Imagine graduating from medical school with $150,000 or $200,000 in debt and looking around for your first job as a doctor.
"You want to get rid of that debt," said Robert Duehmig of the Oregon Health & Science University's Office of Rural Health. "You don't necessarily look at rural areas as an option."
Rural doctors, according to OHSU data, tend to earn less money and work more hours than their urban counterparts. One reason is doctor-to-patient ratios are lower in rural areas. Umatilla County has 1.4 doctors per 1,000 people according to OHSU 2006 data. Compare that to Multnomah County's ratio of 4.6 per 1,000.
Umatilla County is nowhere near the lowest. Gilliam, Sherman and Wheeler show zero doctors, while Morrow has .33 doctors per 1,000 people.
Rural towns often have difficulty attracting physicians for a variety of reasons.
"Populations served in rural areas tend to be older, are statistically not as healthy, have a larger percentage of people who are uninsured or underinsured and have fewer individuals with private health insurance," Duehmig said.
Not only that, but fledgling doctors who hail from metro areas often have negative ideas of small-town life.
Duehmig believes the most effective way to bring doctors to rural areas is to get rural teenagers interested in going to medical school. Those who've experienced small towns are more likely to envision themselves practicing medicine there, he said.
That's why OHSU started a pipeline program that aims to get kids interested in science and introduces the idea of medical school. It's best to start early, he said.
"If you don't get a kid interested in science by middle school," he said, "it's hard to get them interested in high school."
In 1989, OHSU started a rural residency program, requiring third year medical students to do a rotation in a small town.
"This is eye opening from a lot of our students," Duehmig said.
Duehmig said more of these doctors have ended up in rural settings.
Duehmig said there are perks for rural doctors, though funding may erode. One program subsidizes malpractice insurance for providers in rural areas. Another program repays a portion of student loans for doctors who practice in rural areas.
Duehmig worries that a flood of Baby Boomers may prove devastating for small town Oregon.
"The number of retirees is certain to drive up the Medicare populations in rural areas," he said.
"Doctors - the people giving care - they're retiring too."
It shows you can't always predict the future. In the past, the American Medical Association predicted a glut of physicians - about 165,000 too many by 2000. Unless more medical students get into the pipeline soon, the current supply of about 800,000 doctors will begin to shrink during the next decade.