Small Town, Big Ideas
Reshaping Health Care in Rural Oregon
There was a time in the United States when most people lived outside cities. The alluvial banks of American river valleys must have seemed like Eden to the people who first settled there, but today only 20 percent of the U.S. population lives in rural areas; in these out-of-the-way places, people are more likely to be older, poorer and less educated than those in urban settings.
The disparities between urban and rural lives might best be observed in health care because a lack of adequate health care can have life-and-death consequences. Only 10 percent of doctors practice in rural communities, despite the fact that old age and poverty often mean greater health needs and, according to the National Rural Health Association, there is a greater likelihood of traumatic injury from accidents.
“It’s a social need we’ve been struggling with as a country. We have giant health care needs that are stretched across a very thin network of primary health care providers in rural areas,” says John Donovan ’88, vice president at Metropolitan Group, a Portland consulting firm.
Donovan has been consulting since January with Western University of Health Sciences, a non-profit, private graduate school for the health professions based in Pomona, Calif. WesternU, which is already home to the College of Osteopathic Medicine of the Pacific (COMP) in Pomona, has just completed a second school, COMP-NW in Lebanon, Ore., which welcomed its first class in a white coat ceremony on July 30, 2011.
At first glance, Lebanon is not the most likely place to find a medical school. It is a city of 16,000 with a median household income that is $9,000 below the state average. Homes in Lebanon are valued at more than $100,000 less than in the rest of Oregon. Unemployment earlier this year was more than 12 percent. Like a lot of towns in the western shadows of the Cascades, Lebanon’s economy used to rely heavily on forestry; in the ’80s and ’90s, when cheap imports from across the Pacific led to a drastic reduction in logging activity, towns like Lebanon were sent into sustained recession.
But this past July, Lebanon became a center for medical education and health care provision, in large part because of the creative energy of a close-knit group of people — many Willamette alumni — including Jeff Heatherington ’65 and Samaritan Health Services CEO Dr. Larry Mullins. Together they have all come up with an idea that has the potential to transform health care in Oregon and revitalize a struggling economy at the same time.
The Big Idea
Jeff Heatherington had five jobs in 12 years after graduating from Willamette, each one ending when a company went out of business. In his mid-thirties, he went to the doctor — an osteopathic physician who also directed the Osteopathic Physicians and Surgeons of Oregon (OPSO) — and after Heatherington mentioned his professional troubles, the doctor told him that he was leaving his post with OPSO and that Heatherington should apply. Heatherington was not a DO, but his father was, and he felt he knew the business and community well enough to promote the profession.
“If I hadn’t gotten sick I wouldn’t have had the interview, but 10 days later I had a new job,” Heatherington recalls.
Serendipity marks Heatherington’s meeting with Mullins as well. As the new executive director of OPSO, Heatherington was expected to recruit hospitals and clinics to host osteopathic medical students on their third- and fourth-year rotations. He had heard that Mullins was looking to attract doctors to his hospitals in Lincoln City, Corvallis, Albany, Newport and Lebanon, so the two men set up a meeting. As they talked their ideas got bigger, and soon they were having what Heatherington described as a “three-hour cup of coffee.” By the end they were discussing starting a residency program and building a medical school.
“One of the things you know if you talk to Larry Mullins is that he’s one of those people who never let their feet stay in one place,” Heatherington says. “He just took off.”
“It’s fair to say I have a real passion for COMP-NW,” Mullins says. “I knew how critical the need was to develop more physician resources in our state and I just felt that there was a real opportunity for primary care practitioners in rural areas.”
Mullins’ passion for building the residency and supporting COMPNW also comes from a desire to help rural communities in the Mid- Willamette Valley pull themselves out of tough economic times.
“This is something that is innovative and could provide some future vision for rural communities because it is not only going to be a clinical and educational driver, but it is proving to be an economic driver,” he says.
Heatherington praised Mullins’ ability to address a number of complex problems with an integrated solution. “He sees the whole community and this challenge it faces,” he says, “then uses that health system to address it.”
The vision to improve access to quality health care and revitalize rural economies in the Northwest is now taking shape as a 50-acre campus across the street from Samaritan Lebanon Community Hospital. Once completed it will be home not only to the COMP-NW campus, but also to a 100-room hotel and conference center, retail space for a bookstore, shops and restaurants, an office complex for health professionals and medical research firms, and a 150-bed Oregon veterans’ home.
“If we bring the best parts of different people and organizations together, we can achieve some pretty phenomenal outcomes,” Mullins says.
