Called to be a front-lines war surgeon at age 62, Dr. Jim Irwin of Moses Lake spent the past few days trying to make sure his surgery practice will survive without him.

Administrators at the hospital he leaves behind also worry about filling the shoes of the workhorse surgeon.

"He's a big producer, a hard worker, an old-school surgeon," said Scott Campbell, spokesman for Samaritan Hospital. "He'll be greatly missed by the community and the hospital."

When military reservists are called up, small hospitals and rural communities can be hit hard, said Alan Morgan, spokesman for the National Rural Health Association in Alexandria, Va.

"It is a serious issue for rural America," Morgan said. "There's already a work-force shortage in rural areas. Certainly this does not help."

Samaritan Hospital not only temporarily loses Irwin to the war but also a radiology technician, an intensive care nurse and the executive director of the hospital's doctors group.

Irwin, a big man with a crew cut, is one of three general surgeons working at Samaritan. Hospital leaders believe they actually could use four surgeons to keep up with demand for gall bladder removals, hernia repairs and other procedures. They are trying to recruit another -- a tough task for a small hospital.

For rural health-care providers, who make far less than their urban counterparts, serving in the reserves helps supplement current and retirement income.

In exchange for 36 days a year, Irwin makes $16,000 a year as a captain in the U.S. Naval Reserves. His monthly retirement income from the reserves will be about $1,400, he said.

The trade-off includes the possibility of wartime service, disruption of careers and stress on families. For Irwin, who has a solo surgical practice managed by his wife, Frances, a registered nurse, the cost could include his livelihood.

Irwin thinks he'll be gone three to six months, but his orders are for one year. He doesn't think his practice could survive that long.

"We don't have that kind of a cushion," he said, adding that despite help from the hospital, he thinks his practice will lose money while he's away.

The biggest cost is hiring a temporary surgeon to keep the practice going. The substitute doctor's fee will be about $36,000 a month, which will eat up payments from insurers. Samaritan Hospital has agreed to pay a portion and, since the hospital owns the building where Irwin has his office, to forgive the rent.

Irwin's malpractice insurance carrier, Physicians Insurance, also has suspended his premium payments of $3,600 a month while Irwin is at war.

"I didn't anticipate making a career change at this age," Irwin said Thursday. "On the other hand, as a member of the reserves for some time, I feel quite committed. Our front-line troops need the best care they can get, and I think I can provide that."

Irwin will serve with the 4th Medical Battalion, caring for injured Marines. Scheduled to leave Monday, he has said face-to-face farewells to his children and grandchildren.

He expects to work in a front-lines surgical unit.

"A lot of the surgery we do is to control the bleeding, stop any contamination and stabilize them well enough so they can be flown to Germany or the (U.S. Navy hospital ship) USNS Comfort in the Gulf or to a hospital further back," he said.

Irwin spent two years on active duty at the end of the Vietnam War. He was inactive with the reserves 12 years and has been active 17 years, he said.

Well known in Colville, he worked at Mount Carmel Hospital 13 years during the 1970s and '80s. He helped found the Northeast Washington Medical Group there.

Irwin sounded tired as he described his emotions Thursday.

"Being part of the healing professions, I always have very mixed emotions about war," he said. "Yet I took an oath to follow the direction of the commander-in-chief."