Dr. Stuhlmiller: Legislators can alleviate rural doctor shortage

Everyday blessings of rural life are as obvious as the nighttime stars over Eastern Washington. Simple. Quiet. Easy traffic. The other day, two other vehicles shared my morning commute.

Health care out here can be a blessing, too – when you can get an appointment. I am one of four physicians in Tonasket, a town of around 1,000 people. Currently, the wait for a routine checkup is about three months.

Lack of easy access to medicine is something I’ve experienced most of my life: growing up on a farm near Edwall, about 45 minutes from Spokane, and for the past 18 months as a small-town doctor.

Out here, no one takes for granted that, if you wake up with a fever, you can see a physician that day. Specialty care, such as a colonoscopy, might have to wait six months unless you’re up for a long drive. People buy memberships with medical airlift services because insurance doesn’t cover expensive emergency flights to the city.

Some would say these are trade-offs for our choice of a rural life. Maybe, but that doesn’t mean we’re satisfied with the status quo – far from it. In fact, I try to show every medical student on a clinical rotation in Tonasket that rural medicine is a career option that they might find as gratifying as I do.

The students attend the University of Washington School of Medicine. (I did, too.) The school’s training takes them to community clinics in Washington, Wyoming, Alaska, Montana and Idaho (WWAMI). For more than two decades, U.S. News & World Report has called it America’s best rural-medicine education – maybe because it lets students see small-town doctoring up close, warts and all.

In Tonasket and other towns, we immerse UW students in experiences that stretch their skills and set their expectations.

They learn that rural family medicine means doing everything from prenatal care and delivering a patient’s baby to caring for grandpa at end of life. It means more actively treating patients for conditions like heart failure and diabetes, and routinely taking skin biopsies from ranchers, while their city-based peers might sooner refer those patients to specialists.

Rural family medicine can seem daunting: more on-call hours, pangs of isolation, patients seeking advice in the grocery line, more information to master. But some students and residents see those challenges as opportunities to grow. They gravitate to the tight-knit communities and other small-town blessings.

It’s worth mentioning that the UW School of Medicine’s rate of graduating doctors who choose to practice in rural areas is higher than the national norm.

And because I live and work out here, that fact is important to me. Like hundreds of other mentors in the WWAMI program, I want to be part of the UW’s effort to graduate more rural doctors.

The expansion of the WWAMI program in Spokane in 2014 has been a boon for college students who grow up out here and who might be more open to studying medicine with a top-flight education close to home.

UW’s School of Medicine is asking the Legislature for funding to add 20 student seats at its new Eastern Washington base at Gonzaga University. While these extra seats won’t solve the shortage of rural doctors, they’d be an encouraging step. It will help maintain the great clinical training happening in Spokane, Tri-Cities, Yakima and across the Pacific Northwest.

I can say with confidence, as both a physician and a patient in rural Washington, that this investment will improve public health. It’s well worth legislators’ consideration.