Dr. Robert Elsbury was like a dream come true for the Custer County Community Health Center.

Elsbury, 40, was an avid outdoorsman who had worked in other small towns and adjusted easily to life in Miles City.

It took health officials seven months to find and recruit Elsbury, who grew up in Illinois and worked in Chicago before moving to Montana.

Elsbury was killed almost two weeks ago in an auto accident, barely a year after taking over as the only physician at Custer County Community Health Center.

He was the third doctor to work at the small, federally funded clinic, which serves about 1,500 mostly low-income and uninsured patients annually, since it opened in late 2003, said its chief executive officer, Jeanette Carson.

The clinic also employs a nurse practitioner and two registered nurses.

"We are constantly looking for physicians," Carson said. "It does take a while to get anybody in frontier Montana."

Nationwide, 13 percent of physician positions at community health centers are perpetually vacant, according to a study published last year in the Journal of the American Medical Association.

In rural parts of the country, 42 percent of community health centers reported having difficulty recruiting doctors, and 30 percent of rural clinics with vacancies recruited unsuccessfully for at least seven months, the study found.

"It's very difficult because it can take so long. It can take up to a year to recruit physicians," said Mary Beth Frideres, associate director of the Montana Primary Care Association.

"It's not just the physician who needs good placement and to be happy but also their family," Frideres said. "It's quite a time-consuming effort to find good matches all the way around."

Montana's 12 community health centers, which treat almost 75,000 people a year at 20 clinic sites, seem to always be searching for doctors, said Marge Levine, data and information manager for the Montana Primary Care Association.

And it's only going to get worse.

"They're anticipating a national shortage for primary care physicians as the population ages and needs are increasing," Levine said. "And more doctors graduating from medical school are going into specialties and not primary care, which is the major provider for rural states."

The need is already great enough that 7,000 additional primary care physicians could find work in rural America, according to a report issued by the Health Resources and Services Administration, or HRSA, a branch of the U.S. Department of Health and Human Services.

Twenty percent of Americans live in regions designated by HRSA as primary care shortage areas.

In Montana, only six counties -- Beaverhead, Fergus, Meagher, Ravalli, Stillwater and Wheatland -- do not have primary-care physician shortages, according to HRSA.

Areas with shortages can participate in federal loan forgiveness programs, which forgive the student loans of doctors who work in underprivileged areas, but doctors in those programs get to choose their assignments.

That leaves clinics like the Custer County Community Health Center trying to find innovative and inexpensive ways to court potential hires.

"You try every avenue you possibly can," said Carson, who moved to Miles City from Washington two years ago.

Miles City, population 8,000, is a great place to raise a family, and it's close to numerous recreational and historic sites, Carson said.

"There are great opportunities here," she said.

By the numbers

n 12 community health centers operate 20 clinics in Montana.

n 75,000 Montanans sought care from a community health center last year.

n 56 percent of them did not have health insurance.

n 85 percent of them lived at or below 200 percent of the federal poverty level, which is an annual income of $41,301 for a family of four.

n 13 percent of physician positions at community health centers across the country are perpetually vacant.

n 20 percent of Americans live in regions designated by the federal government as primary care shortage areas.

n 50 Montana counties have primary care shortages.

Contact Diane Cochran at dcochran@billingsgazette.com or 657-1287.