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Fresh faces better medical care

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Fresh faces, better medical care

Hospital news | Sunday, August 10, 2014

H&N Staff Reporter

Dr. Glenn Gailis started working in Klamath Falls in 1975 and, after almost 40 years in the community, he's seen many changes.

One of those changes has been the lack of access to primary care physicians such as himself. Now, however, that has taken a positive turn, he said.

"We need more access to primary care physicians," Gailis said. "I think that's important for people. I see it improving."

Sky Lakes Medical Center will open two new primary care clinics near the hospital complex this fall, adding five physicians, along with other providers such as nurse practitioners and physicians assistants, to serve the community.

The opening of those new clinics comes on the heels of Gailis' retirement last week from the Klamath Medical Clinic, which joined Sky Lakes in December 2012.

The new clinics will shoulder the burden of newly added Medicaid enrollees through the Klamath County coordinated care organization, Cascade Health Alliance. As of Aug. 1, patient capacity at Cascade Health Alliance increased by 7,000 enrollees, jumping from about 12,000 enrollees to 19,000, covering the majority of Medicaid-eligible residents in the county.

Almond and Clover

The new clinics will open in buildings already owned by Sky Lakes, said hospital spokesman Tom Hottman. The official names for the clinics are the Sky Lakes Primary Care Clinic on Almond, located at 2617 Almond St., and the Sky Lakes Primary Care Clinic on Clover, located at 2600 Clover St.

The clinic on Almond will open at the end of this month, while the Clover clinic will open in mid- to late September, Hottman said.

For now, the clinics will be staffed with "locum tenens" physicians, or contracted traveling physicians, he said. Hospital staff is working to recruit full-time replacements for the temporary providers.

Dr. Grant Niskanen, the vice president of medical affairs and a hospitalist at Sky Lakes, is part of that recruitment effort.

The recruitment process can often take at least a year, Niskanen said. He has been conducting phone interviews almost daily with physician, nurse practitioner and physicians assistant candidates.

Because many of the candidates will be graduating from their residency programs in 2015, permanent replacements for the locums will probably not be in place until fall of next year. The locums, however, do have long-term contracts of three to five months, with the option to renew those contracts if desired, he said. "I think the locums are just a band-aid right now."

High demand

The relationship between doctor and patient is important and is difficult to develop with a temporary provider, Niskanen explained; locums are a quick, and expensive fix, he said.

It's been an ongoing struggle to recruit health care providers to the Klamath Basin, including in primary care.

Primary care physicians are in high demand all over the country, Niskanen said. There's a shortage of 16,000 doctors in rural areas alone. "It's a tremendous shortage nationwide," he said.

The issue, he said, is that just 2 percent of current medical students are interested in primary care, and only about half of those students actually pursue it. Even fewer are interested in moving to a rural community. Practicing as a specialist, or focusing on one area of the body, is more profitable, Niskanen said.

One of the challenges with recruiting health care providers to Klamath Falls, for example, is that it can be difficult for the candidate's spouses to find employment as well, he said.

The hospital is currently recruiting for family medicine, internal medicine, hospitalists, otolaryngology (ear, nose, and throat), dermatology, a pulmonologist/internist, urology, neurology, and nurse practitioners, Hottman said.

"Everybody who is involved in recruiting is working really hard," he said.

Knowing Klamath

The Cascades East Family Medicine Residency Program, through Oregon Health and Science University, has been a valuable resource, and Sky Lakes has been fortunate to recruit new physicians from there, Niskanen said. Five members of this year's class of residency graduates are taking positions at various clinics under the Sky Lakes, including three who will stay on at Cascades East, one who will help fill the gap left by Dr. Gailis at Klamath Medical Clinic, and one who will join the team of hospitalists, or the physicians who oversee patients admitted into the hospital, at Sky Lakes. Recent graduate Dr. Adria Honda now works at the Veterans Affairs clinic in town, Niskanen added.

That is the highest number of graduates from one class, more than 50 percent, to stay in the Basin, said Dr. Joyce Hollander-Rodriguez, who oversees the Cascades East program."That's exciting," she said.

That increase comes at a time when the community needs it the most, Hollander-Rodriguez said. State health rankings place Klamath County at the bottom of the list compared to other counties.

Cascades East graduates see and understand that need, and they've put down roots in the community, Hollander-Rodriguez said.

