The view from the (surgical) bay

New GME track in Coos Bay widens potential pipeline of rural general surgeons

July 18, 2014


The OHSU School of Medicine and Bay Area Hospital have teamed up to establish a new training rotation for surgeons. The six-month graduate medical education program gives two senior residents an opportunity to immerse themselves in the decidedly non-urban environment of Coos Bay, population 15,857, affording them exposure to a broad set of surgical cases, extended patient care continuity and the chance to develop leadership skills in the operating room.

Drs. Young and YangIsaac Young, M.D., who began his Coos Bay rotation July 1, quickly identified what makes Bay Area Hospital truly different than a training experience on OHSU’s Marquam Hill Campus – and it isn’t the facility itself. “The hospital is fairly large with modern medical resources including electronic records, interventional radiology and even robotic surgery,” he said.

“The rural aspect of the rotation has more to do with the community: a small coastal town where everyone seems to know everyone and you can hardly go to the grocery store without running into a patient.”

“The rural setting provides for unique professional and personal experiences,” said Estin Yang, M.D., Dr. Young’s colleague in the first Coos Bay cohort. “We work with an array of surgical pathologies, work in a hospital with fewer resources than the large university setting, and experience small-town life where you see your colleagues and patients around town." This small town fact of life spills into the professional environment, which Dr. Yang called “welcoming and familiar, and there is a strong trust relationship between patients and their providers.”

This is the second surgical training partnership between the Department of Surgery and a rural Oregon hospital. A similar rotation in Grants Pass has been popular for surgical residents and community physicians alike since it began in 2002 (see “Small town success story,” December 2012). “The best part about my rotation in Grants Pass, and what ultimately pulled me back to take a job in Grants Pass after residency, was the sense of community I felt in both the hospital and the town,” said Megan Frost, M.D., a 2013 OHSU residency graduate.

Workforce trends indicate a critical shortage of general surgeons in rural communities, which can typically support a few primary care providers and one or two general surgeons but not medical or surgical specialists.

While anecdotal evidence like Dr. Frost’s suggests a rural experience can aid recruitment efforts, Karen Deveney, M.D., professor of surgery, OHSU School of Medicine, and residency program director, knew that data were needed to build momentum for similar programs across Oregon and the country. In a paper published in JAMA Surgery in 2013, Dr. Deveney and colleagues demonstrated that residents who spent a year in Grants Pass were more likely to pursue general surgery practice in a similar setting than were those who did not have a rural experience, making the rural training track a potentially big win for rural communities.

“Not only does the Coos Bay surgery rotation allow our residents to develop a breadth of surgical and clinical skills that are unique to practicing in a small community, it allows them to experience what it’s really like to practice in a rural setting,” said Patrick Brunett, M.D., FACEP, associate dean for graduate medical education in the OHSU School of Medicine. “As our residents build relationships with providers and patients, more will be inclined to stay within smaller communities after their training, helping build the rural Oregon physician workforce.” 

And even for those physicians who don’t stay in the immediate vicinity to practice, the experience still has relevance in other settings. Dr. Yang has a keen interest in rural practice and health systems research, and said his rural experience will be useful as he pursues international work in developing regions. Immediately after residency, Dr. Young intends to fulfill a service obligation through the Indian Health Service, where the ability to diagnose and treat a wide range of surgical needs will be essential. 

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