state average is 17 per 10,000 patients.) This is partially because the population of Wallowa County is so low, to be sure. Curious to see what Wallowa County was doing right, I asked Deuhmig at OHSU why he thought there were more PCPs here than in other counties relative to its population. He called out one Federally Qualified Health Center that’s done an impressive job of offering primary care residencies and retaining these residents: Winding Waters. Nic Powers, chief executive officer at Winding Waters, credits collaborations the clinic has with other institutions like OHSU, which sends all 12 of its primary care residents to do a rotation at Winding Waters. That rotation is part of the Cascades East Family Medicine Residency Program, which is a partnership between OHSU and Sky Lakes Medical Center in Klamath Falls. (The clinic also has a relationship with Full Circle Health in Boise, Idaho.) Some of the residents fall in love with the beauty of the region but also with the broad scope of being a PCP in a rural area, where your job can include delivering babies, caring for someone in the ER and doing house calls — all in one week. Being an FQHC comes with enhanced funding—both in terms of reimbursements but also grants. And because Winding Waters is in a rural area, it can also offer loan repayments to those residents who want to stick on as physicians after their residencies end. In fact, Powers’ wife, Elizabeth, was a former OHSU resident 20 years ago, and she’s still a family physician at the clinic today. The couple, both of whom had grown up in rural areas — Nic in the backwoods of New Hampshire, Liz in Michigan’s Upper Peninsula — were drawn to the rugged beauty of Eastern Oregon. “It’s a three-legged stool,” says Powers about the clinic’s ability to seduce and retain top-notch talent. “We can do competitive wages and benefits, we have team-based care, and we’ve got loan repayment opportunity.” He also thinks that people’s stereotypes of rural America go out the window when they move to Wallowa County and see how artsy and interesting the region is—and also how welcoming the residents are. “If you live here, you’re either family, friends or neighbors,” Powers says. “We don’t agree about everything, but we are going to see each other at the grocery store or at the DMV or at the kids’ ballgames, and it’s really important that we take care of each other.” There are also some state legislative wins that should help alleviate the primary care doctor shortage in the state. One was Senate Bill 934, passed back in 2017—which required every insurance company and Coordinated Care Organization in the state to allocate at least 12% of their total health care expenditures for primary care by 2023. The 2022 report shows that 12 are already achieving that goal: PacificSource CCO in Marion/Polk County (26.3%), Trillium Community Health Plan (24.2%) and PacificSource CCO Central Oregon (19.1%). More recently Oregon Senate Bill 476 passed in the latest session and was signed by Gov. Kotek in July. SB476, whose chief sponsor was Kayse Jama (D-East Portland, Boring and Damascus), allows internationally educated and trained physicians to get a provisional license in Oregon and, after four years of full-time practice, a full license to practice medicine here. “The program is a win-win for our state,” said Jama in a press release. “It helps solve workforce gaps here and allows Oregon immigrants to continue in their chosen profession.” Finally, the Health Care Provider Incentive Program (passed by legislation in 2017) provides both loan forgiveness and loan repayment to med school graduates who commit to serving in rural or underserved communities for a number of years. From 2018 until June 2024, this program has already provided loan forgiveness to 72 primary care doctors who have served in rural parts of the state. The program has recruited an additional 335 25
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