HEALTH TRAIN EXPRESS
Mission: To promulgate health education across the internet:
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Science is not "proven" in an absolute, final sense; rather, it is deemed reliable through the scientific method, which relies on falsifiable hypotheses, rigorous experimentation, and evidence. Theories are supported by consistent, reproducible results across many studies, building a consensus that represents the best current understanding of the natural world.
Evidence and Testing: Scientific ideas must be tested against the natural world, allowing for potential disproof (falsifiability).
Replication: An experiment must be repeatable by others to confirm the results, reducing errors or fraud.
Peer Review: Research is reviewed by independent experts, ensuring it meets scientific standards before publication.
Consensus: When many independent studies reach similar conclusions, confidence in the findings increases.
Progressive Refinement: Science is an ongoing process of updating theories as new, better evidence becomes available.
Instead of 100% proof, science provides overwhelming, verifiable evidence that makes certain theories highly reliable.
3. Repeatability & Peer Review
No single experiment "proves" a result. Science relies on a global community to verify findings:
Reproduction: Other independent scientists must be able to run the same experiment and get the same results.
Peer Review: Before research is published, experts in the field scrutinize the methods and data for flaws.
Consensus: When many different studies using different methods all point to the same conclusion, it becomes an "established fact" or "scientific consensus".
4. Self-Correction
Science is designed to be tentative. If new, better evidence comes along that contradicts a previous theory, the theory is updated or replaced. This is a feature, not a bug; it's how science gets closer and closer to a more accurate model of the universe.
Health tech keeps making the same mistake: it measures the right things but ignores the context that makes them meaningful. Wearables collect time-stamped data from your body all day and all night. Heart rate variability, skin temperature, respiratory rate, sleep architecture. Every one of these signals follows a 24-hour circadian rhythm. A "low" HRV at 2pm means something completely different from the same reading at 2am. Your resting heart rate in the early evening isn't the same biological event as your resting heart rate during deep sleep. But most wearables present these as flat scores against population averages, as if your biology were static. No wonder users report feeling anxious, confused, or pressured by numbers that fluctuate "without explanation." The fluctuations aren't random. They're circadian. The device just doesn't tell you that. Now a new wave of wearables (Clair, Peri,Level Zero) is trying to estimate hormones, estrogen, progesterone, LH, cortisol, from these same proxy signals. The ambition is real. But here's what nobody in that conversation is saying: every proxy signal they're using is a downstream circadian biomarker, and the hormones they're estimating are themselves circadian outputs. Cortisol peaks about 30 minutes after waking. Progesterone rises are nocturnal. The LH surge has specific timing architecture. Validating these estimates against a single morning blood draw is the wrong gold standard for a continuous monitor. You'd want concordance across the full 24-hour cycle. A cortisol reading without circadian context is noise, not signal. This connects to something I keep seeing in health AI research too. Most studies test whether AI can match a doctor's diagnostic accuracy using clean clinical vignettes. But that's answering a question nobody is actually asking. The real question is: when a scared, confused person types symptoms into ChatGPT at 2am, does that interaction lead to better decisions than what they would have done otherwise? Same problem. Different domain. The technology works in controlled conditions. But health doesn't happen in controlled conditions. It happens at 2am, mid-cycle, post-travel, under stress, in bodies that run on clocks researchers keep forgetting to account for. The next generation of health tech, whether wearables or AI, won't win by adding more sensors or more parameters. It will win by understanding context: biological timing, individual variation, and the messy reality of how humans actually live with their data. Your body has a clock. Your health tools should know how to read it.
Physician and Hospital shortage requires stakeholders to. take action to provide support services to rural residents.
By 2030, we seek to:
Inspire 100,000 stakeholders
Catalyze 1,000+ wellbeing-first jobs across a network of healthcare partners
Lead by example in 10 rural communities supporting over 20,000 patients
Orchid Wellbeing-First
People-first approach: care teams are valued, trusted, and empowered to prioritize patient and community needs.
Local decision-making: small, empowered teams guide care with focused, meaningful metrics.
Personalized care: builds strong relationships through longer, patient-focused visits. Care is guided by "what matters most" to patients.
Community integration: works collaboratively with local health and community partners.
