Postcards from the Rogue Valley

This past September, as I pulled into the parking lot at a nearby medical practice where I am a patient, a sign in bold black letters caught my eye: “Doctors Wanted.”

I’d come for a quick visit with my primary doctor, older than I, who was on the verge of retiring. My husband’s doctor — in the same practice and also aging out — had announced his retirement the month before. The sign did not bode well for their replacements. 

As I checked in for my appointment, I asked the receptionist whether the “Doctors Wanted” sign was for this office (one of several in this large medical building). Without meeting my gaze, she said, “Yup.” 

Indeed, when we first arrived in Ashland eight years ago, I had searched for doctors who were accepting new patients, a search that led me to Southern Oregon Internal Medicine, the only physician group within 20 miles that had “room.” When I asked a local pharmacist what gives, he quipped, “Lady, in case you haven’t looked around, we’re rural here. Doctors are in short supply. Cows are everywhere.”

Once again

Now, once again, I found myself on the hunt for a primary care doctor who was accepting new patients. I found none. 

This December, seven months after Southern Oregon Internal Medicine had launched its recruitment campaign, I heard that two young doctors had finally signed on. I tried to find out more about them — the medical schools they had attended, where they had done their residencies, their specialties  — but my call for more information was met with, “I’m sorry, I can’t help you.”

When their bios were eventually posted on the group’s website, I learned that both were osteopaths. One had studied osteopathy at a graduate school in Northern California and just completed a two-year residency in Portland. The other was from Mississippi, where he had graduated from a college of osteopathic medicine designed to get doctors as quickly as possible into rural clinics across the southeast

My eyes lit up when a nurse practitioner with ten years of experience, as a cardiac nurse at a local hospital and a provider in the Rogue Valley’s best low-income clinic, joined the list of newcomers. Down to my last week’s supply of anti-anxiety medication, I secured an immediate appointment, and she and I spent a satisfying hour together.

One of the things I’d appreciated about my almost-octogenarian now-retired doctor was how at the end of my annual physical, in which we talked more about medical research (an interest of mine) than my lab results, he’d always say, “Keep on doing what you are doing. Whatever it is, it’s working well.” 

SOS

If you’ve spent an hour watching the award-winning “The Pitt” — with the hardships that come with a single 15-hour work shift at a fictional Pittsburgh trauma center — it is easy to see why doctors and nurses today are burning out more than ever. 

“Increase in physician attrition rates could worsen shortages” a recent Yale School of Medicine report predicts. A nationwide survey by Axios explains that two-thirds of respondents report a shortage of qualified applicants for physician openings in their area. Some states are suffering more than others. “Louisiana could face a shortfall of 5,000 doctors by 2030” a special segment on a CBS-affiliated television station in Baton Rouge began. “There’s only so much burden one doctor, one man, one woman, can take on,” said Dr. Keith Kellum, Chief Medical Officer at Baton Rouge General Hospital. 

But burn out — and an increasingly elderly population with multiple medical needs — is not the only contributor. Some note a shortage of medical schools and the expense of standing them up. There are currently 158 accredited MD-granting institutions and 37 accredited DO-granting schools in the U.S. Most, however, blame the federal government. 

“Today, March 19, is Match Day — the medical equivalent of the NFL Draft — when medical students learn whether they’ve secured a residency, the final and mandatory step to becoming a licensed physician. For thousands of graduates, however, today will be devastating. In 2024 alone, roughly 3,350 medical school graduates went unmatched, effectively ending their ability to practice medicine in the United States. Without a residency, a medical degree is worthless.

This failure is especially troubling given the nation’s growing physician shortage. Demand for doctors continues to rise, yet the supply is artificially constrained. Fewer than half of medical school applicants are admitted, and up to 10 percent of graduates fail to secure residencies. Meanwhile, hospitals face staffing crises, small towns plead for family physicians, and projections warn of a shortfall of at least 86,000 doctors by 2036.

The bottleneck is not a lack of talent, but federal policy. Nearly all residency positions are funded and capped by the federal government, primarily through Medicare and Medicaid, under limits established by a 1997 congressional spending bill. These caps determine how many doctors may be trained each year, regardless of national need. As a result, qualified doctors are locked out, specialties are misaligned, and underserved areas remain without care — all due to an artificial training shortage imposed by Washington.” (The Daily Economy, March 19, 2025)

Put all these factors together and — to non-physician me — it looks like an arterial blockage, where the buildup of plaque in artery walls restricts the oxygen-rich blood flow to a patient’s  heart causing acute, if not chronic, distress. It’s an SOS.

On the other hand, the number of nurse practitioners (NPs) in America more than doubled in the span between 2010 and 2022. Indeed, the Bureau of Labor Statistics expects the nurse practitioner field to grow by 45 percent in the next ten years, making it one of the fastest-growing occupations in the U.S. 

Job saturation seems unlikely, as many older NPs are reaching retirement age. And the same forces that deter primary care physicians from practicing in rural places apply to nurse practitioners as well.

Where does Ashland stand?

