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The Spokesman-Review Newspaper
Spokane, Washington  Est. May 19, 1883

Funding helps health workers serve rural areas

K.C. Mehaffey Wenatchee World

CHELAN, Wash. – Dr. Heather Diaz says she probably never would have come to Chelan, or taken a job at the Columbia Valley Community Health clinic, if she hadn’t won a scholarship in medical school.

In her second year at Oregon Health and Sciences University in Portland, Diaz was selected for a National Health Service Corps scholarship, which paid for her last three years in medical school. In exchange, she agreed to a three-year commitment to work in an area with a shortage of doctors.

“I knew I was going to have to go to a small town somewhere. At the time, I was single and carefree,” she said. “I knew I wanted to give back.”

By the time she finished medical school and completed her residency, she was married and had two children. It would have been easier, she said, to find a job in a major medical center. Being the only doctor at a migrant health clinic, always on call and always under the watchful eye of a small town, suddenly seemed “scary and daunting” when she accepted the job in Chelan in August 2003, she said.

“All of my OB colleagues stayed in the city,” she said. “Even though we were trained to go to rural areas, no one did.”

But for Diaz, 34, there was that little matter of the scholarship. If she didn’t uphold her commitment, she would owe the program more than three times what it paid for her to finish school.

“It forces you to take that leap,” she said.

Diaz is one of 77 health-care professionals in north-central Washington now in a state or federal program that recruits doctors, nurses, physician’s assistants, midwives, pharmacists, dentists and other practitioners to underserved and rural areas.

Many have stayed in Chelan, Douglas, Okanogan or Grant counties after finishing their obligations, state officials say.

Diana Ehri, provider assistance manager for the state Department of Health’s Office of Community and Rural Health, said rural recruitment started through the National Health Service Corps formed in 1972.

Several other programs were added in the 1990s, including visa waivers and the state’s loan repayment program.

Some of the programs require a three- to five-year commitment in a “health professions shortage area,” which generally are rural areas that serve a higher percentage of Medicaid patients and have trouble recruiting health-care professionals.

Some programs pay back loans, others pay directly for college costs and one lets foreign medical students extend their visas by serving in a needy area after finishing their studies here. Four NCW doctors are also getting their malpractice insurance paid by the state so they can volunteer in their local communities.

Ehri said the state last year spent $2.4 million to help pay off college loans in exchange for commitments and $300,000 to pay malpractice insurance for volunteer health-care workers.

With all the programs combined, nearly half, or 35, of the current recruits in north-central Washington are doctors, plus four retired doctors who volunteer.

Ehri said some doctors fill out their commitment and move back to the city for a better-paying job. But more often, they decide to stay at the facility or at least in the community where they were sent. Some also move to another area that’s in need of health-care workers.

“We have a pretty high retention rate,” Ehri said.

Her office’s Direct Recruitment program, which identifies community needs and matches providers, has a retention rate of more than 70 percent, she said. And more than 80 percent of the foreign doctors who studied here and joined the visa waiver program end up staying after their committed time period, she said.

Ehri said the state is compiling survey data to determine retention rates for scholarship and loan repayment programs.

Jean Haskell, administrator of Columbia Valley Community Health in Chelan, said she’s hoping all three of her current recruits will choose to stay after their time is up.

“They do seem to have the desire to work with an indigent population and make a difference,” Haskell said.

Haskell’s other recruits besides Diaz include Kelly Bainbridge, a physician’s assistant who came from the Seattle area in November 2003, and Dr. Cheri Dunham, a dentist who was working in Seattle and joined her clinic in May.

Dunham, 33, grew up outside the Tri-Cities area. She said moving to Eastern Washington was exactly what she wanted.

She didn’t want to start her own business, and she wasn’t enjoying working for another dentist in private practice in Seattle.

“The last job, I just felt like I wasn’t doing health care. I was generating income for the practitioner,” she said. “That’s another reason I was really drawn to community health – the need is so great. I don’t feel like I’m just putting crowns on or replacing silver fillings.”

She said it’s too early to know whether she’ll stay in Chelan after her three-year stint. “I like the mountains and the whole recreation thing,” she said. “But it’s been hard to convince my boyfriend to come live here.”

Diaz said she already knows she’d like to stay, but she’ll make that decision after her term is up. Even with the scholarship, she’s still paying off $100,000 in school loans. “Quite frankly, I could make more in the city,” she said. “If I could get that paid off, there wouldn’t be a reason to leave.”

Growing up in the San Francisco Bay area, Diaz is starting to see the benefits of small-town life. What was once “scary and daunting” is now homey and comfortable.

“Everything’s within walking distance,” she said. “And I know all my patients.”

It’s still tough being the only doctor at the clinic, she said, but she’s starting to give up some of her on-call duties to other physicians in the community and is looking forward to some of the pressure being lifted after the clinic hires another doctor in January.

“It just goes along with my vision of what kind of doctor I wanted to be. I knew I wanted to work with the underserved,” she said. She’s also working with Latinos, using her ability to speak Spanish, and delivering babies – all things she envisioned as a student.

“It’s great to feel needed,” she said.