A Decade of Transforming Rural Healthcare: Orchid’s Chapter One
In 2014, we launched Orchid Health with a courageous vision: to deliver healthcare to the people and places that needed it most. Our founding team saw firsthand the inequities straining Oregon’s rural communities—where nearly 40% of the state’s population lived without reliable access to quality, local healthcare.
Determined to disrupt an overly bureaucratic, profit-first system, we set out to create a transformative model built on relationships, joy in work, and health equity.
From the very beginning, we’ve held strong to the belief that supporting our communities starts with our own staff. A healthy community starts with a healthy health organization where caregivers are cared for and have the autonomy to do what they feel is best for their team and patients.
From Humble Beginnings to Trailblazing Change
Our team opened the first clinic in Oakridge, Oregon, a community where two rural clinics had closed in the previous decade. Orchid started to gain a reputation of rewriting the rules of healthcare with the introduction of hour-long new patient visits and 30-minute follow-ups. Over three short years, with unhurried, compassionate care, the Oakridge clinic team reduced emergency department utilization for Medicaid patients by 42%, proving that a relationship-based model can achieve meaningful outcomes.
Building on this success, we expanded our community footprint. By 2016, we launched the first hybrid school-based rural health clinic in Estacada, integrating medical and mental health services to serve the broader community and local high school students. Our innovative approach continued with the acquisition of the McKenzie River Clinic in 2020, rescuing a cornerstone of the community and one of the nation’s first certified Rural Health Clinics from closure. Even after the devastating Holiday Farm Fire later that year, our caregivers persisted, setting up a temporary clinic to ensure continuity of care.
A Wellbeing-First Operating Model
Orchid’s six thriving clinics now serve over 10,000 patients across Oregon, providing comprehensive care that includes same-day acute visits, behavioral health services, community health worker services, and chronic disease management.
Central to our successful operating model excellence is the happiness and autonomy of our caregivers.
Employees consistently praise Orchid’s supportive culture, where work-life balance, self-management, vulnerability, professional growth, and community engagement are celebrated. Nearly 30% of team members have advanced to new roles within the organization, and Orchid has maintained an industry-leading eNPS score three times the primary care average, ultimately leading to multiple awards and recognitions as a best place to work and healthiest workplace. Orchid’s turnover over the past three years has been about half of the industry average.
Universally, our Orchid teams are achieving a strong net operating margin, and a 9.5 out of 10 patient satisfaction rating. By focusing on the wellbeing of our caregivers and patients, we believe we’ve unlocked the key to delivering remarkable care and building a resilient organization.
Our clinics have earned four and five-star patient-centered primary care home (PCPCH) ratings—the highest recognition available in Oregon—while reducing emergency department utilization by 40% in the first three years of opening our first rural health clinic. With an eNPS score three times the primary care industry average and an impressive 90% employee retention rate in 2023, we are equally proud of our caregiver support.
Looking Ahead
Everyone at Orchid embraces a learning mindset, adapting to challenges and refining our model. Early experiments, like a direct primary care membership model, underscored the need for inclusivity and access. Today, Orchid contracts with most insurance providers to ensure no patient is turned away. We’re also at the forefront of value-based payment models, aligning financial incentives with patient outcomes.
Looking ahead, we aspire to expand our impact by sharing its proven approach. Plans are underway to establish a consulting arm to guide other healthcare organizations in adopting wellbeing-first principles. Additionally, Orchid recently spun off a new nonprofit arm, the Health Creation Network, to further its mission of health equity and innovation.
What started as a grassroots effort to address rural healthcare disparities has grown into a movement redefining community health. By focusing on relationships, challenging traditional power dynamics, and prioritizing the wellbeing of both caregivers and patients, Orchid Health is a beacon of hope for rural communities across Oregon.
As we enter our second decade, Orchid remains steadfast in its commitment to bringing care to where it’s needed most—proving that healthcare rooted in compassion, equity, and innovation can thrive.
Summary
There is little likelihood that new rural. hospitals will be built. Physician recruitment is difficult without hospital support, however Orcid health can provide support services for doctors who chose to practice in a rural setting.
