Launched in 2015, South Coast has the capacity to house 15 learners each month with ten teaching site affiliates in Coos and Curry counties. Currently, the South Coast has recruited six OHSU graduates for practice.

A four hour drive from Portland leads to the southern Oregon coast communities of Coos County which has a population of 63,043 and a five hour drive to Curry County which has a population of 22,364. The Pacific coastline is rich in natural resources of forests and timberland, rivers and streams, and coastal bluffs and beaches. Several Oregon State Parks and recreation areas present visitors with countless opportunities to experience Oregon coastal communities as well as visit the many farmer’s markets and places on the National Register of Historic Places from Coos Bay to Gold Beach.

Southwestern Oregon Community College, the Oregon Institute of Marine Biology, Southwestern Oregon Community College provide higher education in the area. Although the area sustains a variety of forest, agricultural, and fishery resources, the primary natural resource-based economic drivers are timber, fishing, and associated recreation or tourist-based activities. In Coos County, 27 percent of jobs are in that sector, 19 percent are in trade, transportation and utilities, and 11 percent are in leisure and hospitality. The percentages are similar for Curry County and the Reedsport area.

Teaching Affiliates

• North Bend Medical Center (Coos Bay Tier 4 PCPCH, satellites Tier 3 except Gold Beach, Tier 2)
• Bay Area Hospital
• Advantage Dental
• Coos Health and Wellness (Public Health)
• Bay Clinic, LLC (PCPCH Tier 4)
• Waterfall Community Health Center (FQHC and Tier 3 PCPCH)
• Coast Community Health Center (FQHC) (Tier 4 PCPCH)
• Southern Coos Hospital
• Coquille Valley Hospital
• Advanced Health (CCO)

Past Community Projects

Waterfall’s Equitable Patient Outcomes Study
Partner: Waterfall Community Health Center

Homeless Barriers to Care
Partners: The Devereux Center

PCPCH Learning Collaborative
Partner: Patient Centered Primary Care Home (PCPCH) Learning Collaborative, part of Coos County’s Community Health Improvement Plan (CHIP) Access to Care subcommittee

Designations

• FQHC: Federally Qualified Health Center  (U.S. Department Health and Human Services)
• PCPCH: Patient-Centered Primary Care Home  (Oregon Health Authority) 
• CCO: Coordinated Care Organizations (Oregon Health Authority)

Interprofessional Community-based Courses

The Joy of Discovery

Why rural healthcare training programs matter

I grew up in a small town in Arkansas, an agricultural county seat that’s been shrinking for decades. I knew well before college that I wanted to practice medicine in a small town. The medical school I chose produced amazing high number of excellent specialists and only one Family Medicine physician in my graduating class – me. I was frequently asked why in the world I would want to be a family doctor, and why practice in a small town. If this had been my only exposure to rural medicine as a student, I wonder if it would have been the choice I made. Fortunately, I requested, and was given, a rural longitudinal rotation with a family doctor in a small town about 45 minutes away and it confirmed that that rural Family Medicine was the right path for me.

Now I’m a physician who has practiced in a small town on the South Coast of Oregon for twelve years. During that time I’ve seen providers come and go. My colleagues and I always wonder why they left. Perhaps the coast was too remote for them or their families. Perhaps the schools did not offer enough opportunities. Perhaps their partner did not find adequate employment. Burnout, aging parents, retirement, unexpected illness, dissatisfaction with the climate, and lack of adequate housing, any or all of these factors drive new recruits away. Perhaps, instead of asking why providers leave, we should ask why they stay.

Rural, frontier, and underserved communities struggle to recruit and retain healthcare providers of all types. Much is written about improving access health care in rural and underserved communities with an emphasis on provider recruitment. National and international studies attempt to quantify why new health professional graduates choose to practice where they do.

What makes us choose a practice location? What makes us commit and stick rather than bounce every two to three years from location to location, contract to contract? How can we demonstrate that rural practice can be very desirable? Common themes around provider retention should be explored. Those of us raised in small towns are more likely to choose a practice in a similar environment after graduation. Those of us with rural or remote family ties are more likely to commit to practice in those areas. Those of us going into family medicine and primary care choose rural medicine more often than other specialties. We’d be lucky to capture 50% of the providers entering the workforce who came from rural backgrounds but that isn’t the case.

Good work is underway to increase the number of rural students entering healthcare professions, following the “grow your own” philosophy. Our population on the South Coast is aging. Our K-12 class sizes are decreasing. Our pool of local mentees is shrinking. Those of us who stay are starting to get a little gray around the edges as the average age of our healthcare providers increase. In the meantime, our patients might wait three to six months for an appointment for medical or dental care. They might not be able to get into a mental health provider at all.

Somehow, we have to sell our appeal to a wider variety of learners before and during their health care training programs. How do we capture more learners who are “on the fence”? Or providers who have never considered small town life at all? We have to show them the uniqueness and variety that can come with rural practice job offers. We have to immerse prospective recruits into the community. Let them see the leadership opportunities available in smaller healthcare systems and small towns.

Let them experience the joys of caring for generations of the same family, the grief as we lose someone for whom we’ve provided care for years, the fear that comes as we have to stretch our comfort level in managing complexity and severity. Rural medicine frequently comes without readily available specialty care, ICU care, or immediately available emergency transport. It’s difficult to appreciate the challenges colleagues practicing in rural areas experience without working in that environment even if for just a brief period.

And those learners who will never be interested in rural health care – that’s ok. Because of their rural required experience, they will better understand the pressures, complexity, and environment in which their colleagues are serving. We need these future leaders to be our partners as we try to do more with less. We need their remote advice and telemedicine consults. We need advocates actively encouraging the next classes of graduates to consider rural healthcare opportunities. We need mentors to tell students, “YES! Rural and remote communities would be so lucky to have you.”

Megan Holland, MD Regional Associate Dean, South Coast