Salem is home to the only comprehensive ear, nose and throat center in the Mid-Willamette Valley.
Approximately 200 patients a day come to Willamette Ear, Nose and Throat and Facial Plastic Surgery center. They see one of six doctors for consultation, diagnosis, imaging, an office procedure, surgery or follow-up care. In addition, patients may meet with an audiologist, receive allergy shots, be set up for a sleep study or have a plastic surgery consultation.
Patients come from a 150-mile radius—the Oregon Coast, Woodburn, Albany, Detroit, Corvallis, Bend, Portland and Eugene.
The center conducts more than 2,000 surgeries annually and administers 300 injections of immunotherapy each week. Approximately 50 patients a month have office-based procedures such as a balloon sinuplasty, biopsy of the thyroid or excisions of lesions or growths. Hundreds of children a year get relief from chronic ear infections and middle ear diseases with the insertion of ear tubes. And hundreds of people a year have their hearing tested by the team of five audiologists, hearing instrument specialists and support staff. In addition, patients are treated for head and neck cancers.
It’s fair to say that hundreds of thousands of people in the mid-Willamette Valley hear, breathe, look and feel healthier after having received care and treatment at Willamette ENT.
“Patients love it because it is specialty-specific,” says Dr. Bruce Johnson. “The patients get great care and the cases go smoothly because we do so many of the same procedures.”
The solo practice opened in 1960 by Dr. Robert Cooper with one receptionist. Dr. Cooper chose Salem after a generous offer from the administrator of Salem Memorial Hospital. The agreement to practice in the hospital (now Building B of Salem Hospital) included an office (on now Building A property), a receptionist and the purchase of all hospital surgical instruments.
Dr. Cooper designed the small office, which included a built-in sound proof room for hearing testing. The office was furnished, and the instrument were equipped with lease/purchase agreements. All medical and office records were written on paper. Dr. Cooper performed the hearing tests. Hearing aids were not sold, as this was considered unethical in ENT practices.
A head mirror provided illumination for ENT examinations. Exam instruments were autoclaved in office for repeated usage. Sinus x-rays were performed at the hospital.
Dr. Cooper was on call 24/7 in a time when there were no pagers or cellphones. When not in office or home, he checked in and out of the hospital’s switchboard. Memorial Hospital had only one emergency room, staffed by one nurse. All Salem staff rotated on call for the ER. Dr. Cooper assisted patient care during the 1962 Columbus Day storm and the huge city flood in 1964 that closed Memorial Hospital.
Dr. Cooper’s ENT practice was like a general practice before the development of subspecialties. In addition to common T & A, ear tubes and sinus surgery, microscopic ear surgery was performed. Dr. Cooper performed the first stapes surgery in the Willamette valley. Head and neck benign malignant tumors were operated upon. Bronchoscopy and esophagoscopy was done to remove foreign bodies and impacted food. Tracheostomies were common. Many nights were spent in surgery repairing facial fractures and lacerations caused by auto accidents. Cosmetic surgery on the head was part of a busy surgical schedule.
Surgical patients were admitted to the hospital the night before surgery, some staying the night after surgery as well. There were no outpatient surgery centers in the early 1960s. Morning and evening hospital rounds were routine.
Dr. Philip Huewe joined the busy ENT practice as a great and much needed addition. From a cramped office, the two doctors moved into the new multi-specialty Oak Street Medical Center in 1966 (the site of Salem Hospital Building D). With growing need for more practice help, Dr. Larry Eschelman joined the practice in 1973. Dr. Clark Thompson was welcomed into the practice in 1987. Dr. Joe Allan took over Dr. Cooper’s practice in late 1989 when Dr. Cooper, now age 91, retired.
Creation of River Road Surgery Center
In August 2000, Willamette ENT’s River Road Surgery Center opened.
Patients are greeted with friendly staff, an open and bright lobby and waiting areas separated by doctor. Contrary to other doctors’ offices, Willamette ENT feels comfortable and accessible. In fact, glimpses of each doctor’s personality and hobbies are seen in caricature drawings on the wall and funny bobble head dolls on desks.
The center was built to accommodate the increasing number of patients and procedures—without having to rely on a separate surgery center.
“It’s a professional nirvana,” says Johnson. “We can do surgeries and, in the time in between, duck back into the office and see patients.”
There are two operating rooms with 12 registered nurses in the day surgery center. About 10 to 12 patients a day have surgeries at the surgery center.
Nursing Director Libby Godfrey says Willamette ENT takes on more complex cases than it did 18 years ago when she first started.
“We used to do a lot of tonsillectomies and sinus surgeries but now we’ve added thyroid dissections,” she says. “The technology is so much better now so that we can handle the complex cases.”
In addition to seeing an ear, nose and throat doctor and having surgery, Willamette ENT offers other areas of expertise: an allergy center, a hearing center and a facial cosmetic center.
“We are offering our patients an institute—a one-stop facility for services,” says Dr. John Donovan. “If someone has hearing loss, he can come in and get his ears evaluated to make sure it isn’t wax, get his hearing tested with an audiologist and do a minor surgery to patch his ear drum or get him a hearing aid.”
Similarly, patients with chronic sinus problems can have a CT scan to locate any obstructions or congestion, have allergy testing to determine if patient has allergies that might be the root cause or have an office procedure to expand the sinus cavity opening.
All under one roof, and sometimes, in fact, in the same day.
“It is an all-in-one campus for treating patients,” says Dr. Jared Hiebert, who joined the practice almost a year ago. “We see a broad range of issues and we can help with a broad range of problems.”
Continuing to grow
In keeping with Willamette ENT’s history, the center continues to grow. The allergy center, for example, has six staff members. Four years ago, it started with three people.
