On Friday, the Washington State University Board of Regents will be asked to allow the WSU College of Medicine to get into the medical residency business.
In the American medical education system, students normally get a bachelor’s degree, then go on to four years of medical school. That’s unknown as undergraduate medical education. They get their M.D. and then match with a hospital system or clinic or other health care provider that provides training for the first few years of practice. That’s known as graduate medical education, or GME.
Those new doctors are called residents and they’re supervised by veteran physicians. Once they complete their residency training, they can move to the next phase of their careers, including solo practice.
WSU’s first class of medical students has just finished its first academic year. Now, the university is looking ahead to where do those students start their medical careers three years from now after collecting their diplomas.
“It’s really a continuation of the mission that we’re on to train future health care providers to meet the needs of the state, particularly in rural and underserved areas," said John Tomkowiak, founding dean of the Elson S. Floyd College of Medicine. "And what we know for a physician is that many of them will end up practicing within about 100-mile radius of where they finish their residency. That number is increased by if they also do their medical school within the state. So we have the first part of that equation with our college of medicine and now we need to build the second part, which is the residency programs associated with the college.”
“The best medical education programs are the ones that are really integrated with the communities where they are and they’re also ones that are built to serve the communities where they are," Tomkowiak said. "And so we’ve been laying a lot of that groundwork over the past two-and-a-half years as we’ve been building the medical school and, frankly, there’s a lot of enthusiasm across the state, particularly in areas where there isn’t a lot of graduate medical education already.”
WSU’s medical school has four campuses: Spokane, the Tri-Cities, Vancouver and Everett. Tomkowiak says the college will look to those for residency possibilities.
“There are some easy low-hanging fruit in and around some of those campuses," he said. "But we also want to look toward our mission and think about many of those rural and underserved areas and can we build GME programs that would help to serve those areas in particular. So that involves additional community partners that are outside of our four major campuses, but we feel that’s a really important strategy that we’re working towards.”
Medical residencies have traditionally been funded by the federal government, but it has frozen the number of residency slots at existing sites nationwide that it pays for. So, Tomkowiak says, new residency programs have to be creative.
“If you have a hospital or system where there has never been graduate medical education before, there is still an opportunity to get funding through a Medicare program that’s aimed at graduate medical education. If that’s not available, some states across the lower 48 are now choosing to fund graduate medical education, recognizing that it’s an important part of the continuum of education of doctors. And then, third, there are other mechanisms through, for example, the VA system," Tomkowiak said.
"The military has some different funding mechanisms, as well some community partnership programs, not unlike the Spokane Teaching Health Clinic that we already have here in Spokane. That similar kind of model could be replicated or duplicated in other areas as well," he said. "That’s not to mention that sometimes communities or our health care partners are willing to foot some of the bill as well because they recognize the value it’s going to bring to their communities.”
The Spokane Teaching Health Center referenced by Tomkowiak is a clinic run by Providence and staffed in part by resident physicians. It sits on the edge of the WSU Spokane campus.
During the last few years, Rep. Cathy McMorris Rodgers (R-Washington) has worked with medical authorities in Spokane to find and preserve funding sources for medical residencies. Oddly enough, she worked with former WSU Spokane Chancellor Lisa Brown, her 2018 election opponent, to arrange the funding for some of the residencies at the Spokane Teaching Health Center. Now, Tomkowiak says, McMorris Rodgers is helping WSU with medical residency funding options.
“She’s really been instrumental, in particular, in helping us think about how we can partner with the VA and the VA system to bring more graduate medical education, particularly here to Spokane and also to other areas of the state where there are VAs located. In my experience, VAs have been underutilized as an academic partner and I think, particularly here in this state, there’s really a lot of opportunity," he said. "At the end of the day, it’s also about meeting the needs of the VA. The VA has lots of opportunities for partnership and improving their system and so that’s what we want to do.”
If the regents sign off on the College of Medicine’s proposal, Tomkowiak says it would still be a few years before its residents begin seeing patients.
“The earliest that our application could be received and acted on would be October of this year and, if that date isn’t met, maybe February of next year," he said. "But as soon as we get the ability to become a sponsor, that really allows us to open the doors and start having the conversation. Most new residency programs take about two years to develop from incentive to actually recruiting residents.
"If that timeline was followed, potentially two-and-a-half to three years from now, we could have a residency program sponsored by the Elson S. Floyd College of Medicine and that certainly is one of the goals for our graduating students from the college, to be able to step into an Elson S. Floyd-sponsored institution,” Tomkowiak said.