Healing Place approaches one-year anniversary of grand opening; staffing medical clinic remains a challenge

Healing Place, located at 6000 New Way in Klamath Falls, is owned and operated by the Klamath Tribes under the Klamath Tribal Health and Family Services (KTH&FS) division. It is used as a satellite clinic for medical, pharmacy, and dental care and as a primary clinic for behavioral health services.

At a May 8, 2021, General Council meeting, the Council voted to approve the 6000 New Way remodel, plan, and $11.9 million budget. Services at satellite locations will expand to ensure sustainability and accessibility for tribal members. New Way first opened to tribal members on May 19, 2023.

The COVID pandemic shone a light on the shortage of healthcare professionals throughout the nation, and Chiloquin was no exception. In a 2023 October national address, American Medical Association President Jesse M. Ehrenfeld, M.D., MPH, stated, “The physician shortage that we long feared – and warned was on the horizon – is already here. It’s an urgent crisis… hitting every corner of this country – urban and rural – with the most direct impact hitting families with high needs and limited means.

“Imagine walking into an emergency room in your moment of crisis – in desperate need of a physician’s care – and finding no one there to take care of you.”

“We are struggling to recruit and keep both clinics staffed for all services,” said Chanda Yates, Health General Manager for the Klamath Tribal Health and Family Services. “We are in a health care staff shortage crisis. And what we have decided to do in-house is that the Chiloquin Wellness Center in Chiloquin, Oregon, will always be our primary care medical home, and it will be staffed first.”

Currently, the medical clinic, pharmacy, and dental services in Chiloquin are completely open and functioning all business hours. The dental clinic at New Way in Klamath Falls initially opened only two or three days a week for dental emergencies. It opened up full-scope, five days a week, in October 2023. The dental team worked to set up the new clinic and ensure the workflows were identical to the Chiloquin Wellness Center.

The medical clinic in Klamath Falls originally followed a similar approach to its dental clinic. It was open two days a week until temporarily ceasing operations in February 2023 due to the lack of providers to staff that location.

Two-thirds of KTH&FS’s service demands come from Klamath Falls, while the remaining one-third comes from Chiloquin. “So, we’ve staffed according to those demands,” Yates said.

“We are short-staffed, we’re getting up to staff, but everyone is new. And there’s a pretty steep learning curve with providers,” Yates explained, describing part of the process of hiring primary care providers. “And they need to be working out of the Chiloquin clinic to get that full experience and then full orientation before they can work independently at a satellite clinic location. So, in the meantime, when we cannot meet minimum staffing measures, we have to close it. And that’s just not a business model that I’m interested in operating; consistently being open is critical. So, we’re really going to have to pull back and reassess to meet minimum staffing levels.”

As of this writing, KTH&FS has one direct-hire medical doctor, Dr. Susan Sparling. She sees patients full-time.

Part of the reassessment relies on hiring locum tenens physicians, who are essentially traveling doctors. KTH&FS partners with various locum companies, screens, and interviews locums, and if they think the candidate is a good fit, he or she is brought on for temporary hire.

“It’s really important that we’re serving the community with medical doctors,” stated Yates, while acknowledging that relying heavily on locum companies is not an ideal model—a model employed widely throughout the inadequately staffed healthcare industry. Patients across the nation are losing trust in the health system, and the same is true here. We have a lot of work ahead of us to bring as much stability to our health system as possible.”

There are some inherent barriers to recruiting primary care physicians to the Tribes.

“One major factor is that a lot of the medical doctors and physicians, primary care providers, have their choice of wherever they want to be in the United States. And it is very difficult to recruit to a rural location,” Yates said.

She also cited a less-competitive salary the Tribes could offer – being an Indian Health Service-funded 638 contracted tribally-owned community health program – and the small pool of medical doctors across the nation as impediments to recruiting talent.

A small percentage of Native American people go into the healthcare field. Yates pointed out that Oregon Health and Science University’s Northwest Native American Center of Excellence program is working to address this problem, as well as the healthcare needs of all people, by increasing the number of American Indian/Alaska Native individuals in the U.S. health professions workforce.

The pharmacy at New Way is not yet open for services, and Yates does not anticipate it opening until at least one more clinical pharmacist is hired. “So, when they are open, the pharmacy will provide the needful scope of services,” she said.

“The Klamath Tribes will always have a primary care medical home, meaning all of those programs and services in Chiloquin will always be there, and they will always be fully staffed,” continued Yates. “It’s going to be difficult for us to staff the satellite clinic here in Klamath Falls. We will not even be able to open the medical clinic until we increase our staffing. We first ensure successful training happens, and then we will be able to open that location fully.”

New hires come with all of their training and licensure. KTH&FS has its own training and shadowing program in the clinics for new hires so that they are trained on all clinic workflows. New healthcare providers have to learn about KTH&FS’ environment, workflow, and electronic health records.

“They’re trained on how to use the electronic health record,” said Yates. “They’re trained on all of the referral agencies that we work with, such as all the specialty referral services that we refer to, whether it’s Sky Lakes for an MRI, or the local orthopedic clinic, or to a cardiologist. We have to make referrals out to specialists.”

Part of the training program also includes two videos, produced by Klamath Community College and the previous KTH&FS Behavioral Health Manager, on cultural orientation, history, and trauma of the Klamath Tribes.

The 43,300-square-foot facility at New Way was designed based on the Klamath Tribes’ culture. The quail, highly regarded by the Klamath Tribes for its familial bonds, features prominently throughout the lobby.

“And our patients and staff really love that representation,” said Yates, referring to the quail and aesthetics of the building’s interior. “So, we have that in the building in our lobby. And we wanted to make sure that we brought into the lobby a lot of nature because that’s really important. The environment is important to this tribe. Everything we did is designed with Earth, forest, land, water, and flora in mind.”

Each area was designed following certain color schemes the architect and staff devised. The behavioral department has an earth motif inspired by the surrounding area and elicits feelings of strength and security. The pharmacy reception area’s yellow-accented walls represent the wocus, a staple food and flower of the Klamath Tribes. Dental department finishes are blue, representative of water, and a Crater Lake mural is situated in the waiting room. Medical department finishes are all green for plants, landscapes, and trees.

It is worth noting that the Quail Trail bus provides free service to Klamath Falls and Chiloquin. There are five routes a day, Monday through Friday. Two routes stop daily at El Dorado Avenue’s northern terminus, the closest stop to Healing Place. While the Quail Trail does not run directly to Healing Place, KTHFS does offer medical transport to the facility. Additional staff have been added to transport patients to 6000 New Way.

As of March 18, the KTH&FS Medical Clinic is open five days per week at the Healing Place.