Family Medicine Message Resonates With Rural Oregon During Student Bike Tour

Although the Oregon AFP has always stressed the importance of supporting and strengthening the state's rural primary care workforce, that message frequently has been lost in a state that is dominated by large urban areas, such as Portland, Salem, Eugene and Medford.

"Many people forget about the two-thirds of the geography that lies to the east of the Cascade mountain range," said Kim Montee, M.D., a family physician practicing in the small northeastern town of Union. "Most of Oregon is seen as that green, wet state off the I-5 corridor between Portland and Medford."

However, the Oregon AFP found a way to break through that mindset last summer by sponsoring and coordinating a five-week, rural bicycle tour that captivated the attention of the state's population while delivering an unmistakable message about the importance of building a strong primary care workforce in rural areas.

The bicycle project arose from a partnership between the Oregon AFP, the state Office of Rural Health, the Oregon Rural Health Association, and the Oregon Area Health Education Centers. By working together, the organizations were able to secure a one-year, $50,000 grant from the Northwest Health Foundation to engage the rural business community on the issue of rural workforce development.

"At the same time we got the grant, we found out about three medical students who were interested in spending their summer biking around Oregon," said Kerry Gonzales, executive director of the Oregon AFP. "They wanted to do something while they were out, not just (go on) a lark."

Those three medical students were Nathan Defrees, Weston Fuhrman and Matthew Sperry, who are students at Oregon Health and Science University in Portland. At the time of the trip, they were between their first and second years of medical school, and they all are planning to pursue family medicine careers.

Gonzales met with the three students and quickly decided to hire them for a project that would allow them to ride their bikes into small towns and conduct presentations on the issue of rural health care. The three medical students then added Daphne Johnson, a veterinary medicine student at Oregon State University in Corvallis, to the planned trek. Johnson took over the role of trip photographer.

The Oregon AFP took a direct role in managing the project, providing the students with media and speaking training as well as talking points for their presentations. "They did their talk in front of a Toastmaster's group early on, which was great because they got some really nice feedback so they could improve their presentation skills," said Gonzales.

The chapter also produced a seven-minute video that the students used to open their presentations. The video depicts the splendor of living and working in rural Oregon, using pictures and descriptions of rural life to provide a scenic backdrop for the presentations.

"The quality of life in Oregon's rural communities is unsurpassed," says the video. "Maintaining that quality depends on good services, like a reliable supply of primary care physicians. They come to rural Oregon for the same reason everyone does -- quality of life."

But, the video notes, that quality of life is threatened by the lack of primary care physicians in rural areas. The video covers the inherent challenges of recruiting and retaining primary care physicians in rural communities. It also describes the positive economic impact of physicians and family physicians on rural areas, noting, for example, that in 2008, "doctors living and working in our communities generated 242,000 jobs from lab technicians and nurses and others who work in their practices to the employees of the local businesses where they shop."

In addition to the video, the Oregon AFP broke down economic statistics on a county-by-county basis for the students, which allowed them to tailor their talks to individual communities and present data that resonated with local business leaders and representatives.

The Oregon AFP also worked with the students to map out the trip itself, often targeting rural parts of the state where key legislators live. This was important because one of the main goals of the trip was to rally support for state legislative bills that would create a loan repayment and a loan forgiveness program to increase the number of primary care physicians in rural parts of the state.

The bicyclists started in Portland on July 5 and biked west to the coast. They then rode a few hundred miles down the coast before turning east and biking across the width of state, finishing in Enterprise in the northeastern corner of the state on the Oregon/Idaho border on Aug. 6.

The students rode an average of 50 miles a day, sometimes biking as much as 80 miles or as little as 20 miles daily. Each of the students rode a touring bike and carried camping gear, dress clothes, computers, food and water in their bicycle bags.

Along the way, they visited eight small towns, made 16 presentations, answered questions and stressed the importance of a strong rural primary care and family physician workforce from both medical and economic perspectives. Their five-week trek through Oregon's heartland was covered extensively in state and local press outlets, generating ample publicity that reinforced the Oregon AFP's overall message about rural health care and family medicine.

"They got quite a bit of publicity out of the deal," said Montee of the four bicyclists. "At least here in Union, there were two separate stories -- one, they are coming and another one saying they came."

The students usually presented at community-sponsored events and meetings, speaking before local Chambers of Commerce, Lions Clubs, Rotary Clubs and economic forums. "We tacked onto other meetings that already existed," said Fuhrman. "That way it was less challenging to find time and get people together."

The Oregon AFP supplied the students with a list of family physicians in each town who acted as facilitators for that town's leg of the journey. They greeted the bicyclists when they rode into town and scheduled their presentations before the various groups. In addition, the family physician coordinators often provided food and lodging for the students.

"We always felt like royalty, we were treated so well by family physicians around the state," said Defrees.

The students rode through coastal areas, high desert plains and mountainous regions, getting a good feel and perspective for the state's diverse geographic regions and disparate cultures. They also were introduced to a number of divergent practice models.

"There is just a whole variety of ways that physicians, and especially family physicians, practice in these rural areas," said Defrees. "Some of them are still solo practitioners and some of them are in medical groups, working in integrated teams."

"We got to see the whole variety of practice models," he added.

Aside from generating support for primary care and family medicine in rural areas, the bicycle trip worked on other levels.

"From my point of view, one great thing the students accomplished is connecting family doctors in rural areas back to the Oregon Academy," said Gonzales. "This project renewed our ties with the doctors."

In addition, by stressing the importance of primary care in rural areas, the students got a lot of the communities they visited thinking about what they need to do to keep the family physicians they already have, according to Defrees. At the same time, the students were able to connect with several family physicians and to learn first-hand about the practice of family medicine in rural areas.

"These medical students were such great ambassadors," said Gonzales. "They were able to speak frankly and honestly about the challenges of picking a specialty that is relatively undercompensated and the challenges of working in a rural area. This is something they are dealing with and grappling with right now."

Sharon Vail, the executive director of the RimRock Health Alliance, a nonprofit organization in Prineville, Ore., that works to increase access and strengthen health resources for Crook County, facilitated meetings between the bicyclists and physicians when they stopped in her town in the middle part of the state. In an interview with AAFP News Now, Vail was quick to describe the legacy of the students, saying, "They helped in opening a dialogue in rural communities.

"They also helped rural communities feel like there are opportunities for them to find quality physicians to practice in their communities," Vail added. The very fact that the students biked across the state during their summer vacation demonstrates "their passion for rural medicine and their desire to be a part of rural communities."

In the meantime, Defrees, Gonzales and others are convinced that this project is replicable in other parts of the country. "If someone wanted to do this in Kansas or New York, they could do it there, as well," said Defrees. "It was a real meaningful trip for us as students."