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A Season of Change

“The Times They are a-Changing”

Bob Dylan 1963


This document is more important to me than it is to you. I get that. I set these goals each January and I constantly refer to them throughout the year. That’s my job. I hold myself accountable to accomplish what I have set before us. Discipline is the bridge between goals and accomplishment.


But I cannot achieve these goals without your help. Unless we all have the same understanding of the plan, unless we believe in the vision, these are empty promises.


I cannot remember a time of more dysfunction within the medical system. The delivery system seems hopelessly stagnated. Medication shortages and inability to transfer patients to access the care they need is the norm. Feel good metrics from afar often impede addressing actual patient needs. It is progressively more difficult for us to do the same job. As though we are “running against the wind”. Our patients experience the results, and the anger is often directed toward us.

It wasn’t always this way.


“I wish I didn’t know now what I didn’t know then”

(Bob Seger – Running Against the Wind))


Many of us have lost faith in critical governmental and professional agencies to contribute to the solution. There was a time I was active in the AMA and OMA. I was Oregon’s first “young physician” delegate to the AMA.


There was a time when I had absolute faith in the CDC’s recommendations. As part of Evergreen’s townhalls, we had a public meeting on vaccination controversies where I defended CDC and State of Oregon childhood recommendations to a somewhat hostile audience. It made the front page of our local newspaper.


Once, I hoped the OHA would bring efficiency, innovation, and resources to rural primary care. I believed our local hospital was supported by a parent company that truly cared for our community.


I believed hospital systems of large corporations could provide efficiencies and resources to rural communities that independent community hospitals could not.

I wish I didn’t know now what I didn’t know then.



"I used to care, but things have changed"

Bob Dylan 2000


I’m not cynical. And I’m not discouraged. I love what we do. I would choose our noble profession again in a second. This is not a blind optimism. Rather a serious possibilist.

I think we can succeed and find meaning in our mission at Evergreen even if the path between now and then is a never-ending parade of setback, surprise, chaos, and disappointment. Most good things happen because of a reaction to a bad thing.

But I am realistic about where my help is coming from. Whom I trust.


I trust Mercy Medical Center and its administration. You need to hear that. This hospital is essential to our community. As disadvantaged as it is by its corporate alliance, Mercy administration has been a good partner for Evergreen and supported our growth. I respect MMC CEO Kelly Morgan and his team.


I trust you. Our group. I love the people and culture we have developed in Evergreen. Your resilience and pragmatic problem solving has offered access to services this community could not do without. You are the source of my optimism. Because I know the failures, problems and setbacks are what motivates us to find new solutions or remove errors. I’m proud to be associated with this group.


And I trust this community to understand how hard we work and to support us. Not every person. Not every time. But, the level of respect EFM has in this community should be affirming to each of you who make us what we are.


Evergreen is changing too. We are evolving to address the reality of system failures and fill in the holes where we can. Evolution doesn’t teach us by showing what works, but by destroying what doesn’t. We will find a way to provide the care our patients need when other medical systems fail.


But we are also working to provide safety, satisfaction, and new opportunities for our own staff.


What you will read in the 2023 goals is a departure from those I have set in the past. You won’t see metrics. You will see ideas I plan for us to implement together. Concepts over numbers. Harder to measure.


But it will be apparent to you as we come to the end of 2023 whether we have succeeded in these objectives. You will feel the difference. You will see the results in patient care. And Evergreen Family Medicine will be a stronger organization than today.

As you read the 2023 Goals and Objectives, I am asking each of you to look for your role in helping these goals become accomplishments.


I thank each one of you for bringing your best to work every day. It is a privilege to walk this path with you. Despite the tides of change and clouds of uncertainty, I’ve never been more optimistic about our future.


I’ll see you at the end of the trail.


Tim Powell MD

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