The Country Clinic sits near Highway 20 south of Winthrop. Photo by Sheela McLean

Country Docs
Healthcare in the Methow
by Dr. Hugh Straley

The Methow Valley is home to the only two independent primary care practices remaining in Okanogan County: The Methow Valley Family Practice in Twisp led by Dr. Joe Jensen and the Country Clinic in Winthrop led by Dr. Ann Diamond.

Formerly the Twisp Medical Center, Dr. Joe Jensen’s Methow Valley Family Practice is the oldest established medical practice in the Methow Valley. Photo by Sheela McLean

Dr. Jensen’s practice is the oldest in the valley. Jensen, with 42 years of practice experience, came to Twisp in 1992 when he bought the Twisp Medical Center from Dr. Bill Henry, then the only doctor in the Methow. After almost twenty one years and many remodels, Dr. Jensen now has ten staff to run the Clinic that has seen more than 10,000 patients. When asked what he enjoys most about his practice Jensen said, “It’s the variety that we see. We get to see and help with all kinds of injuries and diseases among all kinds of people. I also love living in this place.”

Such independent practices present challenges as well according to Dr. Diamond, the family physician who runs the Country Clinic.

Medicare is a very important part of the Country Clinic’s business, making up over 50% of the visits, Dr. Diamond said. In 2010 Medicare stopped payment to physicians for many months as Congress was debating payment reform. “We were able to meet most of our expenses but I did not take home much income in 2010,” Dr. Diamond related. Fortunately, payment for Medicare services has resumed.

The administrative hassle of billing more than 161 different health plans adds costs and inefficiencies. In order to meet their expenses, independent primary care providers spend a lot of time pleading with health plan providers to pay in full for their billed services. As a service to the community the Clinic provides a free clinic for children on Fridays. “We are meeting our expenses, but just barely,” says Diamond.

Dr. Ann Diamond heads up the Country Clinic in Winthrop. Despite the challenges she says the practice is very satisfying. Photo by Sheela McLean

Like most rural practices, the Country Clinic has a limited ability to recruit new personnel. Many independent practices are closing because they cannot easily find medical professionals to relieve existing staff or to take over a practice for a retiring physician. The Country Clinic has been fortunate in attracting highly qualified practitioners who want to live in the region and practice in this rural setting, Dr. Diamond says. But recruitment is becoming more difficult since fewer doctors and nurses want to practice in small towns.

Current medical graduates have a lot of debt after graduation, well over $100,000 according to most studies, and rural medicine pays less than what can be made in the city. These facts prevent most physicians from practicing primary care in a rural setting.

Despite these problems the practice is still very satisfying for Dr. Diamond. “People should understand that we could work anywhere but all of us choose to live here because we love the practice, the life and the community.” Her patients are also her friends and neighbors. “In this place I know I can do a lot for them and get great results,“ Diamond said.

Reflecting on the practice Dr. Diamond said, “We provide an amazing level of care and we know every one of our patients well.”

A unique part of her practice is what she calls, “The Methow Bubble.” This is the population of active seniors, people over 65 or 70 who ski, run, bike, hike or walk frequently. “I see seniors who ski several hours a day and are extremely active in all parts of their life. I don’t need to spend time talking about the importance of exercise with them,” said Diamond.

While sports injuries are a significant part of the practice, chronic diseases also play a big part in the day to day practice. She says, “We see our share of diabetes, heart disease and arthritis like other family practices.”

The clinics and their patients are dependent on a variety of other health care services offered in the Valley. One of the most important is Aero Methow, which provides urgent care and transport for sick and injured people.

Cindy Button, Aero-Methow’s Executive Director, said that last year they made over 600 calls and transported more than 400 people to hospitals. Aero Methow paramedics and EMTs also provide many services in the home from first response medical assessment to adjustment of medications to administration of IVs for dehydration. These urgent medical services keep many people out of Emergency Rooms and hospitals. “We really are an urgent care center on wheels,” says Button. Aero Methow is in a constant state of readiness. “If you call we will be there,” says Button.

Cindy Button is Executive Director of Aero-Methow, an important component of health care in the Methow Valley. Photo by Solveig Torvik

The Lookout Coalition is another Methow Valley service working closely with the medical practices. This newly-formed volunteer group of doctors, nurses and social workers coordinates home services for people with chronic health conditions and end-of-life problems. “We are all volunteers making house calls. We don’t charge for our services,” said Dr. Raleigh Bowden, one of the founders of the Coalition.

“These services make our job in the Clinic much easier and support the quality of care that can be delivered to all of our patients,” said Dr. Diamond.

What does the future hold for these health care services in the Methow Valley?

“Aero Methow has deep roots in this community and as long as the community continues to support us we will stay in business,” indicated Director Button.

“As long as the need is there and we have the volunteers, we will provide these services, “ says Lookout Coalition’s Dr. Bowden

“The Country Clinic is here to stay,” says Dr. Diamond. “We are not going away. We will change and grow with the times.”

Dr. Diamond has always known she wanted to live in a rural area. Born and raised in Berkley, California by two professors she learned to love the outdoors, exploring and camping all over the Sierras. She studied geology at Harvard and, after graduation, traveled the world as a geologist. She decided to become a doctor when she realized the critical importance of basic health care in underserved areas. After medical school at the University of California San Francisco she entered the Family Medicine Residency in Tacoma where family practice in rural areas was emphasized. After residency she traveled widely, working temporarily in primary care from Puget Sound to Micronesia.

Dr. Diamond came to the Methow in 1996, working first with Dr. Jensen in Twisp. In 2000 she began her solo practice in a small office on Main Street in Winthrop. “I had eight patients that first day and knew that I was in the right place,” she said. She and her husband designed and built the clinic in its current location in 2004.The Country Clinic has served more than 12,000 patients with a clinic staff of 19 including a family practice internist, a pediatrician, a physician assistant, and several nurses.

Dr. Hugh Straley has been visiting the Methow Valley since 1960. An oncologist, he retired in 2008 as Medical Director of Group Health and President of Group Health Physicians in Seattle. The Straley family owns a vacation home up the Chewuch River.

2/27/2013

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Joe Jensen and Anne Diamond represent the heart of rural medicine. Well-trained, indefatigable(most of the time) folks who care about their patients, and the communities that they love and that support them. And when Hugh Straley - a Seattle icon - writes their story, it resonates. We at the University of Washington have been working for the 42 years I've worked here and in the Okanogan to replicate folks like this, but it really comes down to the fiber of the individual. I offer my thanks my admiration.

Roger Rosenblatt

Mallot