Small towns need a little care, too

Smaller communities aren't for everyone.

But illnesses and ailments can affect anyone, no matter the size of the town where they live.

So, what does a small community do to fill a shortage of primary care providers?

It finds incentives.

Sarah Kirkegaard, a nurse practitioner, signed a deal with Primary Care Sequim to practice medicine for three years in Sequim.

As a nurse practitioner in Washington, Kirkegaard has full autonomy, the ability to write prescriptions, fill the role of primary care physician and refer individuals to specialists.

With Kirkegaard signing, Primary Care Sequim becomes an eligible rural loan repayment site and is listed on the Washington State Higher Education Board's Web site,

"What loan repayment eligibility offers rural clinics is a recruitment tool," said Sandra Ramsey, practice manager for Primary Care.

"These providers can apply for student loan repayment, which allows them to work in rural areas facing a shortage of providers."

Typically, rural health care pays less than clinics in bigger cities, so it is difficult to recruit medical professionals.

"This creates a win-win situation for the new provider graduating with debt and the patients who may have to travel outside their area for much-needed medical care," Ramsey said.

Kirkegaard intends to apply for the loan repayment, but she is not guaranteed the assistance. If awarded, she could receive up to $25,000 per year toward her educational loans, which is the Washington state maximum for the program.

The rural incentive plan is available for physician assistants, dental hygienists, nurse practitioners and other medical professionals.

"Sarah and her husband desired a rural setting so they were a great fit," Ramsey said.

Kirkegaard graduated from Pacific Lutheran University in Tacoma with an accelerated master's degree in nursing. The nurse practitioner program she undertook was for people without a degree in nursing.

"I thought I was going into genetic research, but I wanted my efforts to go into a more real setting," she said.

Before graduate school, she did some "soul searching" while she worked at an organic farm in Ferndale. While working at farmers' markets, she learned a lot about nutrition.

"As I was feeding my soul and others', I was looking to get into helping people on a deeper level," Kirkegaard said.

Now Kirkegaard and her husband, John Shelley, an online salesman for ergonomic flooring, have an organic garden of their own. Their home is run with solar energy, supplemented in winter with generators.

"This has been a great winter for solar," she said.

Since high school she has been interested in permaculture, organic farming and sustainable living.

"I thought, what is a way I can leave as little negative impact? Hence, why I'm in health care."

Kirkegaard said she enjoys the peninsula. When she tells people about herself, like-minded people come out of the woodwork and feed off her passion for sustainability.

She also enjoys the challenges people bring into the clinic.

"We see everything here. People cutting their leg open with a chain saw to work-related injuries to people with diabetes ... I like the variety each day."

She feels her own life goals in sustainability will carry over into her practice of preventive medicine.

"I can't fix anyone, but we can collaborate on making them better."

From the start

Nurse Practitioner Bridgett Bell-Kraft opened Primary Care Sequim on Nov. 20, 2006. It offers primary care, same-day walk-ins and urgent care.

The clinic is at 520 N. Fifth Ave., Sequim. Hours are 7:30 a.m.-6 p.m. weekdays. Call 582-1200 for availability.

Matthew Nash can be reached at mnash@

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