(C) Daily Yonder - Keep it Rural
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Q&A: A Digital Bridge for Rural Healthcare Workers in Oregon [1]
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Date: 2025-03-14
Editor’s Note: This interview first appeared in Path Finders, an email newsletter from the Daily Yonder. Each week, Path Finders features a Q&A with a rural thinker, creator, or doer. Like what you see here? You can join the mailing list at the bottom of this article and receive more conversations like this in your inbox each week.
Amelia Roth is a developmental and behavioral pediatrician practicing in Douglas County, Oregon. She knew she wanted to be a physician from an early age, and following her dad and mom – both medical providers – she ended up going to medical school herself.
“The summer before I attended medical school, I was asked to help care for a sweet toddler boy with down syndrome, whom I instantly adored,” she said.
“I recall my mother sending me a newspaper clipping at that time about a newer type of pediatrician, a developmental pediatrician, who actually specialized in children with developmental differences. I became very intrigued with this idea, and later relished in shadowing developmental pediatricians during medical school in South Carolina and throughout my pediatric residency in Oregon.”
Amelia is also a member of the Oregon ECHO Network, a model “inspired by the way clinicians learn from medical rounds during residencies…,” a network for professional development for healthcare workers who meet in online classrooms to hear about real-life cases from experts in their respective fields and gain knowledge and expertise that otherwise would be hard to access.
Today, Project ECHO serves hundreds of communities domestically and abroad, and in Oregon alone, around 20% of participating zip codes are rural.
“Originally, I was invited as a virtual guest speaker to an ECHO involving a team in Ukraine in 2022, and I was very impressed with the program,” Amelia recalled. “I really enjoyed the collaborative forum, and I was later contacted by one of my mentors in the spring of 2023 about becoming faculty for a state-wide psychiatry ECHO through OHSU [Oregon Health & Science University].”
Now, Amelia is both a contributor to the pool of experts and a beneficiary of knowledge shared by other specialists through the ECHO model of learning. In our conversation, we touched on how ECHO can help rural communities meet their healthcare needs, what she found irresistible about the model, inspirations to practice medicine for underserved populations, and much more.
This interview has been edited for length and clarity.
Dr. Amelia Roth practices in rural Douglas County, Oregon. (Photo courtesy of Amelia Roth)
Jan Pytalski, The Daily Yonder: How did you first hear of ECHO?
Dr. Amelia Roth: I first heard of ECHO as one of my closest friends and colleague leads an autism ECHO as faculty, and I was able to see how much she enjoyed and benefited from this program. Having worked hard as a primary care pediatrician, prior to my fellowship, always in areas without an academic center, I loved the idea of creating a space where those providers on the front lines of care can present their trickiest clinical conundrums in a supportive and knowledge-rich environment where both specialists and other primary care providers alike share advice.
One can feel so alone sometimes when practicing medicine, particularly in rural areas, and I loved the collegial vibe and power of connection that ECHO seemed to create. Having left an academic institution to return to a more rural area, I loved the idea of keeping that academic life-line active, as a means of ensuring I would continue to provide the most up-to-date care to my patients.
I currently serve as a regular weekly faculty member for the Child Psychiatry ECHO – one of more than 40 different topical ECHOs run by the Oregon ECHO Network, which reaches thousands of rural providers across every county in the state. I have experienced a dynamic benefit from discussions around various clinical presentations and didactics with my co-faculty members and the participants in equal measure.
DY: Describe the need for a project like ECHO. Why is it so fundamental for rural areas to have that kind of opportunity?
AR: The farther we medical providers get from academic institutions, which are typically housed in big cities, the more complex patients we tend to take on, compared to our colleagues practicing in more resource-rich larger cities. As we get more rural, we find ourselves caring for higher risk families in “resource deserts,” while being physically located farther from specialists. ECHO provides a safety-net for the hardworking medical providers bravely caring for some of the most challenging medical and socio-economic scenarios, without the benefit of a specialist down the hall or a high-level medical center across the street.
ECHO provides direct access to specialist care, while simultaneously helping clinical care experts understand the challenges facing providers and patients living and working in more rural areas. It creates a whole new community of practice with rural providers and specialists that ultimately ensures that rural and isolated families can get the care they need where they live.
DY: How did you end up practicing in a rural area, in Douglas County? What’s striking about our healthcare needs here? How are rural needs different from urban needs?
AR: I had always wanted to work in a rural area, and actually met my husband while doing a residency rotation in a very small town in Eastern Oregon, where he was living and working as a PA-C [Physician Assistant-Certified] in pediatrics. He is from the small town in which we currently live, and we had always hoped to end up back here.
What I find striking is that it seems that in these larger and more spread-out spaces, kids end up coming to medical attention much later for both medical and developmental conditions than they would in a more condensed city. Families seem to be more isolated, and this seems to lead to later diagnoses and thus poorer outcomes. Families have to travel farther to come in for clinic visits and therapies, and this leads to more missed visits, greater stress for families seeking care, and again, less optimal outcomes for children. In urban areas, the services for kids appear to be both more robust and more accessible, meaning families have an easier time finding clinics/therapeutic centers closer to their homes, which decreases barriers to accessing care and improves health outcomes.
DY: What motivates you to practice here?
AR: Selfishly, I love the natural beauty, the plentiful farm animals, the slower pace of life, and the proximity to my husband’s parents. I love the river, the wildlife, and I love the kindness I see in so many who live here, regardless of their level of resources. I also see an incredible need. I see families working extremely hard to care for their children, break the bonds of addictions, and heal their own traumas.
Children in Douglas County have more adverse childhood events than children in any other Oregon county, and that is readily apparent to me as I see them day to day in my clinic. I see so many families who desperately love their children and want the best for them, while simultaneously having trouble organizing their care and finding the resources they need to help them thrive. The work here feels mission-minded, reminiscent of some of the volunteer work I had done in developing countries in my younger years. I am never bored and always inspired to seek ways to do more for these deserving families.
DY: Can you give some examples of real-life benefits of working with ECHO, both for you and for patients?
AR: As a faculty member, I myself have presented some of my most challenging patient scenarios during our meetings, and it has been incredible to glean advice from various providers in a large geographic catchment area. Hearing the case presentations of colleagues in other rural areas creates a feeling of validation and encouragement – as we are all seeing the same levels of need, and all feeling the same desire to provide more healing and care in more creative ways. Moral burnout is a serious threat to clinicians at this time.
This type of burnout results from a chronic feeling of knowing what it is that your patients need, while also not being able to provide this for them. ECHO is an incredible antidote to this moral burn-out, as it creates a bridge to connect our primary care providers to specialists, which enables them to quickly access higher levels of expert care, bypassing months and years-long waitlists in which patients too often find themselves.
This, in turn, serves to decrease rural providers’ sense of isolation while increasing their job satisfaction, both of which can go a long way towards keeping skilled medical providers in rural areas, where there is great need. I have no doubt that rural communities across the country would all benefit from a collaborative program like ECHO, which works to ensure that rural providers get the collegial support they need to continue providing excellent care to the deserving families in their communities.
This interview first appeared in Path Finders, a weekly email newsletter from the Daily Yonder. Each Monday, Path Finders features a Q&A with a rural thinker, creator, or doer. Join the mailing list today, to have these illuminating conversations delivered straight to your inbox.
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