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East Oregonian
DOCTORS: 10,247 of Oregon doctors practice in
urban/non-rural areas and 2,362 work in rural areas
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idence St. Mary Medical Center.
“I love it,” Wick said.
It’s a happy outcome in a
time of doctor shortages in rural
America. The shortage, espe-
cially of primary care physicians,
continues to worsen. That is
partially due to an imbalance in
pay between primary care doctors
and specialists. According to
Medscape’s 2017 Physician
Compensation Report, ortho-
pedists, cardiologists, plastic
surgeons and urologists all earn
$400,000 or more on average.
But pediatricians, internists and
family medicine doctors make
$225,000 or less.
Maggie
Elehwany,
the
National Rural Health Associa-
tion’s vice president of govern-
ment affairs, said rural America
needs more doctors.
“Twenty percent of the popu-
lation is scattered over 90 percent
of the land mass,” she said. “This
20 percent of the population has
nine percent of the physicians.”
In addition, “there’s a higher
percentage of chronic disease in
rural America. They’re poorer
and sicker.”
Oregon isn’t quite that low.
Based on Oregon Medical
Board licensures and the OHSU
Offi ce of Rural Health, 10,247 of
Oregon doctors practice in urban/
non-rural areas and 2,362 work
in rural areas (defi ned as 10 miles
or more away from a population
center of at least 40,000).
The national shortage could
grow to 45,000 by the year 2020,
according to the NRHA. Since
2010, more than 80 rural hospi-
tals have closed, including Walla
Walla General Hospital.
Internist Norman Sitz is a
popular Pendleton physician who
is pondering retirement in the
next couple of years. He worries
about his patients when that time
comes. He doesn’t have hard
numbers but he knows his town
is short on docs.
“People are always calling to
get in,” Sitz said. “I don’t know
what my patients are going to
do.”
Sitz grew up in Ontario, so as a
young internist he felt no qualms
about practicing in a rural area.
Though Pendleton wasn’t his fi rst
choice, he soon grew attached to
this little place where “people get
along with each other” and he has
stayed for 40 years and counting.
The locale was close to good
hunting and fi shing and proved a
great place to raise his and wife
Michelle’s three children. He
doesn’t mind seeing his patients
around town and his home phone
number is in the book.
“People don’t abuse that,” he
said.
Sitz and his partner Daniel
Marier sold their practice to the
Praxis Medical Group three years
ago as a way to rein in costs
and get better bargaining power
with insurance companies. The
increasing regulation, complexity
and requirements for such things
as electronic health records have
altered the landscape.
“You can’t open a small clinic
now,” Sitz said. “There’s no way
to do it on your own. Fifteen
years ago, someone could come
to Pendleton and open a small
practice.”
Still, there are plenty of
mid-level opportunities and not
enough physicians to fi ll them.
Money isn’t necessarily the
reason for reluctance to leave
urban centers. Wick said doctors
who go to rural areas often get
paid more by employers as an
incentive. Doctors, dentists,
optometrists, nurses, physician
assistants, nurse practitioners and
certain others also receive up to
$5,000 in annual tax credits to
entice them to practice in rural
Oregon. The Oregon Legislature
recently renewed the credit,
originally enacted in 1989.
A 2012 survey found that 45
percent of respondents felt the tax
credit infl uenced their decision to
practice in rural Oregon. More
than 2,100 providers, including
60 in Pendleton and 76 in
Hermiston, claimed the credit in
2015, the most recent data year
available.
Barriers to a rural practice
include resistance from partners,
pressure to pay off debt and
worry about being too far away
from academia, specialists and
the amenities of city life.
Some creative efforts aim
to turn the tide. OHSU’s Area
Health Education Centers, scat-
tered around the state, introduce
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K-12 students to the notion of
working in health care through
career exploration activities.
OHSU also requires medical
students to experience small
town medicine during rotations
in rural parts of the state.
Greggory Dallas, a second-
year OHSU medical student
from Pendleton, is one of several
students with rural roots who
helped organize rural medicine
discovery trips to small towns
this past year. The treks were
designed to open urban medical
students’ minds to rural medicine
and remind rural students about
reasons to return.
Dallas’ own plans are
evolving. She left Pendleton in
2002 to attend Columbia Univer-
sity — in the center of New York
City — not planning on returning
home for a career.
“I assumed I’d be in a city,”
she said. “I never imagined I’d be
back in Pendleton.”
After a stint in Madagascar
as a health care worker for the
Peace Corps and before enrolling
in medical school, she worked at
the Pendleton Center for the Arts
and her thinking changed.
“I saw the impacts of what you
can do in a small community,”
she said. “That excited me.”
Hoping to pass some of this
excitement on to her fellow
medical students, she helped with
a pair of trips to rural Oregon,
including a trek to Enterprise and
La Grande.
