Pediatricians hard to find near home

Appeal Tribune

When 11-month-old Ava Dahlberg was just one month old, she broke out in a rash that covered her entire back.

Her mother, Chelsea Dahlberg said the alarms in her mind went off and after a quick call to her pediatrician, she was in her car racing toward south Salem wondering what was happening.

The rash on Ava’s back turned out to be caused by heat and sweat, but for Chelsea, a first-time mother, it was a scary ordeal as she gathered up her child and drove more than 20 miles to see a doctor who specializes in treating children. The incident left her questioning why a city with a first-class hospital has so little specialty care for its youngest citizens. According to hospital records, there were 1,642 babies born at the hospital last year.

When the Silverton Pediatric Clinic on Oak Street shut its doors last year after only a year and a half in the community, the city was left without a single pediatrician practicing in town.

Silverton is home to many family practice physicians scattered around the community but none of the clinics or the hospital has a pediatrician on staff. The question on many parent’s minds is why.

The answers vary according to various people. Silverton Hospital Vice President and Chief Executive Officer Gary Pulsipher said it is partly due less demand for pediatricians and because of the rotational demands on doctors in small communities. He said in Salem, a pediatrician may be on call at the hospital once every 20 days compared to every other day at Silverton Hospital. Dr. Diana Linderoth said the answer had more to do with the family practice physicians in Silverton.

Linderoth worked for Silverton Pediatrics for less than a year before it shut its doors. She said she got into pediatrics in part because of her experiences as a young patient and her desire to help society’s youngest members. She now works at Woodburn Pediatrics in Woodburn.

While she recognizes the role of an all-encompassing family practice physician, she said for many families and children with special needs, a pediatrician is a wiser choice.

“I think a lot of people consider us both to be family care specialists in our field,â€? Linderoth said. “Family practice doctors are good at seeing all different age ranges of patients. They do really well with the straight-forward everyday patient of any kind. Their difficulty is trying to know so much about everything and knowing when they need a specialist’s help.â€?

She said a pediatrician is better suited to understanding the needs and care for an age range of kids whose bodies are constantly changing. She said different age ranges even with children can mean a variety of health care needs.

For Chelsea, Ava’s care also means an understanding of the way she has chosen to care for her daughter.

Ava was born at home by water birth with the assistance of a midwife. Chelsea said she prefers a natural approach to childcare, which she said more pediatricians understand. She said her search for a pediatrician came a week after Ava’s birth when the newborn needed to be given tests usually administered at birth.

“We looked around and found there was only one option at that time,� she said. “Even then they were planning to move to Salem. It was disappointing that that was all that there was.�

She said she wanted to find a doctor that supported long-term breast-feeding and delayed vaccinations, something she said most family practice physicians knew little about.

She said she became involved in an online support group that helped guide her to a pediatric physician in Salem.

Silverton resident Maria Wood also said she would prefer to find a pediatrician to help care for her son.

“You go to a pediatrician for the same reason you would go to a dentist,� Wood said. “They are more specialized and efficient.�

At Silverton Family Clinic next to the hospital, Dr. James Walker sees patients of every age. He said he disagrees with Wood’s and Dahlberg’s assertions that a family practice physician isn’t trained to handle children as well as a pediatrician. He said he attends several special training every year in various subjects, but said he focuses on what his patients needs are, whether its pediatric specific or not.

He added he does recognize the trend toward specialized care.

“More and more people are going to an internist for adult issues and an Ob-Gyn for women’s health, a pediatrician for babies,â€? he said. “That’s kind of inefficient according to the family medicine model where you can get 80 to 90 percent of your care from a family doctor.â€?

He said while each specialty plays a special role in overall patient care, for most routine medical exams and care a family physician works well.

“In a family practice residency, you get the wellness training for pediatrics and obtain a certain level of comfort caring for sick kids to the degree that they aren’t life threatening illnesses,â€? Walker said.

He said there isn’t any animosity between pediatricians and family practice physicians in Silverton. He said there just isn’t enough special cases that would require a family physician to send a patient for a pediatric consult. He also said routine well-child checks are a large part of a family practice doctor’s practice and not something they want to give up. He said he doesn’t believe the community is large enough to support a pediatric clinic.

“I think it would take an awful lot of growth to support a consultative practice,â€? he said. “In consultative terms, I don’t see it happening soon.â€? He said an ideal physician would be one with credentials in both internal medicine and pediatrics, although he said this is usually a rare find.

Silverton Pediatrics was owned and operated by the Yakima Valley Farm Worker’s Clinics, a group that works primarily in communities with “underservedâ€? residents before it closed in June 2006.

“We thought there was a demand for pediatricians,â€? said Yakima Valley spokesman Glenn Cassidy. “We found the people of Silverton were happy with family practice.â€? Linderoth said during her tenure at the clinic, she found family practice physicians didn’t embrace the group of four pediatricians, partly because she said they felt their own practices would lose patients. Cassidy said this issue came up in discussions about the clinic’s future.

“The physicians never felt very welcome by the family practice doctors in that community,â€? he said. He said Silverton hospital’s requirement that the pediatricians be on call every other day burdened the clinic doctors too much.

“We wanted it to work and expected it to work,� Cassidy said. “But there were too many demands for hospital care and office care.� He added he believes the community needs pediatricians who work directly for Silverton Hospital.

This is the same direction Pulsipher said the hospital is looking to move in 2007 after its recent loss of two staff pediatricians.

“We’re working to attract pediatricians to this community,â€? he said. “We just interviewed one candidate. She will finish her residency this spring and hopefully come to us by summer. We probably need at least two just to handle the call.â€? He said the hospital has looked for pediatricians after the previous two left for other clinics outside of the area. He admitted that being on call every other day has kept some from applying.

“We think that is part of the issue in our recruiting efforts,� Pulsipher said. “We think we can get at least two working here by the end of the year.�

He said while doctors may have less on-call time in larger cities, doctors who work in smaller communities also have the opportunity to develop their practices faster.

He added that the hospital has noted the trend toward specialized care instead of general practice and is also working to stay on top of Silverton’s population growth and what incoming residents want through the hospital system, including privately owned clinics. However, he noted it wasn’t a priority for the hospital until recently.

“From a business perspective, pursuing pediatrics wasn’t on the top of our agenda,â€? he said. “As far as what can make this hospital run better and be better.â€?

Pulsipher started at the hospital 6 months ago and said he immediately saw the need upon arrival.

“There was a need given the number of …babies we deliver at Silverton Hospital. Young families want to have a pediatrician available and we want to recruit that.�

He said he didn’t think there is enough of a market to maintain a privately owned pediatric clinic and said that may have affected Yakima Valley’s decision to close Silverton Pediatrics. However he also noted that the physicians at that clinic also never developed strong relationships with area doctors emphasizing their specialty care.

Cassidy said he thinks the hospital’s approach in hiring its own pediatricians is probably the wisest at this point and added he hopes area clinics will consider bringing pediatricians into their practices.

Until options open in Silverton, Chelsea said she will continue to take Ava to Salem for her routine medical care. She said she hopes Silverton will eventually have not only a pediatrician but one that understands and embraces a variety of parenting choices.

“Nobody cares more about their child than their parents,� she said. “A pediatrician understands that.�
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