Program aims to fill gaps in rural health care

There were 55 miles between Nicole Russell’s childhood home along the Mission Mountains and her primary care doctor in Missoula.

“In Charlo, there aren’t any clinics,” Russell said of her hometown of roughly 400 people. “I guess in that way I noticed the gap, but it just felt normal for mom to bring us to Missoula.”

Russell is one of the latest graduates from the University of Montana’s three-year Family Medicine Residency of Western Montana. The program began in 2013 with the mission to funnel physicians into the state.

Access to medical care has always been stretched thin in a state of roughly 1 million people scattered over more than 94 million acres. But a study released last year shows the state will need 40 percent more health-care workers in a decade than it has now. As it stands, 53 out of 56 Montana counties are underserved and 11 are without physicians, according to the family medicine residency program.

Since its inception, the Missoula-based family medicine program has doubled the number of residents trained in Montana each year.

Russell represents one of the program’s success stories: a Montanan who was able to find training at home and stay home.

The family physician recently accepted a position at the Flathead Community Health Center in Kalispell, where she completed her residency. After training in Kalispell, she had a familiar rotation of patients and knew the specialists in town. It made the choice simple.

“You don’t have to move where there’s an unknown,” Russell said. “It always seemed like I’d come back to Montana, I have that draw. But even so, it would have been hard if I did a residency out of the state.”

NED VASQUEZ is the director of the residency program. He left a 27-year-long practice in Lolo in order to help scatter the graduates to Montana’s underserved populations.

“Existing programs were very successful in keeping people in the state,” Vasquez said. “We thought, ‘why shouldn’t that be replicable?’”

Nearly 60 percent of physicians remain within 100 miles of where they’re trained, according to the Society of Teachers of Family Medicine. In Montana, that number is nearly 70 percent. However, the state has often placed last in the nation for its number of locally trained physicians.

“Actually, we were last before the program, now I believe we’re third,” said Justin Buls, the Kalispell site director for the residency program.

Montana has three medical residency programs. The Billings Clinic Internal Medicine Training Program has six residency slots for each class. The state’s first program, the Montana Family Medicine Residency program in Billings, has eight. As the newest addition to the mix, Family Medicine Residency of Western Montana has 10.

The program has three sponsoring hospitals which include Kalispell Regional Health Medical Center, Providence St. Patrick Hospital and Community Medical Center in Missoula. The core program is based in Missoula, where 24 residents are trained on an ongoing basis. Three residents from each class of 10 are matched with the Kalispell track, where six residents spend their second and third years.

The program works with a rural training network of 10 sites so residents can connect to places like the Blackfeet Community Hospital, Buls said.

“And more people are starting to know about this program,” he added. “I think we had 70 applicants the first year.”

For its last application cycle, the program had more than 800 applicants.

“While interest in the program is growing, its focus has remained to pick residents who are interested in rural health and working in underserved communities,” Buls said.

Of the program’s 2016 inaugural graduating class, seven out of 10 graduates are employed in rural and underserved areas and six of the seven are practicing in Western Montana. In the most recent cohort of eight graduates all remained in underserved areas, with four planted in Montana.

While several graduates have found jobs in places like Ronan and Polson, most have remained in Kalispell or Missoula.

Bryce Ward, an economist with the University of Montana, said while 10 new physicians isn’t “a huge number in the large scheme of Montana’s work force, it is a large number when they talk about bringing in physicians.”

Ward was one of the economists that worked on the study released last year by the Bureau of Business and Economic Research that said Montana will need 7,000 more health-care workers by 2025 to meet a growth in demand, and another 9,000 to replace retiring health-care professionals.

He said as positions in the state’s larger cities fill with program residents, following physicians could spill into vacancies in more isolated locations.

“My guess is they’ll satisfy their Montana craving that they’ve grown accustomed to,” Ward said. “In a few years we can see if that’s true by observing if a place goes from not having a doctor to having a doctor, if wait times decrease and access to care increases.”

MEGAN Vigil, 36, never expected to work in rural health. She received her undergraduate degree in Seattle and didn’t see herself leaving — until she visited Montana and eventually joined the state’s newest residency program.

“Working in rural Montana, getting to know the communities, the people I would be working with, it made me think twice about it,” Vigil said.

When she joined the first graduating class of the program, she accepted a job as a family physician for St. Luke Community Hospital. Now, she and her husband own a home and 29 chickens on the outskirts of Ronan, a city of roughly 1,000.

“This is where we want to be. It’s good for the soul,” Vigil said. “You’re cradle to grave, you’re delivering babies and then you’re delivering their babies 20 years from now.”

She said September marks a year at her job. Her practice is growing fast and patients are booked about a month out. When she receives one new patient, the person’s spouse and children are typically soon to follow.

“We need more physicians. At least six of the seven doctors in this area are not taking any new patients, they just can’t,” she said. “...It creates an overwhelming workload, but we sign up for it. I like what I do. I love my patients. People have done it for decades before us.”

When the doctors are spread thin, Vigil said patients have faced a two- to three-month wait. Or they’ve had to drive to places like Kalispell or Missoula.

Ward said the residency program is one of the forces in the state trying to change the Montana’s capacity to train and retain high-level health professionals.

“It’s good to see that the system is trying to respond,” Ward said. “We’ll only know if it was a success in a few years when the need is there.”