As of late 2023, there were approximately 49 physicians serving the Ashland, Oregon area — a ratio of about 1.85 primary care doctors per 1,000 residents. Ten of these are osteopaths. (The number of osteopathic physicians is increasing rapidly, with a 70–81 percent growth in the U.S. over the last decade, now representing over 25 percent of all medical students.)

There were 35 nurse practitioners. Oregon is one of 22 states that grants NPs full practice authority, allowing them to assess, diagnose, treat, and prescribe medications without physician supervision or a collaborative agreement. 

Complementary therapies

William Shakespeare is not the only historical giant animating Ashland. The Greek physician Hippocrates, perhaps the world’s first champion of personalized, holistic health, haunts the city, too

“Natural forces within us are the true healers of disease,” wrote the “father of medicine” circa 400 BC. 

“To do nothing is sometimes a good remedy,” Hippocrates cautioned. (The Hippocratic oath, to do no harm, rises from this notion.) 

While Ashland may be short on physicians and nurse practitioners, providers of complementary therapies are abundant in this notably New Age, wellness-focused city. The data (offered by AI from sources like Healthgrades) lists roughly 140 licensed massage therapists, 40 chiropractors, 20 acupuncturists, and two dozen naturopaths working within ten miles of Ashland. 

The offerings are expansive: deep tissue massage, craniosacral therapy, aromatherapy with organic oils, hydrotherapy, Lomi Lomi, Shiatsu, neuromuscular therapy, Thai massage, passive or active stretching, pre and post-natal chiropractic, pediatric chiropractic, upper cervical chiropractic, quantum spinal mechanics, active release technique, dry needling, ATP Resonance Biotherapy, Chinese herbal remedies, fertility acupuncture, cupping, moxibustion, Gua Sha, and much more. 

While many practice with little fanfare, others work under aspirational banners: Luminous Well-Being, Be Held Bodywork, Heart Waters Massage, Morning Sun Massa, Sanctuary Massage & Body Mind Radiance, Lymphatic Glow, Natural Kneads, Hands On Wellness, Tail of the Sun, Inner Compass Chiropractic, Elements of Being Family Chiropractic, People’s Choice Acupuncture, Golden Way Acupuncture.

The owner of one of the most popular offerings in town, Chozu Bath and Tea Gardens, writes:

A Santa Barbara native, I moved to Ashland in 1997 to establish a chiropractic business. My work as a chiropractor focuses on movement therapy and I believe strongly in helping people learn how to continue the healing that starts in my office. I first created Agile Healing Arts, a Pilates center with classes, exercise rehabilitation and a focus on wellness and self-care. 

In creating Chozu, I was inspired to help people find a path to preventative wellness by nurturing their bodies in the tradition of Japanese baths. While traveling in Japan I felt a deep connection with their healing traditions. My idea was simple. In many other cultures, public baths are where people have traditionally gone to take care of themselves for good hygiene and health. As a community people heal together. My goal was to create a tranquil and healing space where people could come for self-care and personal work. 

In addition to the bath gardens, Chozu has a skilled team of massage therapists and bodyworkers to complement your stay in the gardens. We also have a lounge and tea house with a Japanese-inspired menu. Chozu’s overarching approach is to simply plunge into tranquility. I invite you to come experience the traditional Japanese philosophy of self-care, relaxation, rejuvenation and the soothing of tensions.”

For my part, I am not a stranger to the world of complementary therapies. Back in New England, I sampled acupuncture for stress reduction, chiropractic for neck stiffness, and weekly massages for whatever body parts needed attention. For me, massage was the winner. In New York City, I frequented a practitioner in Chinatown whose trigger-point massages delivered what might be called therapeutic pain.

Since moving to Southern Oregon, though, the best tonic I’ve found is hiking daily with my husband in the forests and mountains behind our house — an energetic 1,000 foot ascent with gnarly madrones at every turn, sweeping views of the Rogue Valley, and abundant silence.

As I approach my seventy-ninth birthday, I am reminded again and again that the greatest wealth is health.

“I look forward to meeting again,” my newfound nurse practitioner at Southern Oregon Internal Medicine said as I left my appointment a week ago. “Stay well!”

“I wish it were that easy,” I answered.

Notes:

(1) I write this post fully aware that my “wellness journey” is that of a privileged white woman blessed by (knock on wood) relatively good health. For those with no or limited health insurance, being able to access health care at all towers hugely over the adverse effects of a doctor shortage. And “complementary therapies,” needless to say, are only for those with the money (and time), where paying $100 for a massage – typically during working hours — comes easily. 

(2) I am reminded that the global wellness industry, valued at $6.3 trillion in 2023, generates massive profits for corporations, private equity firms, and shareholders.  It is almost four times bigger than the pharmaceutical industry ($1.8T) and 60 percent as large as all global health expenditures (including consumer and government spending of $11.2T).  Because the trends fueling the wellness industry will only accelerate — an aging population, rampant chronic disease and mental unwellness, and a market newly focused on prevention and longevity — it is predicted that the industry will grow at an even faster pace (7.6 percent annually) through 2029, when it will approach $10 trillion. (The Global Wellness Institute, Nov. 2025)