Residents in the Three Sisters Rural Track Program (RTP) arrived in Madras earlier this month and are immediately helping fill a need in the community by providing care for up to 900 patients a year in local primary care clinics and at St. Charles Madras. Drs. Ben Khalil and Callie Krewson are the first two residents to participate in the program, which is sponsored by Oregon Health & Science University and is the first graduate medical education program in Central Oregon.
“It’s thrilling to see these doctors caring for community members. We have been planning and eagerly awaiting this moment for many years and now it’s here,” said Dr. Jinnell Lewis, RTP director and St. Charles family doctor. “This program is helping us to develop and train providers who will specialize in rural family medicine and also helps us fill a shortage of primary care doctors in the region.”
Residents spend the first year of the program completing advanced training at OHSU before spending two years training and caring for patients in Jefferson County with a focus on rural family medicine. Khalil is caring for patients at Mosaic Community Health, while Krewson is caring for patients at St. Charles Family Clinic in Madras. Both doctors conduct rotations at the hospital and with area specialists where they train in family medicine, family birthing, emergency medicine, behavioral health and hospital medicine. They will also have learning opportunities at the Indian Health Services’ Warm Springs Health and Wellness Center.
"Drs. Krewson and Khalil have hit the ground running and are already enhancing the care of patients in our region,” said Dr. Katie Snyder, clinical medical director for Mosaic’s Madras Health Center and residency program teaching physician. “I look forward to continuing to partner with this critical program and train physicians locally to benefit our community for years to come."
Research has shown that about 55% of physicians stay within a 100-mile radius of their residency site. This means, within 10 years, Three Sisters RTP is estimated to produce more than 20 physicians who would reside in Central Oregon and provide care for 20,000 to 40,000 patients in the region.
About St. Charles Health System St. Charles Health System, Inc., headquartered in Bend, Ore., owns and operates St. Charles Bend, Madras, Prineville and Redmond. It also owns family care and specialty clinics in Bend, La Pine, Madras, Prineville, Redmond and Sisters. St. Charles is a private, nonprofit Oregon corporation and is the largest employer in Central Oregon with more than 5,000 caregivers. In addition, there are more than 400 active medical staff members and nearly 200 visiting medical staff members who partner with the health system to provide a wide range of care and service to our communities.
About Mosaic Community Health Mosaic Community Health is a nonprofit community health center that serves Central Oregonians from all walks of life. Through a network of more than a dozen clinics across the region, we offer integrated health services that address each patient’s medical, dental, behavioral health, nutrition and medication needs. Our care is never influenced by how much money our patients make, what language they speak or the status of their insurance coverage. Mosaic Community Health provides quality care for all. For more information, please visit MosaicCH.org.
Come join us for our Diabetes Education Group event at St. Charles Family Care Clinic - La Pine! Whether you're newly diagnosed or have been managing diabetes for years, this group is a great place to learn, share and connect with others facing similar challenges. Topics discussed will include:
Additional support to manager your blood sugar more effectively
Diabetic diet and behavior modification information
Strategies to increase motivations
Answers to questions related to your unique challenges
Come join us for our Diabetes Education Group event at St. Charles Family Care Clinic - La Pine! Whether you're newly diagnosed or have been managing diabetes for years, this group is a great place to learn, share and connect with others facing similar challenges. Topics discussed will include:
Additional support to manager your blood sugar more effectively
Diabetic diet and behavior modification information
Strategies to increase motivations
Answers to questions related to your unique challenges
Come join us for our Diabetes Education Group event at St. Charles Family Care Clinic - La Pine! Whether you're newly diagnosed or have been managing diabetes for years, this group is a great place to learn, share and connect with others facing similar challenges. Topics discussed will include:
Additional support to manager your blood sugar more effectively
Diabetic diet and behavior modification information
Strategies to increase motivations
Answers to questions related to your unique challenges
Physician Associate Mandi Bryson went into family care medicine because she wanted to help people. “I love building relationships with patients,” said Bryson, who works at St. Charles' Bend East Family Care Clinic.
But in recent years, Bryson found herself tied to her computer more and more, due to increasing documentation requirements, inbox messages and phone calls to return. “There was a mental burden of all the stuff that you have to do that’s not taking care of the patient in front of you,” said Bryson. She found herself leaving the clinic about 6 p.m. and then spending an additional hour or two at home every night completing required documentation on the computer.
Last spring, the stress became so overwhelming that Bryson considered leaving the profession all together.
“I was desperate. The demands were so heavy, I was looking for other jobs. I knew I couldn’t continue to do this to myself. What was a life-giving job had become too much. I thought, ‘Either I get something that helps me, or I have to leave this work that I love,’” she said.
Bryson got help with the burdens of technology from an unlikely source - new artificial intelligence software called DAX. Not only has this technology cut charting time significantly, but it has also allowed Bryson and other physicians to better connect with patients during exams. That’s because the technology completes the documentation, allowing providers to focus all their attention on their patients.
“This has been a game changer. I’ve stopped applying to different jobs,” said Bryson, who says she is now leaving work by 5:30 p.m. with notes done and an empty inbox. “I love my work. There are still challenging aspects, but documentation isn’t one of them. I can focus more on the parts that bring me joy.”
She is one of approximately 55 primary care providers at St. Charles now using DAX and there are plans to bring the service to other clinical areas.
