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Chehalis Family Medicine Residency Program Aims to Improve Quality of Care in Rural Areas

The Chronicle - 2/22/2018

Feb. 20--For the past three years, the Chehalis Family Medicine clinic has been operating a rural residency program in an effort to improve the standards of care received by its patients.

In rural areas, which includes the vast majority of Southwest Washington, access to health care services is often sporadic and unreliable. Hospitals are few and far between, and primary caregivers are typically spread so thin due to their workload that they are not afforded the opportunity to consult with their patients before some sort of urgent care is needed.

"This 'Rural Residency Track' in Chehalis is part of the larger, Providence St. Peter Family Medicine Residency Program that has graduated about 150 providers in the 25 years it's been going on. Residency programs are great because they increase the number of providers in the area as a large percentage of the residents end up staying and becoming doctors in the area they do their residency," explained Chris Thomas, communications senior manager for Providence Health and Services in Southwest Washington, in an email to The Chronicle. "The Rural Residency Program is specifically for those providers who are looking to (be) a doctor in a rural area. So it's great that this is going on in Chehalis, because hopefully we'll be increasing the number of doctors in our area (since) access to primary care providers is lacking throughout the area and all over the country."

For the rural residency program, Chehalis Family Medicine staff interviews applicants from around the world in order to find the those who are perfectly suited to join the Chehalis Family Medicine team. After being selected, participants move to the Twin Cities and begin working through a three-year residency program that will watch their patient roll grow from about 40 people to around 400. Those patients will run the gamut from pregnant mothers and newborn babies to the elderly who are approaching end of life care.

According to doctor Miguel Lee, a managing faculty member at Chehalis Family Medicine, the purpose of the program is not to mold new doctors but to refine existing doctors, so that they are more comfortable and nuanced with the care that they provide.

"One thing that is important to know is that when we get people in here they are already doctors. They are not students," said Lee, who explained that the stigma of "new doctors" can be one of the biggest hurdles to clear when bringing in new patients.

Lee noted that all residency faculty work closely with veteran doctors at the clinic and added, "These people are already done with med school and were selected for their academic accomplishments. They're just here to figure out how to utilize all that they've learned."

One of the motivating factors behind running the rural residency program is that there is a known gap in the United States between rural residents and the doctors available to care for them. According to Lee, roughly 30 percent of doctors who participate in a residency program wind up staying long-term in that same community, while others filter out into the vast backwaters in order to help previously underserved communities.

"Rural care programs are starting to pop up because there is a glaring need for doctors," said Lee.

Unlike other fields of medicine that have a tendency to become highly specialized and isolated, family medicine is a field that requires a broad base of knowledge to navigate. That's because family care doctors are also typically a patient's primary caregiver.

"Family doctors are required to do a wide range of things, especially if they are going to be rural doctors," explained doctor Rein H. Lambrecht, another faculty with the residency program. "The goal of the residency is that you will take care of a whole family unit."

While many clinics are no longer taking new patients, the influx of residency doctors at Chehalis Family Medicine has allowed them to institute an open door policy as they continually attempt to grow their roll of patients. In addition to their regular doctors, the clinic currently has three residency doctors on staff, as well as a behavioral therapist, a physical therapist, a social worker, a gynecologist and a nurse practitioner, among other specialists and general physicians.

According to Lee, by having all of those specialists under one roof, Chehalis Family Medicine can help to ensure that patients are receiving coordinated care.

"It will increase the likelihood that they will take their medications and that they will listen," said Lee, who noted that seeing new doctors and comprehending a new diagnosis can be an overwhelming experience. "This is better than talking to five different specialists who are not talking to each other."

On Thursday, Chehalis Family Medicine staff were busy ranking applications for the next round of residencies. This year, the program will expand from one person per year to three, and the clinic has received around 1,000 applications from all over the world. Although the program managers always hold out hope that participants will stick around Lewis County after their three years are up, a person's origins have no bearing on their consideration for a residency. Lee says that the primary criteria for selection are the rigor of their academic studies, a desire to serve rural communities and an ability to work in a team setting.

"We value diversity, so we really don't care where they come from so long as they are good doctors," said Lee.

While the program's first resident is set to graduate in June and is currently on rotation at the Centralia Women's Center, resident doctors Kristina King and Jordan Snell are in their second and first years, respectively. Interestingly, both doctors selected Southwest Washington as their first choice of destination when filling out their applications.

"It's a wonderful place to learn all of those skills and it allows for a continuity of care," said King, a Canadian national.

King noted that she is married with children and looking to settle down. She and her husband even own a house locally. She says her motivation to learn the ropes of rural medical practice is rooted in her personal experience.

"Growing up in a rural community, I found it really hard to find a doctor that you could relate to and feel comfortable with," said King.

For Snell, who grew up in between rows of corn in Nebraska, the concept of rural health care is not foreign.

"This is a very well rounded program with a lot of connections in the community even though it is so young," said Snell, who also has a young family and purchased a home locally.

With a fleet of young, bright doctors on hand at Chehalis Family Medicine, the learning goes both ways for faculty on hand.

"That's what we like best about our job," said Lambrecht. "We learn from them and they learn from us."

Lambrecht noted that perhaps the most exciting area of practice at Chehalis Family Medicine is prenatal and postpartum care. She noted that when a pregnant woman comes in for care she will develop a relationship with her doctor that will continue into the delivery room and into infant care and beyond.

"That's the best part of our jobs," said Lambrecht, who noted that once the cord is cut, doctors have two patients where there was previously just one.

While those on the job payoffs are immediate, Lee hopes that the residency program will have lasting impacts in Lewis County and beyond.

"Not only are we able to take care of these additional patients but we are able to train these doctors," said Lee. "We have always felt that everyone should have excellent care regardless of socioeconomic status."

Chehalis Family Medicine is located at 931 S. Market Blvd., Chehalis, and can be reached by telephone at 360-767-6300. Learn more online at washington.providence.org/clinics/chehalis-family-medicine.

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