A national shortage of health care providers is creating a crisis as the demand for medical services from an aging population outstrips supply.

Oregon Health & Science University President Dr. Joseph Robertson, who addressed a crowd of about 40 people at the Columbia Forum Tuesday night, said rural communities across the state are struggling to find doctors and nurses to meet their needs.

As resources get stretched thin, Robertson said retirees will increasingly be seeking communities with the health care services they need.

For a rural Oregon county, Clatsop County is doing a pretty good job providing a broad range of medical services that are reasonably accessible to local residents, Robertson said.

But the county has "a thin margin of error" because local doctors are getting older.

"You're perilously close to the edge," he said. "You could quickly find yourself in the situation of other communities."

Robertson assured the crowd his university is committed to creating a healthier Oregon by training more doctors and nurses and forming partnerships with rural communities across the state.

But the global economic meltdown will make for a tough year ahead for OHSU, Oregon's only academic health center.

Economic crisis takes a tollWith its investment income plummeting, OHSU has been forced to cut between 500 and 1,000 staff positions this year.

Instead of generating $19 million of income, Robertson said, the university's investments have taken a $26 million loss.

"That's a $45 million hit," he said. "OHSU will maintain its excellence. We'll have the same number of missions, but the scope and scale in some instances will not be as broad."

Robertson was originally scheduled to speak at the Oct. 7 Columbia Forum about improving health care across Oregon through partnerships between OHSU and rural communities but had to cancel and reschedule. He said the world financial meltdown has changed the text of his speech.

"The world has changed so much between Oct. 7 and today," he said. "The change in financial climate underscores the importance of partnerships, which increase our ability to maximize our resources and to tackle the health care crisis."

Robertson has been president of OHSU since 2006 and served for several years as dean of OHSU's School of Medicine and vice president for Medical Affairs. He grew up in a town of 1,800 people in rural southern Indiana.

His community expected him to go to medical school and come back home to work as a family physician. But he took a different path.

"I am a great failure in my home town," he joked.

Robertson earned his bachelor's degree in neuroscience at Yale University in 1974 and earned his medical degree in 1978 from Indiana University. He came to OHSU in 1979 as an ophthalmology resident and has worked at the university ever since.

Supporting rural communitiesLeading OHSU toward improving health care for Oregon's rural communities is a way Robertson said he stays connected to his roots.

Clatsop County is doing a good job of providing health care services compared with the rest of the state, he said.

"Relatively speaking, you're pretty well off," he said. "I would be really proud of what you've assembled here and what you've created."

But the nation as a whole is experiencing "a woeful shortage of providers in all areas," he said.

OHSU's answer to the growing crisis is to train more people and increase the size of its schools and the number of its students in medicine, nursing and dentistry.

The university is making an effort to extend its resources to rural communities throughout the state through student training programs and the Oregon Rural Practice Research Network, a group of medical professionals created specifically to study ways to practice and improve health care in rural areas.

"It links people together," said Robertson. "It creates vital data that otherwise would not be assembled."

Doctors practicing in rural areas may have family and friends in the community and a beautiful environment surrounding them, he said, but they are professionally isolated. OHSU can offer research opportunities and professional alliances to keep rural doctors connected with their peers and advancements in their fields of expertise.

OHSU considers rural heritage as a factor in the diversity of its student body, Robertson said, because students from rural areas are much more likely to practice medicine in rural areas.

During the talk Tuesday, Astoria City Councilor Arline LaMear told Robertson one major problem in Clatsop County is finding doctors who will treat Medicare patients.

"This is becoming a real problem," Robertson said. "In five or 10 years, when people decide where they want to retire, the No. 1 factor will be the availability of health care to them in that spot."

University research is already showing that some people who have lived in the place of their dreams for awhile are leaving rural Oregon counties to find better health care, he said.

Health care talk is 'long overdue'Terry Finklein, chief executive officer of Columbia Memorial Hospital, asked Robertson if he would discuss the trend of doctors moving from private practice models, where a doctor runs an office alone, to employed models, where physicians work as salaried employees of a hospital.

Robertson said the trend is "sweeping the state and the country" as doctors move away from the headaches of handling administrative issues, such as collecting reimbursement from insurance companies for each patient.

Medical students take on tremendous debt to complete their schooling, Robertson said. At OHSU, the average is $135,000. The need to repay debt nudges graduates of OHSU toward urban settings and higher-income careers.

Ed Nelson,a retired U.S. Coast Guard admiral and a member of the Columbia Memorial Hospital Board of Trustees, asked Robertson whether OHSU was planning to expand its student training programs in rural areas.

OHSU sends students to communities around the state to gain medical experience. Students who have good experiences in rural communities are more likely to practice in rural areas, Robertson said. But with an unstable financial road ahead, the university isn't making plans to expand its programs until the economy turns around.

Finklein said many third-year OHSU medical students come through Columbia Memorial Hospital to work with Dr. Katherine Merrill's family practice.

After the forum, Finklein said economic turmoil has hit his hospital, as well, and he's hoping to partner with OHSU for hospital staff mentorship and recruitment, patient referrals and access to new technology.

"The need for collaboration is critical," Finklein said. "It's becoming more difficult to recruit for a variety of reasons. Having a relationship with OHSU brings credibility to our medical delivery system locally. ... This discussion is long overdue."


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