While many Montana communities have been losing primary-care physicians, Billings has been better able to weather the storm, says one of its top hospital officials.

"We've had a little bit (of turnover), like most large groups, but we've not had as much problem or as much turnover," said Mark Rumans, physician in chief at the Billings Clinic.

Primary-care doctors - family doctors and internists - are the general practitioners of medicine. They are the doctors that most patients see first, and who help diagnose and manage their patients' diseases and sometimes refer them to specialists.

Internists specialize in seeing older, adult patients, and are particularly hard to recruit.

More primary-care physicians have been leaving their practices in some Montana towns, often for financial reasons, and it's difficult to replace them, because fewer medical students are choosing to become primary-care doctors.

Ruman says the Billings Clinic pays its primary-care doctors based both on how many patients they see and another component called "quality service leadership," which rewards physicians for keeping their patients healthier.

"I think that helps keep compensation at a very competitive level," he says.

The Billings Clinic employs more than 200 physicians. About 30 are primary-care doctors in Billings, as are another 20 at its sites in Red Lodge, Columbus, Miles City and Cody, Wyo.

Billings has seen some departures of primary-care physicians in recent months, but not as much as some other Montana cities, he adds.

Still, it's a challenge to recruit and retain these doctors, Rumans says.

"Fewer individuals are going into primary care, especially internal medicine," he says. "It's a concern all across the country, and it's been a high-priority focus for us at Billings Clinic, to maintain chronic-disease management."

Officials at St. Vincent Healthcare, Billings' other major hospital, couldn't be reached for comment.