Spokane is home to two medical schools. The University of Washington trains students here for their first year-and-a-half, in conjunction with Gonzaga University. Washington State University's medical school is based in Spokane and it trains students in Spokane, Richland, Everett and Vancouver.
After medical students graduate, they train in specialty residency programs for the first few years of their careers.
Spokane has, for years, had a few residency programs, but not nearly enough slots to satisfy the demand from its graduating medical students. There are a variety of reasons for that, including the high cost of creating and maintaining residencies and a federal cap on the number of residency slots the government will fund. The latter may be changing.
There are two residency-related developments in Spokane.
The Providence/Sacred Heart psychiatry residency program is expanding from four residents a year to six. Dr. Rebecca Mallo is the chief medical officer for Providence in Spokane.
Rebecca Mallo: Fortunately, the federal government has an expansion program to expand residency spots. Psychiatry has their own spots not associated with the rest of our residency programs, which makes it a little bit complicated. We were capped at three resident funding, essentially, three resident spots, which means that the rest of the program was on the dollars of Providence, essentially, to support it, which made it difficult to expand the program over the last many years.
So when this program came up from the federal government to expand, especially underserved programs in underserved areas, we decided to apply. And fortunately, we have some great people who have lots of knowledge about applying to the ACGME and the CMS to get that funding and they were awarded five FTE, so five full-time equivalent spots, which over the course of a four-year program, means we could expand. What we ended up doing, we expanded two in the first year. We used to be four first years, five second years, and then five from there out. So we went to a six per year throughout the whole program.
DN: I'm assuming there's a great need for psychiatry residents and psychiatrists in general. Tell me a little bit about that.
RM: Yeah, the need, unfortunately, has continued to grow, partly acknowledging lots of changes in the world, but also the more greater recognition of mental health challenges and so the need for psychiatry has just grown and grown and grown and we've seen that continuously.
It also hadn't, historically, been a very well-known sort of entity in some ways and so those residency programs were relatively small, including ours. We are recognizing that we need more and we need more not just in psychiatrists, but also in all the other mental health care providers that we have. So we are expanding those as well.
DN: And is there demand for your program? Are there enough people who want to be a part of that program?
RM: Yes, we have been very fortunate. This program has filled successfully every year. They get very good candidates. We've had many from UW and WSU locally here. We have lots of local people. Our current class that we just matched on Friday, everybody has ties to Washington. Four are out of the University of Washington program. I think two are out of WSU. We're very excited about the local impact. We have a very high retention rate of these people who graduate from this program. There's about 60% of them that stay local or within the region, which is huge.
DN: Does Sacred Heart have a lot of need for them? I mean, if they want to come out of the program, is it fairly easy for them to get on at Providence?
RM: Depends on what they want to do. But yes, generally speaking, we have quite the need. We have several open positions right now. We are trying to expand our footprint of in-person psychiatry consultation available at Holy Family, which has not historically had a psychiatrist on site. So we've expanded that footprint. Our inpatient psychiatry unit obviously has been there for quite a while, so we're continuing to staff that.
We also are trying to expand our ECT therapy program, which is electroconvulsive therapy. We only do it here at Sacred Heart. There isn't another one in the region and so trying to allow access for those. And then most importantly, in my mind, is also getting upstream. We're trying really hard to expand the footprint in the clinic. On our outpatient clinics, we have expanded what we call integrated behavioral health with mental health counselors in our primary care clinics, in our pediatric clinics, as well as our psychology, which is similar but separate from our psychiatry department. So all of those just expanding fully access and so anyone coming out of psychiatry right now, we will find them a spot.
DN: So are you throwing more resources into this than you have in past years?
RM: We are strategically placing more resources into mental health care, not always into psychiatry, although this is obviously a fairly large investment into psychiatry training programs. But we're also expanding, as mentioned, the integrated behavioral health. It’s embedded in primary care so that when people are having challenges at the moment, we can connect them with a mental health counselor right there. In the clinic, they can hand off to them in the moment and that can avert a lot of crises that otherwise would brew and potentially become worsening situations. So we're trying to really get upstream of these things and so people get the care at the right location in the right time frame that they need it, and then preserving access to psychiatry for those who really need the full-fledged psychiatry care.
