This article was published in our 2015 Annual Report.
For Dr. Milt Fowler and physician assistant Leslie Osterman, teamwork is the key to continuity of care.
Dr. Milt Fowler had just completed his residency when he arrived at Gifford in 1976.
He and his wife were eager to leave the city and wanted to be part of a small community.
He’s still practicing at Gifford forty years later, and now he faces another major life transition: easing into retirement.
“I’m having a hard time cutting back. I’ve known some of my patients for 35 or 40 years,” he said. “There’s a deep richness and joy in practicing primary care in a small community. Once you’ve shut the door on the chaos and paperwork and sit to connect with a patient, the office is like a sacred space.”
Providers at Gifford often say that an ongoing patient relationship is the most satisfying part of their work. For family physicians, the bonds can grow especially strong: it is not unusual for long-time primary care physicians to have treated several generations in a single family.
“I see my role as being a positive influence, someone a patient can come to for help—not just with medicine, but with other issues as well,” said Dr. Ken Borie, who has been practicing family medicine at Gifford since 1980. “Family doctors can build trust in ways a specialist can’t. That’s what’s valuable about being a primary care physician—it’s one of the intangibles that you can’t put a price on.”
Across the country a shortage of primary care physicians is forcing rural community hospitals like Gifford to look for alternatives to this traditional model. As a generation of long-time physicians starts to retire, fewer new providers choose a career in primary care.
Many factors have contributed to this shortage: primary care pays less than other fields and many medical students, burdened with student debt, specialize in other areas. Those who do practice primary care are in demand, and are much more mobile than the providers who settled in Randolph years ago. Rural communities are especially hard hit, since salaries are much higher in urban areas.
To respond to this primary care recruitment challenge, Gifford has implemented a team model, often pairing a physician with a physician assistant or nurse practitioner. These healthcare professionals have been specially trained to diagnose and treat a variety of conditions, prescribe medication, order and interpret tests, counsel, and manage patient care.
Fowler works closely with Physician Assistant-Certified, Leslie Osterman. The arrangement shortens a patient’s waiting time for appointments, but also helps to make sure that patients have quality time with a provider during visits.
“There are not enough MD/DO’s to care for everybody—we have to find new models,” said Fowler. “Leslie and I work really well together. She’s taken over much of the acute care and the preventive and health maintenance visits like annual physicals and cancer screenings. I tend to manage care for patients with more complicated needs.”
Osterman previously worked as a respiratory therapist but found she wanted to be more involved in patient care. She saw that the physician assistants she worked with could focus on preventative medicine, and shared knowledge and decision-making as a team. She returned to school, received a Masters of Physician Assistant studies from Franklin Pierce University (she completed three of her nine rotations at Gifford), and came to practice at Gifford in 2015.
“Milt introduces me to his long-time patients and they see us working together. If their next appointment is with me, I won’t be some random person they haven’t seen before,” said Osterman. “Continuity of care is really important to people.”
The new team model increases patient access to primary care professionals while preserving a quality provider/patient relationship. Like the long-term providers they work with, physician assistants and nurse practitioners say they specifically chose their roles because they wanted to build ongoing connections with patients.
“I trained as a physician assistant because I had seen that many doctors weren’t able to spend extra time with patients discussing concerns or preventive care,” said Osterman. “Sometimes patients need extra time for education or explanations, and I wanted to help fill this need.”