Wearing a white lab coat with a stethoscope looped around her neck, Desiree Hansen knocks twice and then breezes into an exam room at Samaritan Internal Medicine in Corvallis.
"Hi," she says. "You must be Gerald."
With a combination of chatty charm and businesslike briskness, Hansen quizzes her 54-year-old patient about his health, current medications and recent changes in condition while reviewing his chart on a computer screen. He reports no problems since his last visit.
"OK," she says, placing the stethoscope against his chest. "That’s what I like to hear."
Hansen’s not a doctor yet; she’s a medical student. But with a physician shortage on the horizon, the competition for the next generation of doctors has already begun, and mid-valley health care providers are very much in the hunt.
Hansen is one of 12 third-year osteopathic medical students from Western University of Health Sciences, a private college in Pomona, Calif., who arrived in Oregon in June to begin year-long clerkships at Samaritan Health Services’ hospitals in Corvallis, Albany and Lebanon.
And area health-care executives are hoping that after they finish medical school and complete their residencies they’ll come back to the mid valley to practice.
Hansen performs an examination. After gathering information, Hansen wiil wili talk about her findings with Dr. Fred Weisensee.
The students get a chance to work with patients and learn from physicians. And Samaritan gets a chance to sell itself — and the mid-valley — to a group of doctors-in-training.
Larry Mullins, the regional health care network’s chief executive, says the new relationship with Western University represents a crucial recruiting opportunity.
"There have been a lot of studies that say physicians have a predisposition to stay in the communities where they do their internships and residency training," Mullins said. "This should help us in our recruitment efforts. Plus, we get a look at them. It’s a good way to test each other out."
A similar program has been in place at The Corvallis Clinic since 1980. Each summer, doctors at the clinic’s Philomath office host two students from Oregon Health & Science University for clinical training rotations.
"Their very first student, Sydney Piercey, is now a neurologist at the clinic," said Judy Corwin, a spokeswoman for the multispecialty practice.
At least half a dozen other med students have returned to the mid-valley to practice after going through the program, Corwin said.
As recently as the last decade, policymakers were predicting a glut of physicians in the early years of
the 21st century. That led U.S. medical schools to limit enrollment.
But the forecasts turned out to be mistaken. Now med schools are scrambling to churn out enough doctors for an impending demographic storm.
"It’s really only in the last five to seven years that people realized the time frames have changed and the numbers have changed," said Edward Salsberg, director of the Center for Workforce Studies at the Association of American Medical Colleges.
In the 1980s and ’90s, many experts were touting managed care as a way to reduce the need for more doctors by controlling utilization of medical services. But utilization has gone up, even in the HMO model, Salsberg noted.
Meanwhile, the U.S. population was both growing and aging, while the number of medical school openings stayed flat. The physician population was also aging, and now that older doctors are retiring, the new generation of physicians is looking for a more balanced lifestyle — meaning they want to work fewer hours.
The result, Salsberg said, is a crisis in the making.
"It’s pretty clear the demand for services will be rising rapidly," he said. "It gets a little scary, to be honest."
In 2005, the Association of American Medical Colleges called for a 15 percent enrollment increase by 2015. Last year the association doubled its recommendation to 30 percent.
But even with 90 or so of the country’s 125 medical schools — including Oregon Health & Science University in Portland — taking steps to admit more students, it will be years before they complete their education. In addition, recent changes in immigration policy have restricted the number of foreign med school graduates coming to America.
"It really takes 10 to 15 years to change the physician supply," Salsberg said. "There’s very little we can do between now and 2020 — and the baby boom generation will begin to hit 75 in 2020."
"It’s not just a shortage of numbers, but a maldistribution of practitioners," said Dr. Mark Richardson, dean of the OHSU School of Medicine.
Small towns have a tough time attracting physicians, and much of Oregon outside Portland remains medically underserved. In addition, some specialties are unevenly represented.
The situation is getting worse as doctors hit retirement age.
"In 2004-05, 1,200 physicians retired or left practice or the state, and we produced 200," Richardson said, citing Oregon Employment Department statistics. "OED projects we will need 1,200 new physicians and 800 due to replacement between ’04 and ’14."
A recent study by the state indicates that 22 percent of Oregon doctors plan to retire in the next five years.
