Rural health

Dr. Kyle Terry sits with second-year students from Washington State University’s Elson S. Floyd College of Medicine, Alexandra Drury, at far left, and Taylar McGuire, at far right, in Dayton earlier this week. At center in the back is Terry’s nurse, Kathy Spencer.

Rural medical facilities such as those in Walla Walla and Columbia counties face a number of challenges, one of which is a critical shortage of doctors opting to practice in those settings.

That’s where a program connecting Columbia County Health System and Providence St. Mary Medical System with students at Washington State University’s Elson S. Floyd College of Medicine is aiming to help.

For the next few days, two students from the College of Medicine will be immersed in rural health care in Dayton. And in Walla Walla, two students are just wrapping up their week at Providence.

“We’re trying to pull graduates away from the I-5 corridor,” said Dr. Mathias Stroemel, a nephrologist — or kidney specialist — with Providence St. Mary who worked with the students in Walla Walla.

Research shows that students are more likely to go to work in communities where they attended school or where they’ve had clinical experience. That’s why these clinical contact weeks in rural communities are vital to the mission of the College of Medicine.

Doctors in training meet with various leaders on these health system campuses and receive experience in a range of departments from the emergency room to clinics.

“Our hope is that by investing time, these students will develop an appreciation for practicing in a more rural setting,” Stroemel said.

The story is the same in Dayton, where the need for primary care physicians is even greater.

“Recruiting providers to rural facilities is always a challenge, and we recognized early the opportunity to partner with the Elson S. Floyd College of Medicine as a way to show medical students some of the benefits of working in a rural environment,” said Columbia County Health System CEO Shane McGuire.

The hospital district that operates Dayton General Hospital as well as Booker Rest Home and two clinics — one in Dayton and one in Waitsburg — has worked with the medical school since 2015 as a host for students as part of their clinical training.  

Rural medicine can be challenging but rewarding. That’s the message leaders in Dayton and Walla Walla want these students to hear.

“Our providers work across multiple disciplines including emergency department, wound care, primary care, and hospital in-patient which is different from larger facilities where providers often work or specialize in one area,” McGuire said. “Rural can also afford a better work/life balance to providers as well as provide a practice structure for them to meaningfully engage the population to better affect healthcare quality and outcomes.”

The two students in Dayton who started on Tuesday are Alexandra Drury and McGuire’s own niece, Taylar McGuire.

She represents a perfect example of the type of student the WSU medical school was created to serve, according to Dr. Farion R. Williams, associate dean of clinical education with the Tri-Cities branch of the college.

“Three factors come into play as people are choosing where to practice medicine including where they are from, where they go to medical school and where they do their residency or specialized training,” he said.

Keeping doctors in the state after graduation is important to the College of Medicine, so students who are not already Washington residents must meet three out of four criteria to enroll in the program: they must have been born in the state, have spent their childhood in the state, have graduated from a Washington high school or have parents or guardians who currently live in the state.

“Part of our mission as a College of Medicine is to be a resource to the state of Washington and serve the people in both rural and underserved communities. This is critical to what we do,” Williams said.  

In the Walla Walla region, this has meant sending medical students for a clinic contact week to both Dayton and Walla Walla facilities. These students, will return to Columbia County Health System and the Providence St. Mary campus for a week about every 12 weeks to work with clinical community faculty in an immersive experience, Williams said.

“It gives the student the opportunity to practice basic doctoring skills they are learning in their Art and Practice of Medicine course,” he said. “It also gives them exposure to communities throughout the state of Washington.”

The challenges facing rural health care facilities are great – especially at critical access hospitals such as Dayton General, but Shane McGuire and others hope these types of programs will be key to addressing the physician shortages.

“There are misconceptions around wages being lower, that we are not busy, and that rural is not innovative,” Shane McGuire said.

As well, students feel a lot of pressure to specialize to become hospitalists, emergency doctors, orthopedic specialists, and so on, he said.

“It’s true that many rural facilities refer (patients) to specialists in larger, urban hospitals rather than directly employing them, but I would argue that rural does take care of an older, sicker population that can be very challenging,” he said.  

Health care workers in small communities need to be “multidisciplinary to work across multiple care areas, but unless one spends time working in a rural setting, they may not understand our needs.”

Students are more likely to practice in rural settings after completing their training if they have had opportunities to learn in them, according to Williams.

Dian Ver Valen can be reached at or 509-526-8320.

Dian is U-B news editor and editor of Lifestyles magazine. She has worked in local journalism since receiving her bachelor's in journalism from Western Washington University in 2003. She received her master's in communication and leadership from Gonzaga.

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