DN: Dr. Rebecca Mallo is the chief medical officer for Providence in Spokane.
The other health care system in Spokane is opening a residency program in a different specialty, internal medicine. This week, MultiCare announced it’s opening a new clinic where those new doctors will practice. Dr. Jennifer Knowles is the chief academic officer for MultiCare.
Jennifer Knowles: Five years ago, we started talking about putting a residency program for internal medicine at Deaconess Hospital.
There were a lot of barriers, not the least of which was finding the funding to do that. We partnered with many people both in our organization and outside the organization to overcome those barriers. And we had some serendipity along the way, including finding this clinical space. We had some very generous fundraising from our government relations team, from Senator Marcus Riccelli in bringing in a $500,000 Washington state grant, and our own health care system matched those grant dollars, and we were able to take that small amount of money and totally renovate this clinic space into the beautiful residency clinic that it now is.
We will start seeing patients here on April 6th, and next year, in June of 2027, we will welcome the first class of medical residents to start their training in internal medicine here at this residency.
DN: So for the average person on the street, what is the significance of opening a program like this?
JK: Residencies are really time-consuming and expensive to start. The accreditation process is onerous. The funding is not always straightforward, so to be able to have the opportunity to bring a high-caliber residency program to the Inland Northwest is an opportunity that's too good to pass up. So even though there were a lot of challenges, we knew that we had the opportunity here and that we needed to make good on it because the Inland Northwest is so shy of primary care physicians and this will bring improved access in the now, as we start building a patient panel, and even better access in the future when we've got a full complement of residents here. As we start to graduate those residents in several years, and they hopefully stay here within our community to practice, the access to primary care will start to become easier for all of our Inland Northwest residents.
DN: How do you find the people for your residency program that you think are going to stay?
JK: Part of that has to do with the program director, Dr. Hollon, and his team, recruiting specifically for people who have ties to this area, who know and love Spokane and the surrounding Inland Northwest region, and who are committed to coming back here to practice when they're done with their training. If we start with that end in mind, we have found in other programs within the MultiCare system that that's a really successful model for being able to retain those physicians in those communities.
When a resident spends three or four years in a community training, they've usually set down some roots there. Their family is established. Their kids might be in school in that community. And so it's not that far a stretch to be able to say, hey, come join this organization that provided you your residency training and continue to live and practice here. So we anticipate being successful in that endeavor in retaining a large percentage of those residents for our community.
DN: So your first class is going to be six.
JK: Correct.
DN: How do you anticipate the program growing over the years?
JK: The footprint for this program, both from a clinical space standpoint and what we feel we can support within Deaconess Hospital, we want to have a program that is 24 residents strong.
DN: That would be 24 each year or 24 over three years.
JK: 24 total. That means eight residents in each of the three classes. So for this startup year, we're starting with six. So we will recruit this fall for six to start in June of ‘27.
But each year after that, we anticipate being able to recruit for eight. And we will achieve that size, I guess, in 2030 after the graduation of the six residents in the first class. Then all of our classes after that will be eight residents strong.
DN: I know you're focused on this program, but I'm thinking the psychiatry residency program is going from four to six. I know WSU has got new residency programs over the last few years. Is Washington starting to solve its issue when it comes to shortage of doctors and physicians?
JK: Well, yes, this is definitely a step in the right direction, but it's insufficient to say we've solved the problem.
If you look at the demographics of existing physicians in the state of Washington, a lot of them are my age. They're baby boomers and they're getting ready to retire. We aren't currently training enough physicians in graduate medical education, so the education that comes in a residency after medical school here in the state. We need several more residencies here in the state in a variety of specialties in order to backfill the anticipated retirement of physicians from my generation. So is it a step in the right direction? Absolutely. Is it sufficient? Not yet, but we’re getting there.