OHSU is taking several steps to address the looming shortage, Richardson said, including:
• Bumping the size of its entering class from 104 to 120, with plans to increase that number to 160 in the next five years if funding for additional classroom space can be found.
• Exploring fast-track premed programs at the state’s three major universities.
• Developing partnerships with hospitals outside the Portland metro area. Med students are already doing some clinical rotations at Sacred Heart Medical Center in Eugene and St. Charles Medical Center in Bend, and OHSU hopes to expand the program to Medford and Corvallis.
OHSU’s outreach efforts suffered a setback in the last legislative session, when funding for a "regional campus" plan was denied.
Under that proposal, OHSU would have sent groups of third- and fourth-year medical students to Oregon State and the University of Oregon for some of their classroom instruction while they got clinical training at Good Samaritan Regional Medical Center in Corvallis and Sacred Heart Medical Center in Eugene.
A dozen of those students were supposed to be headed to Corvallis next year, but for now the program is on hold.
"The money to do that was not allocated," Richardson said, calling it "a monkeywrench in our plans."
A new partnership
In the meantime, Samaritan’s new partnership with Western University of Health Sciences is moving ahead.
Western is home to the College of Osteopathic Medicine of the Pacific, where students learn osteopathic techniques in addition to the allopathic training offered at conventional medical schools. Osteopathic medicine takes a holistic approach to treatment that includes an emphasis on the musculoskeletal system.
COMP is the only osteopathic college on the West Coast, and the clinical rotations in Samaritan’s Albany, Lebanon and Corvallis hospitals are part of a recent effort by thc college to place more osteopaths in the Pacific Northwest.
"We have traditionally drawn students into our osteopathic medicine program from the Northwest states, and our Northwest track is sort of a formal construct of
that," said Dirk Foley, the college’s Portland-based regional director for educational development. Since 2003, Foley said, the college has admitted 30 students a year from six Northwest states into the program. The students must commit to do their third- and fourth-year clinical training in the region.
The students go through four- to six-week rotations in various medical specialties. Every 12 weeks they travel to Portland for a week of classroom work, presentations and exams.
After graduation, many Northwest track participants hope to do their medical residencies the region as well.
"A lot of them, because they’re self-selecting for this program, they want to stay in the Northwest," Foley said.
COMP is in discussions with Samaritan Health Services to establish a residency program here, which could further increase the chances that the students vvould ultimately return to the mid-valley to practice medicine.
"It’s really exciting, the partnership that’s going on with Samaritan," Foley said. "The future looks bright."
A choice to make
After examining her patient, Hansen discusses the case with his regular physician. Dr. Fred Weisensee. The two sit down in front of a computer screen to review the man’s medical history.
"OK, this is Gerald, a 54-year-old male," Hansen begins. "He has some diverticulosis. He’s due for a follow-up colonoscopy after five years. I looked at his labs — everything’s in normal limits."
Weisensee is Hansen’s preceptor for her internal medicine rotation, supervising her interactions with patients and imparting what he’s learned in years of professional experience.
He grills the 27-year-old student on her examination of Gerald: Did he mention any changes in his blood pressure? He’s been worried about that in the past. When do you think we should check his cholesterol again?
As a third-year med student, Hansen is limited in what she can do in treating patients, and any diagnosis she makes must be confirmed by a practicing physician. But after two years of classroom instruction in Pomona, she’s excited to be able to apply what she’s learned.
"Everything I’ve done up to now has been like playing house," she said. "This is the real thing."
And although she still has another year of school and at least three years of resir dency before she hangs out her physician’s shingle, Hansen’s starting to think about where she might like to practice.
The Idaho native has strong Northwest ties, and she’s enjoying her first visit to the mid-valley.
"I have to say I have felt very welcomed by the wholg community and Samaritan,” she said. "I really like the area."
But she knows she could make more money in a big city — a significant consideration for someone whi) could be carrying as much as $250,000 in debt coming out of college. And she also knows the demand for doctors has never been higher.
"Being a physician, I have the opportunity to practice anywhere I want to go," Hansen said. "I think there will be a job for me."
Bennett Hall can be reached at 758-9529 or; firstname.lastname@example.org.