Oregon ranks 43rd in medical students per 1,000 people. According to Dr. Paula Crone, executive associate dean of COMP-NW, research and common sense show that most medical students end up practicing close to where they trained. “One of our missions is to train students who are from the Northwest for the Northwest. The students who choose to come here are selecting us for that future.”
COMP-NW has thus embraced Lebanon, and Lebanon seems glad WesternU chose it. COMP-NW even made t-shirts for Lebanon’s strawberry festival that said, “Lebanon’s Medical School.” Even before officially opening its new campus’ doors, COMP supported literacy programs and health education in the public schools; its leaders hope to find more ways to get students and faculty into the community.
Lebanon mayor Ken Toombs said the arrival of the new medical school was a “monumental event”
and a “tremendous step forward.” Rose King, owner of The King’s Coffeehouse, said that she has noticed greater optimism in town. She believes COMP-NW has given the community “a sense of hope.”
That vision to revitalize rural economies ... is now taking shape as a 50-acre campus.
What is a DO?
Lebanon has embraced the new medical school, but if anyone in town was wary, it might have been because osteopathic medicine is not well understood. Doctors of Osteopathy (DOs) believe in three main principles: 1) The body is an integrated unit of mind, body and spirit, 2) The body has an inherent capacity to defend, repair and remodel itself, 3) Structure and function are reciprocally interrelated.
In practice, these principles mean that DOs take a holistic approach to medicine and learn manipulative skills similar to those practiced by physical therapists or chiropractors in addition to traditional medical knowledge and techniques.
Heatherington describes osteopathic medicine this way: “If you don’t look at the structural part, then you’re treating the symptom, but not what’s causing it. Osteopathic medicine is more of a whole-systems approach rather than an episodic approach.”
According to the Osteopathic Medical Profession Report in 2010 there are more than 70,000 DOs in practice in the United States, but that number makes up only 7 percent of the total number of physicians.
Dirk Foley ’88, director of student affairs, enrollment and community outreach for WesternU, started working for the school in 2004. As the executive director of the Northwest Track program he developed third-and fourth-year rotations in hospitals and clinics throughout the region. It was Foley’s job to find both students and hospitals to join the program.
“I was the road warrior,” he says. “We did the circuit in Idaho, Washington, Oregon, a tour or two in Montana.”
In those early days he would give a presentation that opened with the slide, “What is a DO?” He expected members of the audience — mostly prospective medical students — to have a partial knowledge around which he could fill in missing information. However, he found that many knew little about osteopathic medicine.
“The first few times there were crickets when that slide went up,” Foley recalls with a laugh.
Yet, it didn’t take long before residents and hospitals were benefitting from the relationships Foley had fostered, and it was Foley’s work that laid the foundation for residencies at Samaritan and COMP-NW’s decision to locate in Oregon.
Recalling the early stages of the relationship that developed between WesternU and Samaritan, Mullins said that it was “an enlightening experience to learn more about osteopathic medicine and how it aligned with the same principles we had in community health.” He quickly learned that osteopathic and conventional medicines are not very different. “I think they’re getting closer and closer because of the desire for both educational experiences to connect the physicians with their patients and to look at other factors that affect the health and well-being of a patient.”
Lebanon’s Medical School
The staff and faculty of WesternU have had to do their own share of learning about their new home in the Mid-Willamette Valley. Heatherington said that in his early conversations with WesternU he had to work hard to convince people that the area was worth investing in. “They kept asking me, ‘Where’s Lebanon? We looked at Corvallis and there’s nothing up here.’ I’d say, ‘Samaritan has five hospitals. It’s the third largest hospital system in the state. You need to come up and talk to these people.’”
Mullins recalls seeing that initial reluctance on the part of some WesternU team members. “I was watching their eyes get wider and wider. They’re from a pretty metropolitan area in Southern California and this was the wide-open territory of Oregon.” However, their skepticism did not last long. According to Mullins, Western University’s president, Dr. Philip Pumerantz, and provost and COO, Dr. Benjamin Cohen, were convinced on their first tour that Samaritan’s philosophy of care and medical education was compatible with their own. Dr. Cohen said to Mullins after that visit, “This is the kind of environment I want our students exposed to.”
Since 2004, COMP’s Northwest Track students (who spent some time over the last several years in the Northwest even though the COMPNW facility wasn’t constructed) have been exposed to all of the rewards and challenges of providing care in the Mid-Willamette Valley. Two of them — Ben Hudson ’01 and his wife, Mandi (Gordon) Hudson ’00 — are Willamette alumni and among the first students to enroll in COMP’s Northwest Track. Today they are residents at the Good Samaritan Regional Medical Center and will soon be practicing medicine in the region.