Locum tenens
9 rural locations that desperately need locum tenens physicians
Apr 20, 2025
7 Min Read
Kathleen Stone
Locum tenens physicians are in demand across the country, from the largest cities to the smallest towns, but some locations have a greater need than others. Here are nine rural locations that are desperately in need of physicians. Our list is based on their scores as Healthcare Professional Shortage Areas (HPSAs) and number of open locum tenens jobs with the largest locum tenens agencies.
Out of all the rural locations that need physicians, New Mexico tops the list with a HPSA score of 17.93 out of 25 for primary care and mental health. It’s one of the most rural states in the country, with a median county population density of just 7.1 people per square mile. In addition, New Mexico was ranked fourth in the nation for its poverty rate — 17.5% of New Mexico residents falling below the poverty line. This means that many New Mexico residents face two barriers to receiving healthcare: the physical barrier of a long drive to access care and the economic challenge of paying for it. Locum tenens physicians play a critical role in bringing healthcare to the people where they live through New Mexico’s rural clinics and hospitals.
2. Georgia
Georgia has the tricky combination of a growing population and a rural population. According to the American Medical Association, Georgia ranks 30th in the nation for physicians per capita. Since it’s growing quickly, the need for doctors is growing as well. To address that need, Augusta University has created a program that places medical students in 350 locations across Georgia to give them real-world experience. Its other aim is to introduce them to the more rural areas of the state. Like the other states on this list Georgia’s rural healthcare facilities need locum physicians to provide the coverage they need.
3. Missouri
Missouri's physician shortage continues to grow. The Institute for Public Health estimates that Missouri will need 687 additional physicians by 2030, which represents an 18% increase. Some of Missouri’s counties have been hit particularly hard by this shortage. For example, Osage County has a ratio of 13,688 people for every one physician. In comparison, the national average is 2300:1.
4. Arizona
Arizona only has 37% of the physicians it needs to care for its population. And with an aging population of patients and physicians, this need is likely to grow. Much like Georgia, Arizona also has a growing population; it’s home to two of the top four fastest growing cities, and Phoenix is the fastest-growing large city in the country. Locum tenens physicians are in high demand to keep up with the needs of the state’s growing population.
5. North Carolina
North Carolina is one of the top locations that need physicians because its population faces a variety of issues when it comes to healthcare. First, 20% of the population lives in a rural area. Plus, this rural population has risk factors that lead to lower income and a higher rate of health issues: They are older, poorer, and sicker than those living in urban areas. This means that this population needs extra medical care but has trouble accessing the caregivers who can provide it. Plus, they’re less likely to have health insurance, so it’s that much harder to get the necessary care.
6. Washington
Washington is home to four of the 15 U.S. counties with the highest physician shortages. This might come as a surprise considering the state is home to large cities like Seattle and Spokane, but healthcare tends to be concentrated in these areas, which makes it less accessible to Washington’s rural areas. By 2030, estimates find that the physician shortage in Washington will reach 6,037—and Washington citizens in rural and large areas will feel the effects.
7. Florida
In terms of the physician shortage, Florida makes Washington look better. By 2035, the Sunshine State will have a gap of nearly 17,000 physicians. Of these, 5,974 are primary care specialists, but Florida is also anticipating a shortage of 1,519 emergency department physicians, 654 anesthesiologists, 1,230 psychiatrists, and more. Florida and its sunny beaches are a perfect retirement set up, but as retirees and their doctors age, the demand for physicians will continue to grow and so will the need for locum physicians.
8. Texas
The Texas Department of State Health Services projects the shortage of physicians in Texas will nearly double by 2032. As of 2018, there was a shortage of 6,218 full-time equivalent physicians, but by 2032 that number will skyrocket to 10,330. Texas is the fastest-growing state in the country, and it has an aging population, which will drive the demand for healthcare providers higher and higher.
9. Oregon
Oregon anticipates a shortage of 1,174 physicians by 2030, and the rural areas of the state will once again be hit the hardest because of the concentration of people in urban areas like Portland. The Oregon Office of Rural Health is working to attract doctors to jobs in rural areas with special incentives, policy changes, and recruiting efforts.
The physician shortage is putting a strain on health systems across the country, and physicians interested in working locum tenens will continue to be in high demand, especially in rural locations. Doctors who are willing to take jobs in high-need areas can make a big difference in the lives of both their patients and the communities in which they live.