Niskanen is a 1996 Cascades East graduate himself, and returned to the community to work at Sky Lakes seven years ago after working in New Hampshire.

Those Cascades East residents not only understand what it is to work in a small community, but also already understand Klamath Falls itself, Hottman said. "They literally can hit the ground running," he said.

Patient influx

Much of the need for more primary care physicians can be linked to the implementation of the Affordable Care Act, which went into effect this January.

Cascade Health Alliance was unable to accommodate the influx of thousands more Medicaid patients because of the lack of capacity at existing clinics in the community.

Many of those people instead turned to the hospital emergency room to receive care, Hottman said.

With the ER the provider-of-choice for those Medicaid-eligible residents not assigned to a primary care doctor, Sky Lakes saw a record-breaking number of patients in the ER this summer. That's not the ideal way to receive care, Hottman said.

The ER is not set up to take primary care patients, Niskanen agreed, although the department is working to set up a "fast track" system for non-emergency patients, he said.

With the new clinics, patients will have better continuity of care, Hottman said. For one thing, doctors at the clinics will be less likely to need to leave a patient's side to take care of a trauma case, he explained.

ER relief

The new clinics will potentially off-load pressure from the ER staff as well, meaning that it can function more efficiently, he said. The record-breaking days, in which the ER saw up to 100 patients in one day, were not the main cause that lead to opening the new clinics, but it did offer an extra push, Hottman said.

The Medicaid expansion was the main driver behind the provider increase, but access to primary care had been an issue in the community even before then, Hottman said. "It's kind of a chicken and an egg," he said, explaining that it's hard to say which came first: the increased need for primary care access or the beginning of the Affordable Care Act. "It was part of the conversation."

Either way, the new clinics came together quickly, Hottman said. "This was a very short runway," he said of the new clinic plans, which took a lot of work by a lot of people.

Other clinics, including Klamath Medical Clinic and Cascades East, have added more providers as well, which will help take the pressure off, Hottman said.

New family nurse practitioners, or mid-level providers, at the Sky Lakes Family Medicine Clinic and the Sky Lakes Adult Medicine Clinic will also be able to see patients, which also helps ease the pressure for access to primary care, Niskanen said.

The mid-level providers will be able take care of a few thousand extra patients, but after that, both clinics will be full, Niskanen said.

That few thousand extra patients is not enough to cover the 7,000 patients newly enrolled in Cascades Health Alliance, which again points to the need for the new primary care clinics, he said.

Importance of primary care

Dr. Gailis, who is retiring from Klamath Medical Clinic, chose to practice primary care after a rotating internship in which he was able to experience multiple different specialties: he liked each of the different areas, he said, so he decided to do something where he could do a little bit of everything. "It's been very rewarding," he said.

Primary care, or family medicine, doctors should take the time to talk with their patients, offer them health education, visit schools, and more, Gailis said.

The focus of the health care industry needs to shift to focus on preventative care, rather than just treatment with prescription drugs or invasive surgeries, he said.

That shift can start with primary care; drug and alcohol abuse, obesity and lack of exercise all can lead to a variety of other health problems, which in turn leads to an increase in health care costs, he explained.

Gailis relayed a story of one patient who lost 100 pounds over two years, and, because of that, was able to get his cholesterol, heart problems and glucose intolerance under control, after a frank conversation with Gailis. It's a story that Gailis often tells other patients to inspire them to make healthier choices as well, and it highlights the importance of a close doctor and patient relationship, preventative care, and of health in general.

"That to me is sort of a bright light in the darkness," Gailis said.

He would love to see the county improve its standing in the community health rankings, he said. "We have to be a healthier community."

Care taking root

There is good evidence that the more people who have access to primary care improves the health of a community as a whole, Hollander-Rodriguez said.

Both Gailis and Hollander-Rodriguez said they are glad that the conversation about health has taken hold.

There are a large variety of people working to improve the way people in the community live and work, helping to make healthy options the easy options, and the investment and enthusiasm surrounding improving individual and collective health, Hollander-Rodriguez said.

"I'm excited that we're talking about it," she said.

With increased access to primary care, Gailis hopes things will get better over the next few years. In the meantime, he has this advice for new physicians in the community: "Listen to your patients, they'll tell you what's wrong if you listen long enough."

PHOTOS: (Top) Dr. Glen Gailis. (Bottom) Dr. Grant Niskanen