“Many of them said they’d
never been to Eastern Oregon,”
Dallas said. “A lot of them left
feeling really inspired.”
Many, however, fi nd it hard
to imagine themselves working
in a rural environment. Besides
concerns about spouses getting
jobs and the other reasons, she
said lack of diversity is another
apprehension.
“Some of my classmates
from minority or LGBT back-
grounds wonder if they would be
welcome,” Dallas said. “That’s
something that’s come up a lot
this year.”
Lending credence to that
fear, an OHSU emergency room
doctor tweeted this week about
racism she occasionally expe-
riences from ER patients. Dr.
Esther Choo authored the series
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chairs near the railings ready for customers.
The DJ booth sits at the opposite end. Some
tables and chairs make up the rest of the spartan
accommodations.
Evans was at the club Thursday night and
in charge of most operations. Another man
worked as security while the “house mom”
took the cash to get in and helped Evans with
the four dancers.
He said since the “grand opening” around a
couple of weeks ago, Zen-Den had maybe 20
customers. The pace picks up around 1 a.m., he
said, when folks leave the Riverside Sports Bar
and Lounge, one of the other adult entertain-
ment venues in Umatilla.
The city’s mayor, Daren Dufl oth, owns the
Riverside. And Steve Bunn owns Honeybunnz
Hideout, the other strip club in the city. Like
Zen-Den, Honeybunnz serves no alcohol. Bunn
and Evans have a history of confl ict that in early
2015 resulted in a felony assault conviction
for Evans. That history led Milton-Freewater
months later to reject Evans’ application to
open a strip club there.
Zi Chen of Hermiston is buying the prop-
erty where Zen-Den is located. He owns the
Fortune Garden restaurant on Hermiston’s
north end. He said he heard a couple weeks
ago about the adult entertainment club but was
not aware it lacked a business license. He said
he pays Preferred Property Management Inc.,
Hermiston, to oversee the site.
Randy Randall is the principal broker of
Preferred Property and is chair of the Umatilla
County Planning Commission. He said he
has yet to see evidence Zen-Den has been a
problem or is violating any rules or laws.
“Without a citation, I can’t take action,” he
said.
The people working in the two secondhand
and gift shops next to Zen-Den said they have
seen no problems with their newest neighbor
and didn’t even know who worked there. Evans
said the business is open to the public 9 p.m. to
3 a.m. Thursdays through Sundays.
“By the time we open there’s not a single
other business in Power City that is open,”
he said. “We are completely out of sight, out
of mind as far as the mainstream community
is concerned. ... I don’t know why anybody
would have a problem or a complaint with the
facility or the location of it.”
The sheriff’s offi ce last Saturday responded
to the club after an anonymous caller report of
a fi ght. But there was no fi ght.
“What we believe is going on is the compet-
itor in Umatilla is falsely reporting,” Rowan
said.
Rowan didn’t specify which competitor
that might be. Evans said he had no doubt that
was the case and illustrates the unfair treatment
Zen-Den is receiving.
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of tweets in response to the white
supremacists and Neo-Nazis
who marched in Charlottesville,
Virginia, last weekend. The
Asian-American
physician,
educated at Yale University and
Boston Medical Center, said
patients occasionally refuse
treatment because of her race in
favor of a white, less-experienced
intern.
“Sometimes I just look at
them, my kin in 99.9 percent
of our genetic code, and fail to
believe they don’t see our shared
humanity,” Choo tweeted.
As a way to move past the
worries and get actual experience
in a non-urban place, OHSU’s
Oregon Rural Scholars Program
places students in rural Oregon
for three-month stints. Dr. Paul
Gorman, assistant dean for
rural medical education, spends
every day focusing on exposing
medical students to rural areas.
He made the jump himself in
the 1980s as a young doctor who
grew up in Chicago. He and his
wife — also a doctor — took jobs
at a clinic in Astoria.
“We wanted to be small town
docs,” he said. “We thought it
would be a really great place to
start a family.”
Gorman said OHSU requires
every student to complete a rural
clinic experience. Students are
free to sample specialties during
their rural rotations.
Elehwany, of the NRHA,
said OHSU is on the right track.
Her organization, with their eye
on the entire nation, encourages
both rural rotations and grow-
your-own efforts. The latter has
proved successful in the wilds of
Alaska.
“They’ve been able to attract
kids, get them interested in
attending medical school and
get them back,” Elehwany said.
“Growing your own is a big part
of the solution.”
Sitz, the doctor preparing to
retire in Pendleton, gave his own
off-the-cuff solution with a grin.
“We’ll probably just have to
throw money at them to get them
to come,” he said. “Once they’re
here, they won’t want to leave.”
———
Contact Kathy Aney at
kaney@eastoregonian.com or
call 541-966-0810.
Saturday, August 19, 2017
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