Struggling To Bring Health Care To Rural Washington

Community health centers have been busier than usual. They’re seeing more patients, many of them newly insured.

The centers, which provide care for mostly low income families, are meeting the demand by branching out to remote, underserved communities. But the challenge now is finding enough providers to staff these clinics.

Sea Mar Community Health Center’s clinic in Yelm has only been open since February. But the clinic sees more than 40 patients a day, and there’s no doctor yet on staff.

Jessica Greb is one of two nurse practitioners here. She’s been with Sea Mar for about a week. She says they’re seeing many patients who are getting medical attention for the first time in years. And they’re not necessarily easy patients.

“They have lots of different problems going that have not been addressed for a long time,” Greb says, “lots of medications that need to be addressed.”

One of those patients who has put off care is Johanna Brock, 59. She got health coverage earlier this year under the state’s Medicaid expansion. She received her first physical exam in three years here.

Brock says she had been reluctant to see a doctor unless it was really urgent because she couldn’t afford it. “You just live on that edge, and it’s a scary place to be,” she says.

Cradle To Grave Care

Before Sea Mar opened here, there was only one other clinic in Yelm. And it wasn’t taking new patients.

Yelm is rural, known for farms and forests. But today it’s a bedroom community for military personnel who work at Joint Base Lewis-McChord.

The clinic anticipates getting even busier later this year when it finishes renovations. It will have more exam rooms, a pharmacy and a behavioral health clinic.

It may have the space, but not enough providers. Sea Mar is looking for a doctor to complete its clinical staff. It hasn’t been easy, says credentialing specialist Rachel DeLauder.

“We’re looking for a family physician,” she says, “somebody who can cover the full scope, from cradle to grave.”

DeLauder is part of the team at Sea Mar that recruits for its medical staff. Besides Yelm, it’s expanding in Concrete, in Skagit County, and Vancouver, in Southwest Washington.

DeLauder says for the Yelm clinic, Sea Mar is looking for someone who’s either starting out in their career, or someone close to retirement who wants to work a few more years.

She says it might take time to find the right person to work in such a remote area.

“We’d much rather wait and find that ideal candidate who’s going to be satisfied and stay long term and not just have a churning effect with a lot of turnovers,” she says. “It’s not good for our patients.”

“We’re trying to build the clinic where those family members keep coming back and that doctor gets their Christmas card every year because he or she is part of the family.”

Meantime, Sea Mar has teamed up with hospitals in the Puget Sound area. The program allows medical students to do part of their residency at Sea Mar, exposing them to what practice is like in community health centers. But that can’t fill all the demand.

The Med Student Gap

There’s a shortage of doctors nationwide. Many are about to retire, just as baby boomers are aging and needing more care.

The issue came to the forefront here recently when Washington State University announced plans to open its own medical school by 2017, with a goal of supplying doctors to rural areas. It’s a controversial move, as it involves splitting up with the University of Washington, its partner in the region’s medical education program.

WSU President Elson Floyd says that the region needs another medical school to meet the growing needs.

“Right now there are only 120 Washington residents who are admitted in any freshman class at UW. There are some 350 qualified,” he says. “The delta between those admitted and those who are qualified – those students need a place to go, whether it’s out of state, of out of country in some instances.”

Floyd envisions a program that funnels medical residents directly to underserved communities like Yakima, Wenatchee and Vancouver. For now, both universities are making transition plans.

And both will be asking for state funding when the state legislature convenes in January.

Back at the Yelm clinic, Carmin Russell has brought in her 2-year-old daughter for immunizations. She says having a clinic closer to home has been good for the community. Before Sea Mar, she had to drive 40 minutes to Olympia for medical appointments.

“I have to load up the kids, and it turns into an all-day affair,” she says. “But now I’m right down the road, it’s more convenient, you’re respected and welcomed here completely.”

Russell grew up in Yelm and is raising her children here. She notes the community has changed in the last decade. There are more people living here. Some big box stores have opened in the area. And now, their option for health care has expanded, too.