When Drs. Nathaniel Cheney, Jolene Gremel, and Patrick Roach arrived in Madras this past August, they became the latest class of physicians training through the Three Sisters Rural Track Program — a partnership between Oregon Health & Science University (OHSU) and St. Charles Health System designed to build a durable rural healthcare workforce in Central Oregon.
Three months in, the doctors are building patient panels, learning the community, and getting a firsthand education in what rural family medicine actually looks like.
What the Program Does
The Three Sisters Rural Track is a 1-2 residency model: residents spend their first year training in Portland through OHSU's family medicine residency, then relocate to Central Oregon for two years of focused rural practice. During their Central Oregon years, they rotate through three continuity clinic sites:
- St. Charles Madras Family Care
- Mosaic Medical Madras
- Indian Health Services (IHS) Warm Springs
Each resident can provide care for up to 1,200 patients annually — a meaningful addition to local capacity in a county where healthcare access has historically been stretched thin.
Building a Pipeline, Not Just Filling Slots
The program's underlying theory is straightforward: rural communities across the country struggle to recruit and retain physicians, and the best predictor of a doctor practicing in a rural area is having trained in one. By immersing residents in Madras and Warm Springs for two years — not just rotating them through for a few weeks — the program aims to create physicians who understand and are invested in rural community health.
Earlier program graduates have pointed to the depth of patient relationships and the breadth of cases as key draws. In rural family medicine, physicians often handle situations that would be referred to specialists in urban settings — building clinical confidence and community ties simultaneously.
A Growing Program
Cheney, Gremel, and Roach are not the first residents to come through Madras under this model. The program admitted its first residents, Drs. Ben Khalil and Callie Krewson, in an earlier cohort and has been steadily expanding. The residency is designed to recruit up to six residents per class as it scales.
What It Means for Jefferson County
Jefferson County residents benefit from the program in two direct ways. First, training physicians see real patients at local clinics — immediately expanding appointment availability. Second, residents who build strong community ties during training are prime candidates to stay in Madras or Central Oregon after residency, contributing to long-term workforce stability.
Combined with COCC Madras's nursing and medical assistant programs, the Three Sisters Rural Track represents a layered approach to building healthcare capacity from the ground up in one of Oregon's historically underserved rural counties.
For more information on the Three Sisters Rural Track Program, visit stcharleshealthcare.org or the OHSU Oregon Family Medicine Residency site at oregonfmresidency.org.