Small Towns Wage Competition for the Hard-to-Find Country Doctor : Health care: Not enough physicians are willing to take on a rural practice. Medical recruiting is serious business for many small towns and clinics.

Every day, Leah Layne asks if there’s a doctor in the house.

The answer is nearly always the same for the health administrator who is trying to lure physicians to the Columbia Basin. She and many of her colleagues are finding it difficult to attract doctors to an area where salaries are low, equipment is older and the workload is often heavy.

In her search she has reached years into the future.

Layne has encouraged an Othello High School graduate to pursue an interest in medicine and, eventually, return to her hometown to practice. A medical student from Southern California has received a Washington state scholarship on condition that she practice in Othello.

Layne expects it will be nearly 11 years before the high school grad can become a physician and six years before the medical student can serve.

Two vacancies could not wait. Layne recently hired a San Bernardino, Calif., physician through a federal loan repayment program and is negotiating with a Midwestern doctor to fill the other position.

She persists, in the belief that any candidate is worth chasing.

“I’m ready to do anything,” said Layne, the Othello-based executive director of the Columbia Basin Health Assn. “I’ve been in this business 18 years, and I’ve never before felt my efforts have been so fruitless.”

In the state’s northeastern corner, a 20-bed hospital at Metaline Falls has been closed three years for lack of a doctor. Residents rely on a smaller clinic 10 miles away at Ione, where a physician’s assistant based at Colville fills in for half a day each week.

George Kubota, a Metaline Falls hardware store owner who heads the local hospital association, said recruiting has become very competitive among many rural communities.

“Everybody wants a doctor. That’s part of the problem,” he said.

A few communities are finding success through ambitious recruitment drives, but for most, finding a physician willing to move to a rural area has become an acute problem.

Two-thirds of the areas without enough physicians are rural, said Jeff Human of the federal Office of Rural Health Policy.

Doctors who do start up rural practices often leave after a few years because of heavy case loads, long hours and too little time off, Human said.

“There is a big problem with physician burnout in rural areas,” he said. “The nature of rural practice is you can’t get away from it. You go down the grocery aisle and run into many of your patients, Often, they’ll be telling you their symptoms in the checkout line.”

Steven Meltzer, the director of the Area Health Education Center’s Eastern Washington office in Spokane, attributed the shortage to the recent retirement of many family doctors who began rural practices in the 1950s.

The issue is critical for rural communities, where populations in recent decades have declined or remained static. Families with small children won’t move to a town that is a long drive from the nearest doctor, said Dr. Gordon McLean, administrator of Whitman Hospital and Medical Center at Colfax.

“Economic development depends on the existence of a health care system,” he said.

In recruiting, rural hospitals that emphasize family medicine find it impossible to match the financial power and prestige of large urban hospitals with the latest equipment. Money can be a big issue for a recent medical school graduate anxious to repay student loans.

“It’s an issue of the competitiveness of the market and being able to match salaries and benefits,” Meltzer said.

The rural lifestyle is another barrier. Many married doctors decide against rural practice because their spouses can’t accept the country lifestyle, McLean said.

Some point to a medical education system more tailored to a specialized, urban practice than to a general practice in a rural setting.

“I’m just not convinced we have prepared our doctors for rural practice,” Layne said. “They often don’t feel competent to practice in rural communities.”

Yet, for all the obstacles, some rural communities do manage to recruit and keep doctors.

In St. John (pop. 499), Dr. Hans Gahler retired in the mid-1980s after 29 years in practice. Jim Howell Sr., a farm implement dealer who helped to recruit Gahler back in the 1950s, was one of those who led the search for a replacement.

Howell found recruiting a doctor much more difficult in the 1980s than in the 1950s. Seven candidates who visited the town turned down offers to practice there.

“We had nearly given up,” Howell recalled. “We had tried for two years.”

Then Dr. Kim Mellor, a Spokane native recently out of medical school, dropped by one day in 1988. Within hours, as word of the unplanned visit spread through St. John, community leaders gathered enough people to pack the local gymnasium and staged an impromptu welcome luncheon for Mellor. Only those working in the fields did not attend.

After his visit, church leaders, the Chamber of Commerce and others wrote letters thanking Mellor for stopping by. The recruiters offered Mellor a special deal on a house and other incentives.

The salary guaranteed wasn’t much, but Mellor was suitably impressed.

“I feel like I could have carved a niche anywhere, but people in St. John really needed me and showed they needed me,” Mellor said.

Today, the 36-year-old physician and his partner, Dr. Richard Holmes, have a bustling practice that serves Endicott and Colfax as well as St. John. Their new clinic was completed a year ago, next door to the Colfax hospital.

And the hospital--which a few years ago was in danger of becoming a limited-care facility--is thriving. Voters have overwhelmingly approved bond issues to help the hospital get back on its feet financially. Obstetrics and other services have been expanded.

“St. John just set the standard for any community in need of a doctor,” McLean said.