We read the article in the August 16 issue regarding APA's Corresponding Task Force on Rural Psychiatry and the survey it commissioned. Apparently, less than half of the programs responded to the survey. We do not believe it came to us, but had we seen it, we would have filled it out, as this is an area of particular interest to us.

Our program in Oregon is the program that trained Dr. Bill Herz, whose picture appears on page 10 of the same issue of Psychiatric News. Every year roughly one out of every five graduates from our department takes a job in a rural area. This year one of our residents left here to work in a small town in Delaware. The year before, one of our graduating residents took a full-time job at a mental health clinic on the Oregon coast. The year before that, one of our residents took a job in a rural county about 50 miles from Portland. Two residents from our 1992 class are working in rural areas: one on the border of Idaho and Oregon; another, currently in Maine, but now headed for southeastern Oregon.

The Public Psychiatry Training Program at the Oregon Health Sciences University is a state-university collaboration, directed by a board that includes both the chair of the department and the state administrator for mental health and developmental disability. It has been sending residents to rural areas since 1973. There are currently six or seven psychiatrists living on the Oregon coast; half of them trained with us. Eastern Oregon, that part of the state east of the Cascades all the way to the Idaho border, contains a little more than 200,000 people. Out of a total of 15 in eastern Oregon, five of the 15 trained with us and cover among them 12 counties. Many of our graduates live in the Willamette Valley. Two of our graduates live and work in Jackson County, on the California border.

We're at a point where we are running out of "rural places" in our state for our graduates to go, and some have actually had to leave the state for rural locations in other parts of the country. We have done this by giving all of our residents a community psychiatry rotation, which allows them an opportunity to go to a rural area if they choose. We pay their travel costs for six months; they stay for two days and then return to Portland for the rest of the week. This scheme for third-year residents has been very successful. It does not put anyone in a track, it does not force anyone to go to any particular place, it doesn't require any paybacks for rural areas, and it has been extremely effective in encouraging people to work in these places. Dr. Bill Herz, who trained with us, can certainly attest to the influence of that experience. He did a training rotation in an eastern Oregon county many years ago. He is also not the only psychiatrist in eastern Oregon who covers several counties.

A few years ago we collaborated with faculty of the University of Maryland to conduct a series of workshops and consultations nationwide on state and university collaboration, funded by the PEW Foundation and sponsored by APA. There are now a number of other residency programs around the country that have rural placements available. At any rate, we don't believe rural training is as bad as it used to be. There are models for addressing it. From where we sit, the maldistribution of psychiatrists between urban and rural areas is beginning to balance, and, perhaps if the survey had a better response rate, it might have shown that. We would be happy to provide a list of programs that we believe are doing good training in rural community psychiatry, which is far more extensive than that which was mentioned in the article in Psychiatric News. Perhaps direct contact with some of those programs would lead to a better idea of what is really happening.

David L. Cutler, M.D.

Portland, Oreg.

Rupert Goetz, M.D.

Portland, Oreg.

(Psychiatric News, October 18, 1996)