The couple knew as biology majors at Willamette that they wanted to go to medical school, but they had a hard time finding the right program at first, especially because they were seeking one in which they both could enroll. After a couple of years of searching, they discovered COMP and its growing presence in the Northwest.
“COMP was a chance to come back to Oregon, practice in Oregon, and get some ties back here. Ultimately, this was where I wanted to work,” Ben says.
But more than that, they found that COMP would teach them how to be the kinds of doctors they admired.
“Joining COMP was like joining a family,” Mandi says. “There is so much enthusiasm for educating the next generation of physicians. These doctors look at patients as whole people, not just as organ systems or disease states.”
The Hudsons say that their work with doctors, patients and community members allows them to put Willamette’s motto into practice. In the next two years, as they finish their residencies, they plan on working with COMP-NW students by giving lectures and helping them form clubs. They also want to work with high school students, running programs that will encourage young people to go into health professions. Once they finish their education they plan to stay in the Mid-Valley and possibly teach at COMP-NW in addition to practicing as physicians.
“We would love the opportunity to stay here and carry on the legacy,” Mandi says.
COMP-NW is building this legacy on what its members would liken to a foundation of service. Heatherington has served as a mentor to Foley, who translated his international studies major into careers in both the private and non-profit sectors. Foley’s work with WesternU now allows him to mentor future health professionals like the Hudsons, who are already “paying forward” the opportunities given to them. In each case a liberal arts education and a commitment to helping others have allowed them to pursue new ideas and to make those ideas succeed.
Among the 100 students who will be part of COMP-NW’s inaugural class is another Willamette graduate, Meghan (McNeil) Aabo ’03. Aabo grew up in Beaverton, Ore., and after Willamette spent three years in Peru as a Peace Corps volunteer. There she was an interpreter at a clinic that saw as many as 1500 patients a day.
“It was amazing to see to see these doctors apply themselves outside their normal day-to-day work. They made such a profound difference in people’s lives,” Aabo says.
After she returned to the United States, she moved to New York and worked in a Manhattan doctor’s office, where she saw extreme wealth that contrasted starkly with the poverty she witnessed in Peru. That experience only further solidified what she already believed: Her calling was to work with underserved populations. When she heard about COMP opening a campus in Oregon, she was excited by the possibilities. “It seemed like the stars were lined up for me. It’s a really good opportunity to reconnect with this area.”
According to Heatherington, candidates like Meghan Aabo, or Ben and Mandi Hudson — future doctors who have life experience and have demonstrated an ability to care for others — are the future workforce COMP-NW is trying to build. And the fact that they are Oregonians who might not have otherwise had the opportunity to return home means that the program is already proving itself successful.
“It takes the entire spectrum of medical education to train successful doctors. That’s the strength of what we have here and what we are building,” says Dr. John Pham, assistant professor in the Department of Family Medicine. “We’re building something bigger.”
To build that bigger something it has taken a small city, a community hospital, a growing field of medicine, and a few committed people from a local liberal arts university that fosters big ideas.
Dan Rivas graduated from Willamette in 2002 with a major in anthropology. A former college writing instructor, he is currently a freelance writer based in Portland.
Lebanon was named by Jeremiah Ralston after his hometown of Lebanon, Tenn., although some early residents preferred “Pinhook.” When Ralston arrived in 1847 he opened the first store and over the next 40 years plotted, block by block, the boundaries of the city. Located at the mouth of the Santiam Highway, Lebanon’s economy has relied on the timber industry. Today, in addition to the health services and education partnership between Samaritan and WesternU, Entek’s plastics manufacturing plant, and a Lowe’s Distribution Center are the largest employers in Lebanon.
Distances to Nearby Cities:
- Corvallis - 19 miles
- Eugene - 46 miles
- Salem - 28 miles
- Portland - 81 miles
“We have giant health care needs that are stretched across a very thin network...”
— John Donovan ’88
Jeff Heatherington ’65
“They kept asking me, ‘Where’s Lebanon? We looked at Corvallis and there’s nothing up here.’”
—Jeff Heatherington ’65
“I knew how critical the need was to develop more physician resources in our state ...”
— Larry Mullins
Dirk Foley ’88
Ben ’01 and Mandi (Gordon) Hudson ’00
“We would love the opportunity to stay here and carry on the legacy,”
— Mandi Hudson