“DAX allows providers to get to do what called them to medicine in the first place – caring for patients,” said Dr. Matt Clausen, ambulatory chief medical informatics officer, who led the effort to bring DAX to St. Charles.
DAX is more than a transcription service; it uses artificial intelligence to summarize and provide accurate notation within a patient’s electronic health record. Physicians using DAX first get permission from patients to use the service – then, they pull the app up on their phone as they walk into a patient’s room. The provider conducts the exam with the patient as usual – but there is no need to take notes or sit by a computer. Instead, the physician can focus entirely on the patient while DAX listens in the background and fills in the patient’s chart. Providers review the notes to ensure accuracy, but it significantly cuts down the time spent charting.
Clausen says burnout among physicians has increased in the past few years and he believes that is directly linked to the demands of documentation. This AI tool was brought in specifically to help with burnout and the results have been overwhelmingly positive.
Before using DAX, 47% of St. Charles primary care providers said they were “definitely burning out” and experienced more than one symptom of burnout. After implementing the DAX program, that dropped to just 7 percent of providers. Physicians using the technology also reported higher job satisfaction (88%), that they are more likely to continue practicing medicine (75%), that they have better documentation quality (88%) and better work-life balance (75%).
“We are early adopters for this technology and we are already seeing it help us with recruitment and retention,” said Clausen.
But perhaps the most significant aspect of this technology is its impact on patients. Eighty-nine percent of patients said that their provider was more focused during their visit when they used DAX and 100% said their provider spent less time on the computer.
Dr. Nathan Thompson, a family care physician in Redmond, says doctors have a choice: Do I chart in the room and look at my computer or do I give my attention to the patient and try to remember everything they are saying to document later? “It’s a horrible tension,” he said.
Now, with DAX, that tension is gone.
He said documentation used to take him up to 20 minutes per patient before DAX. Now it’s down to minutes of review. For Thompson that means he now has time to volunteer coaching soccer at a local high school and he is more able to be present mentally, physically and emotionally to his family.
Thompson worried that some of his patients might be skeptical of the technology. “I worried a lot of people would not go for it, but it’s been the complete opposite. I am very grateful to our community for accepting it. I want them to know this is only something we use to be more present as humans. It’s allowing us to be more human in the room.”
Bryson agrees that her patients have also been very supportive of the technology.
“I’m hearing from patients, ‘you were really listening; it felt like you weren’t rushed; I’ve never had an appointment like this.’ It’s so nice to not have a computer between me and them,” she said. “St. Charles really offered something that helped me where I needed it most. Day-in and day-out, this is making a difference and I am very grateful for that.”
Above, Dr. Katie Ruth looks over Lindsey Hutchinson of Klamath Falls during an office visit at the OHSU-Cascades East Family Medicine Center in Klamath Falls, 2019. Ruth performed her residency at Cascades East, a collaboration between OHSU and Sky Lakes Medical Center working to improve health access in rural Oregon. Credit: OHSU/Kristyna Wentz-Graff
Oregon Health & Science University is in the early stages of creating what is expected to be the first graduate medical education program primarily based in Central Oregon.
OHSU has received a $750,000 grant from the U.S. Department of Health and Human Services through the Health Resources & Service Administration’s Rural Residency Planning and Development Program. OHSU will use the grant to develop a new family medicine residency program in partnership with Bend-based St. Charles Health System.
“Establishing a family medicine residency program in Central Oregon can help address health care gaps that occur too often in rural areas,” said Joe Skariah, D.O., M.P.H., M.B.A., who directs OHSU’s family medicine residency program and is leading the new program’s creation. “Knowing physicians often choose to stay and practice in the communities where they complete their residencies, this new program could also attract more skilled and compassionate health care providers to Central Oregon.”
Residents are new physicians who have recently completed medical school and receive advanced training in a specific medical field. This program will focus on family medicine, primary care that specializes in caring for the entire family.
After receiving accreditation, the program could welcome its first residents as early as July 2024. The program’s first year, known as an internship, would be based out of OHSU’s Portland campus. The program’s subsequent years would primarily bring residents to St. Charles Madras. Many of the program’s details are still being decided, including the number of residents involved.
The program will build on OHSU’s long-established rural medical education program. Every OHSU medical student completes at least one month of training in a rural setting, including in the Central Oregon communities of Warm Springs, Madras, Redmond, Prineville and Sisters. During OHSU’s last academic year, 42 medical students had clinical rotations with Central Oregon physicians, many of whom are associated with St. Charles Health System. Portland-based OHSU residents have also had rotations in Bend and Warm Springs.
The new residency program is being organized through the OHSU School of Medicine’s Department of Family Medicine, which was recognized this year by U.S. News & World Report as the nation’s best family medicine program. OHSU is home to one of the oldest family medicine residency programs in the U.S., and the first family medicine residency program in Oregon.
“I am excited to grow our collaboration with OHSU and create an important avenue for medical education in Central Oregon,” said Robert Ross, M.D., director of provider academics research and clinical service at St. Charles Health System and a clinical associate professor of family medicine at OHSU.
At St. Charles Family Care, we are passionate about providing patients with comprehensive medical care close to home. By using our team-based care approach, we work to ensure you receive the treatment you need based on your unique health circumstances.
What to bring to your appointment:
An insurance card and photo ID
Consent for medical treatment of a minor (if not accompanied by a parent or guardian)
A list of current prescriptions and non-prescription medicines, vitamins and supplements
A list of questions you would like to discuss with your doctor