“It’s doubled because of the number of patients,” says Alice Jarvis, a registered nurse and the Allergy Center manager.
The same is true across the rest of the departments. Willamette ENT has about 70 staff members. In 2001, it had about 25.
Behind the lobby and upstairs, offices are significantly cramped.
Teresa Bailey, a registered nurse and the manager of surgery scheduling and preauthorization department, has six employees compared to 25 years ago when she was the only one. Now her desk is in what was the storage closet for old billing forms.
Her staff has grown not only because there are more patients, but also because insurance and federal requirements have increased.
“In a lot of offices, a scheduler is just that—someone who schedules appointments,” Bailey says. “In our office, staff provide insurance pre-authorizations for procedures and educates patients about their particular procedure.”
Even with electronic medical records taking up less space, space is at a premium.
The doctors gave up their offices for patient rooms and now conduct any office work in tiny “dictation pods”—the name accurate in its description of the size. When they first moved to River Road, each doctor had one certified medical assistant. Now they each have three CMAs and an additional assistant who floats between doctors.
Subspecialties within a specialty
The doctors were happy to lose office space if it meant serving more patients. They are a collaborative compassionate group, each of them grateful for choosing a specialty that allows them to see patients in appointments, surgeries and for problems that impact daily lives.
And they would prefer to see patients in their office rather than the emergency room—where the costs can be twice as high.
“We see everybody, regardless of their ability to pay,” says Jeffrey Baird, Willamette ENT’s administrator.
Even though the six physicians at Willamette ENT can see any patient with any ear, nose or throat problem, within this practice, they’ve been able to subspecialize. It means that Willamette ENT patients see a doctor who is an expert with their symptoms and the best remedy.
“Our field is so wide and diverse, it is impossible to be at the high end of all of it,” Dr. Clark Thompson says. “So, it is really helpful to have partners with areas of expertise that I haven’t stressed in my practice.”
Thompson regularly sees a 103-year-old patient to clean wax from his ear. It may seem simple, but the procedure means that the man can communicate better with his family and friends.
Those run-of-the-mill procedures are just as important as the dramatic unusual ones. One day, Thompson was called to pull a yellow jacket from a 10-year-old boy’s ear canal. The insect had tried to chew through the child’s eardrum.
In another case, a patient had an infection in his tooth spread into his neck and affect his breathing. Thompson performed surgery and the patient was in the intensive care unit for five days.
“It was truly a lifesaving effort,” Thompson says. “Nobody likes to be involved with cases when someone is that critically ill, but it is truly practicing medicine at its highest level and it is so gratifying to have a positive outcome.”
Under a microscope, Dr. Joseph Allan replaces the stapes, a stirrup-shaped bone in the ear, in patients who have what’s called a frozen ear bone.
“It can be truly miraculous to the point that people start crying because they can hear again,” Allan says. “I have had patients who are completely deaf but there is still hearing deep in the ear. After the surgery, they can walk around without any hearing aid.”
Looking to the future
Physicians in the ear, nose and throat field have already seen changes that have drastically changed the scope of medicine.
Dr. Johnson says prostheses and procedures help patients and improve their quality of life.
“There are more efficient and adaptive bones for the middle ear,” he says. “There are bone-anchored hearing implants. And the balloon sinuplasty allows us to open the sinuses without surgery.”
Vaccines for strep (pneumococcal), HPV (human papilloma virus), measles and mumps have helped prevent a host of ENT problems.
“The pneumococcal strep vaccine has greatly decreased severe life-threatening pediatric infections,” Donovan says. “We were operating on kids in the middle of the night—draining their ears or neck. Or when adults get measles or mumps, it is 10 times as bad and they can have permanent hearing loss.”
Donovan says that he educates all his patients about vaccines.
“Vaccines are just as important as car seats,” he says. “If a woman catches HPV as a teenager, she can get cervical cancer in her 30s or 40s. A man could end up with tonsil cancer at age 50. It’s really hard to tell someone who didn’t smoke that he has throat cancer and needs surgery and radiation.”
Society’s rules regarding safety have also kept former problems at bay. Bike accidents, baseball injuries and dashboard injuries are rare.
“We used to fix a severe facial fracture once every two weeks,” Donovan says. “Now we rarely see those fractures except when people drive four-wheeler vehicles.”
Of course, technology, such as flexible scopes and better microscopes, has allowed ENTs
to solve problems that they couldn’t even see in the past.
“The operating room in an ENT center is like a video game,” says Dr. Gary Nishioka. “There is computer imaging on a screen of the sinuses, for example. You can do everything by looking at that video monitor.”
The changes in the near future are likely to be even more dramatic, Nishioka says. Technology continues to advance rapidly.
“One hundred years from now the physician as we know them may be gone or their role greatly diminished,” predicts Nishioka. “The face of medicine will really change. It will be like science fiction. A computer will diagnose you. Robots will perform procedures without humans. You will see technology inserting itself to a greater degree.”
But for now, the physicians at Willamette Ear, Nose and Throat are comfortable providing the human touch to help treat the wide range of maladies affecting the head and neck, ears, nose and throat in patients from infancy to advanced senior status. They are grateful for the many modern tools that allow them to better provide healing and comfort for those patients.
Willamette ENT and Facial Plastic Surgery plans to be a part of the future—whatever it looks like. The practice will likely expand again to accommodate its current overcrowding and be prepared for even more growth, Administrator Baird said.
“We are in the business of helping people,” Baird said. “We want to do that in the best possible environment and with the best possible equipment and infrastructure.”
“Everyone is nice and very efficient.”