Deep in Southern Oregon — facing backdrops of rich forests, a world-class migratory bird flyway and vivid landscapes — Brandon Drws is helping to transform how UC Davis is training future doctors for rural communities.
He is the first student from the UC Davis School of Medicine assigned to care for patients out of state under a unique partnership with Oregon Health & Science University (OHSU). The collaboration, known as COMPADRE, sends students and residents to clinics and hospitals in Sacramento and Portland, as well as the vast, more sparsely populated land in between where physicians are in short supply.
Drws’s six-week stint at Cascades East Family Medicine Center serves as a preview of the life and work of a rural doctor. And the assignment is a good fit: he’s a nature lover from rustic El Dorado County. So choosing a clinical rotation in this city of 22,000 is like a dream come true.
“I love the community that you get to build with your patients, the relationships you get to have,” Drws said. “But I also love the kind of medicine you get to practice.”
In urban settings like Sacramento, Drws explained, it’s easier for primary care physicians to refer patients to specialty care when they encounter a disease they are uncertain about diagnosing. But in Klamath Falls, which is two-and-a-half hours from some specialty care services, family medicine doctors in a sense are the specialists.
“In places like this,” Drws said on a recent afternoon between patient appointments, “you have to practice to the highest level of your license. No matter what kind of doctor you are, you have to become more comfortable with all of the conditions that you see.”
He added: “This is the kind of program that I really liked thinking about when I first considered a career in medicine.”
Transforming the physician workforce to meet rural needs
COMPADRE, which stands for California Oregon Medical Partnership to Address Disparities in Rural Education and Health, started when leaders from the UC Davis and OHSU medical schools joined forces in 2017 to apply for a grant from the American Medical Association to transform access to care between their campuses.
They received $1.8 million and tapped 10 health care systems, 16 hospitals and a network of Federally Qualified Health Centers as training sites for students and newly graduated doctors entering various residency programs. In California, COMPADRE sites are in and around Eureka, Redding, Ukiah, Santa Rosa and Sacramento; Oregon sites are in Portland, Hillsboro, Roseburg and Klamath Falls.
If the schools could boost the number of residents assigned to train in underserved areas, they reasoned, they should be able to increase the number of doctors who practice there.
“We certainly know that when a physician trains in a residency program, about 60% of them stay within about 100 miles of that program,” said Tonya Fancher, M.D., M.P.H., an internal medicine physician and the UC Davis associate dean for workforce innovation and education quality improvement who helped launch COMPADRE.
“When we look out our door and look across Northern California, we feel it’s our responsibility to really work with those communities, health centers and hospitals to create the doctors who will work there,” she added.
UC Davis has long been devoted to advancing health in rural and remote communities. In 2007, it started the Rural-PRIME pathway, a medical education track for students who envision a career working in California’s out-of-the-way areas.
“We focus on Rural-PRIME because we serve so many rural communities from Northern California and receive those patients here at UC Davis, but those rural communities also need providers there, physicians there, taking care of them as well,” said Melody Tran-Reina, M.D., an assistant professor of internal medicine and executive director of the UC Davis Community Health Scholars program, which administers Rural-PRIME.
After COMPADRE created infrastructure for residency training, Rural-PRIME benefitted too: COMPADRE invites third-year medical students, like Drws, to train in the same sites during their clinical rotations.
Treating ‘the whole gamut’ of health conditions
Drws shuttles from exam room to exam room in the busy health center that overlooks Upper Klamath Lake and the Cascades. Patients come with an array of concerns, and some have delayed care because they live far. They come with diabetes, aches and pains, hypertension, anxiety, reproductive issues. “The whole gamut,” Drws likes to say.
As a third-year student he’s barely past the midpoint of medical school but has similar responsibilities to some doctors here. He interviews patients, builds rapport, compiles treatment plans and shares them with residents and attending physicians who supervise him. The clinic training, he said, “is very, very autonomous, and very faithful to what practicing medicine is really like.”
UC Davis students live rent free, spend four weeks in the outpatient clinic and two at nearby Sky Lakes Medical Center. “It’s a really supportive environment for students to learn and get a lot of hands-on experience,” said Nellie Wirsing, M.D., who oversees medical student education at Cascades East Family Medicine Center and is Drws’s faculty mentor.
Promoting patient care and the local scenery
Communities like Klamath Falls have long struggled to attract doctors who often prefer higher-paying jobs in vibrant and prestigious cities. According to a 2023 report by the Health Resources and Services Administration, 65% of rural areas suffer from a shortage of primary care physicians.
Drws, whose family has been in the Sierra foothills and nearby regions for six generations, can appreciate what it’s like to live in a slower-paced world, far from school, work and hospitals.
“Regardless of which specialty I end up in, my wife and I absolutely see ourselves settling down in a small town, someplace rural,” he said. “We both like the rural environment, and we both recognize that the opportunities that you give up by leaving a large city are more than made up for by the opportunities that exist out here in these kinds of places.”
