The number of physicians per capita in Oregon and across the country increased substantially from 1991 to 2001, according to a report released by the United States General Accounting Office (GAO) Monday.

But local and state health officials say the numbers aren’t an accurate portrayal of the last few years in Oregon as fewer physicians have shown interest in coming to rural areas and some have left.

Nonmetropolitan areas in Oregon witnessed a 22 percent increase resulting in 156 physicians per 100,000 people, according to the GAO report. Nonmetropolitan areas include the entire state except for Portland, Salem, Eugene and Medford.

The metropolitan areas saw a 6 percent increase. There were significantly more physicians – 249 doctors per 100,000 people – in the cities than in the rural areas.

The GAO reported Monday that the number of physicians per 100,000 people in the whole country had increased by 26 percent from 1991 to 2001. By 2001, there was an average of 239 physicians for every 100,000 people in the United States.

Karen Whitaker, vice provost of the Office of Rural Health at Oregon Health and Science University, said the increased growth varied substantially in Oregon during the 1990s from the urban to rural parts of the state.

”We had real successes attracting physicians from metro areas into rural areas,” she said.

Multnomah County had a 14.5 percent increase in number of physicians, while Central and Eastern Oregon saw 51 and 24 percent increases respectively.

A rural health bill passed by the Legislature in 1989 that beefed up recruitment efforts and established a tax credit for rural doctors helped to spur the state’s recruitment efforts, she said.

But the trend has changed in the past few years and Whitaker said she’s not sure why.

According to the Office of Rural Health, from 1998 to 2002, the number of Oregon physicians in what are considered frontier counties, such as Crook, Baker and Grant, declined by about 1 percent. Baker, Grant, Harney and Malheur counties lost one to two physicians each, which in counties with as few as six doctors can be quite significant.

Crook County gained two doctors, bringing their 2002 total to 13.

Rural and mixed urban-rural counties, which includes Jefferson and Deschutes, saw small average increases in numbers of physicians, 2 percent and 7 percent, in the four years. Deschutes County did stand out, with a 29 percent increase during the same time period.

Meanwhile urban Multnomah County saw a 16 percent increase in the number of physicians.

Jim Kronenberg, associate executive director of the Oregon Medical Association, said he believes the level of physician growth now has dropped off – and may be stopping altogether.

A 2003 survey by the Oregon Medical Association of almost 5,000 physicians reported that 4 percent have closed, sold or plan to close their practices, with the numbers in eastern and southwestern Oregon much higher. The survey was mailed to 10,050 doctors with active licenses in this state.

Kronenberg credits high rates of medical malpractice insurance and low reimbursements for Medicare patients for creating an environment that physicians don’t want to work in.

”Anecdotally, no matter where you go in the state, particularly in rural areas, there’s continual reports of the difficulty of recruiting young physicians,” he said.

That’s the case in at least a few Eastern Oregon counties, according to their hospital administrators.

David Harman, administrator of Harney County District Hospital in Burns, said the GAO report of increased physicians numbers isn’t consistent with his experience. Burns has four family practice physicians.

”Recruiting is as difficult as it’s always been,” he said. ”We have the same amount of physicians now as we did (in 1991).”

In fact, the rural hospital has hired a full-time recruiter – something unprecedented for small hospitals, he said – to tackle the job.

It’s a tough one.

Bob Hauser, chief executive officer of Blue Mountain Hospital in John Day, said the hospital has been trying to recruit a general surgeon for a year and a half.

Susan McGough, administrator of Mountain View Hospital in Madras, said the hospital has needed a general surgeon and another family practice doctor for about the same time period.

”It’s still a challenge to find people interested in a rural setting,” McGough said.

The rural jobs often pay less than their urban counterparts. They can require physicians to do a wider range of work and rarely offer the doctors the luxury of a back-up help.

Sandra Assasnik, former recruitment services coordinator for the Office of Rural Health, said 32 sites around Oregon have state or federal health professional shortage designations, including places in Crook, Deschutes and Jefferson counties.

For example, Bend has many primary care physicians but a doctor and a nurse practitioner are the only primary care providers in La Pine. They serve an area that includes about 18,000 people.

The Office of Rural Health offers help to such places in recruiting and retaining health care professionals. Offering good compensation, continuing medical education and proper equipment are a few things rural communities can do to entice physicians and other health care professionals to come their towns and stay.

Other programs such as student loan repayment, tax credits and guaranteed income agreements, in which hospitals supplement the income of a physician if he or she doesn’t make a certain amount, also help, she said.

But the rural hospitals also need to find a good match.

”There are a lot of people who don’t want to practice in an urban area,” Assasnik said. ”You want someone who wants to practice in a rural area, instead of someone who is going take their loan repayment money and leave.”

Dr. Jim Ritzenthaler, medical director of the Bend Memorial Clinic (BMC), said the challenge in Bend isn’t attracting primary care physicians, but specialists. For example, he said the BMC has been trying to recruit an

endocrinologist, a doctor specializing in gland problems, and a gastroenterologist, a doctor who specializes in stomach and intestinal problems, for several years.

He said Bend seems to have enough primary care physicians to serve the population.

But what’s enough?

Whitaker, with the Office of Rural Health, said it’s hard to determine exactly how many physicians a community needs – and the number doesn’t necessarily determine whether everybody is getting served.

Her office estimated that it takes 2,500 people to support the practice of one primary care physician. Federal guidelines use the figure of one physician for every 3,000 as one factor in determining whether an area is medically underserved.

Other factors, in addition to the number of doctors, play an important role in whether a person has access to health care.

”Some people are not getting good access to health care regardless (of the physician supply),” she said.

The uninsured, poor, elderly, people on Medicaid and some minority populations may have problems finding providers even if there’s an adequate number in an area.

Kelly Kearsley can be reached at 541-383-0348 or at kkearsley@bendbulletin.com.