Locum tenens work in rural and underserved areas offers more than a change of scenery—it’s a chance to reconnect with purpose. Hear why emergency medicine physician Dr. Russ Reinbolt finds fulfillment working rural locums assignments:
Explanation of the Pandemic of Vitamin D Deficiency
Only 20% of our vitamin D reserve is meant to come from the diet. The remaining 80% is expected to be produced in our skin from the UV-B of the sun. In contrast to the context of the recommendations of the 1960s of 4000 to 5000 IU/d to avoid rickets, our diet today is poor in wild fish (×10 richer in vitamin D), wild eggs, and fresh milk. Children are playing and people are working indoors all day long, and powerful sunprotective cosmetics are used to prevent melanoma. Even sunny countries such as Greece present a high prevalence of vitamin D deficiency, as the angle of the sun rays from autumn to spring do not result in sufficient vitamin D production with usual sun exposure.
Optimal Vitamin D Supplementation
With the target for vitamin D set at 100 nmol/L, the dose, frequency, and duration of supplementation will be important factors for healthy subjects committed to optimizing their nutritional status.
Since in the case of vitamin D, serum levels depend on dietary intake (20%) and sun exposure (80%), a practical approach would be to recommend at least the three-fourths of the upper tolerable dose proposed by the Endocrine Society to be taken as a supplement all year long except for circumstances such as vacations in which one engages in sunbathing. This could translate to, for instance, 1000 IU for children <1 year on enriched formula and 1500 IU for those older than 6 months who are breastfed, 3000 IU for children >1 year of age, and up to 8000 IU for young adults and thereafter, with non-pediatric doses adapted to the body mass index with the target set to 100 nmol/L instead of 50 nmol/L. More importantly, according to the Endocrine Society’s clinical practice guidelines, doses up to 1000 IU/d for infants up to 6 months, 1500 IU/d for infants from 6 months to 1 year, 2500 IU/d for children aged 1-3 years, 3000 IU/d for children aged 4-8 years, and 4000 IU/d for everyone over 8 years can be given safely without medical supervision just to prevent vitamin D deficiency, while higher doses may be needed to correct hypovitaminosis D.
Importance of Vitamin D Supplementation
Such a strategy relies on adequate supplementation among pregnant and lactating women, and on timely supplementation of every newborn before seroconversion towards autoimmune targets occurs. The benefits for individuals’ general health status, apart from the obvious gains in skeletal health, cannot be fully foreseen, but may very well be surprisingly greater than expected given the impact of vitamin D deficiency on metabolic syndrome itself. Improvements in vitamin D status may help reduce the public health burden of metabolic syndrome and of potential subsequent health conditions, including type 2 diabetes and cardiovascular disease.
Other considerations
Reasons for a 5000 IU Prescription
Diagnosed Deficiency:
A blood test showed your levels were low (below 20-30 ng/mL), requiring a higher dose to restore normal levels.
Inadequate Sunlight:
Living in northern climates or spending most time indoors reduces natural Vitamin D production.
Malabsorption Issues:
Digestive disorders (Celiac, Crohn's) or obesity can hinder Vitamin D absorption from food, necessitating higher intake.
Bone Health:
Essential for calcium absorption, supporting strong bones and teeth.
Immune Support:
Vitamin D plays a role in immune function, and deficiency can lead to getting sick more often.
Specific Health Conditions:
May be used for conditions like osteoporosis, certain cancers, or to support heart/metabolic health.
Unfortunately, medicine took a very long time to realize that vitamin D is not simply a vitamin that prevents rickets. For that purpose, 400-600 IU/d may be enough. However, we know today that vitamin D is a powerful nuclear receptor-activating hormone of critical importance, especially to the immune system. With the available data mentioned above, the proposed doses would probably suffice to maintain vitamin D levels around or over 75-100 nmol/L, with practically zero risk of toxicity. Undeniably, further studies are needed to clarify the optimal supplementation of vitamin D, although it is uncertain whether a universal recommended dietary allowance is feasible. Meanwhile, actions are urgently needed to protect the global population from the threats posed by vitamin D deficiency.
