From our perspective as two semiretired specialists, we look ahead to the medical care you and we may expect to receive in our community. We reflect on 33 years as practicing physicians. We're concerned about the challenges patients, physicians and the hospital face.

Mercy Medical Center is in capable hands and continues to offer an environment in which physicians can provide and patients can receive quality care. Unfortunately, some patients and physicians are not utilizing Mercy or local health care as much as they could.

In the '70s, Roseburg experienced a change from a largely general practitioner base to a healthy mix of specialists and family practitioners. Young, well-trained specialists who chose to forego a big city practice and higher income for a small town environment and a better quality of life fueled this change.

Over the years, technology and quality of care have improved immensely, beyond what similar sized towns might expect. A hospital's livelihood and its physician base are dependent on both patients and other physicians. We currently face rather severe shortages and difficulties with both.

Presently, we have more doctors in Roseburg than in the '70s, but no more and in some areas fewer specialists than we had then. In addition, our doctor population is aging; we're living on our past. We're using more patient “extenders,” such as nurse practitioners and physician assistants. These individuals provide quality care, but are not as well trained as physicians. Well-trained foreign doctors have helped fill the gap to some degree, but shortages continue to grow.

It's increasingly difficult to attract specialists to rural Oregon, in general, due to relatively low pay, longer hours and more on-call requirements. Far fewer medical students are choosing rural practices as they try to recoup their education costs.

Patient volume and type have become an increasing problem. The elderly, under-insured and uninsured have remained supportive of local care; however, the middle-aged population and insured frequently leave town for medical care, often unnecessarily. Roseburg will not likely ever be able to support some subspecialties, but it does have many excellent specialists and a quality hospital.

It's even harder to recruit specialists when they see this patient drain. It's more difficult for Mercy to best serve the community when better insured and paying patients “shop out of town,” thus affecting their profit margin and financial ability to reinvest in technology.

Some physicians are part of the problem with long waiting times, lack of full-time coverage and failure to promote local specialty care.

Increasingly, more trauma cases that were formerly cared for locally are transferred to Eugene or Portland, due to the lack of the full-time coverage we enjoyed in the past. These transfers engender thoughts of out-of-town care for elective, non-emergent care.

We're concerned for our former patients and our own care as these factors impact the community. We all deserve quality local care and full-time coverage, but must each do our part to preserve, build and grow. Medically, an important part of the healing process is closeness to family and friends.

Just as we're all part of this problem, we can each be part of the solution by investing our health care dollars locally whenever possible. To aid in this solution, we must dispel some small town health care fallacies:

• Specialists in larger cities are not better trained, qualified or better than local ones.

• The last doctor seen usually appears the smartest as they have more test results available and the help of time to see what did and didn't work.

• More procedures done, to a degree, don't necessarily equate to better results. The reality is that small town health care has often proven better as the doctor must “live” with their results. It's well documented that cities with too many surgeons perform too many surgeries compared to national averages and indications.

• Local doctors are not “leftovers” or those unable to make it in the big city, rather they have the independence and qualities that take them to less lucrative and higher workload areas.

The patient, family, employer, taxpayer, hospital and community are adversely impacted when patients unnecessarily choose to leave town for health care.

Our developing problems with local health care will be slow and difficult to reverse, but if each of us thinks unselfishly and acts with more sense of community while making health care decisions, we can grow and improve. As one of our founding fathers said during our country's struggle for independence, “we can either hang together, or we will most certainly hang alone.” So, the next time you need health care, think locally first. You'll be helping ensure that you and others will have easy access to local, quality care long into the future.

William L. Streitz is an orthopedic surgeon and David E. Owens is an otolaryngologist-head and neck surgeon. Both are based in Roseburg.