON’T KNOW REALLY WHAT YOU ARE GETTING INTO AND THEN ALL OF A SUDDEN, YOU KNOW, YOU ARE IN YOUR THIRD YEAR OF MEDICAL SCHOOL GOING WHAT IS THIS? YOU KNOW, YOU — YOU KNOW, YOU KIND OF GET A LITTLE BIT OF A SHOCK. SO CAN WE START THAT EARLY? I DON’T KNOW. I DO THINK THAT RURAL AREAS CAN INVEST IN THEIR KIDS AND ENCOURAGE THEM TO COME BACK AND I WAS JUST PART OF A RURAL FOCUS BASICALLY WITH HIGH SCHOOL STUDENTS OF DIFFERENT — YOU KNOW, DIFFERENT WORKFORCES IN TOWN, WHETHER IT’S THE P.U.D. OR THE SCHOOL SYSTEM OR — THERE’S MANY DIFFERENT JOB OPPORTUNITIES FOR KIDS. IT’S NOT JUST FAMILY MEDICINE, OR MEDICINE ITSELF. >> WE ARE SHORT ON TIME. WE HAVE RUN OUT OF TIME. THANK YOU ALL FOR BEING HERE. IT’S A FASCINATING TOPIC. THAT WILL DO IT FOR “HEALTH MATTERS.” THANKS TO EVERYONE WHO CALLED IN OR EMAILS. A BIG THANK YOU AS WELL TO OUR PANEL FOR BEING HERE AND SHARING THEIR EXPERTISE. JOIN US ON JUNE 18TH WHEN OUR TOPIC WILL BE PLASTIC AND RECONSTRUCTIVE SURGERY. I’M TERESA LUKENS. GOOD NIGHT. >> “HEALTH MATTERS” IS MADE POSSIBLE BY VIEWERS LIKE YOU, THE FRIENDS OF KSPS. AND BY THE FOLLOWING: >> I’M ARNIE PETERSON. I’M AN ORTHOPEDIC SURGEON. AND I WORK IN THE SACRED HEART PROVIDENCE MEDICAL GROUP. WHEN I NEEDED MY HIP REPLACED, I CHOSE PROVIDENCE BECAUSE OF THE PROFESSIONALISM AND THE CARE I KNEW I WOULD RECEIVE. I NEVER THOUGHT TWICE ABOUT GOING ANYWHERE ELSE. >> I’M DR. ANDREW BOULAY, AND WHEN MY WIFE HAD A CARDIAC ARREST, I CHOSE PROVIDENCE BECAUSE I KNEW EVERYTHING WE NEEDED FOR HER COMPLEX CARE WAS AVAILABLE FROM THE MIAMI ROOM, TO RADIOLOGY, TO THE NURSING STAFF, TO THE SPECIALISTS WE NEEDED FOR HER CARE.
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