$29 million bond could pave way for family medicine residencies at Pullman Regional Hospital

Pullman Regional Hospital will build a 45,000-square-foot outpatient medical facility, upgrade its electronic records system and take a major step toward creating its first residency program if voters pass a $29 million bond in November.

The hospital is working with Washington State University’s College of Medicine to establish the family medicine residency. Hospital officials say the passage of the bond, which would increase property taxes for homeowners in Pullman, is a necessary step toward creating the residency program.

“It became clear that the medical school probably needs to use their expertise to develop the programmatic infrastructure, the curriculum, faculty, leadership, assuring accreditation and all the things that go into keeping it on the right track, and we then have the responsibility to create the space,” said Scott Adams, the hospital’s CEO.

Medical school graduates must spend at least three years in a residency, training under the supervision of experienced doctors, before they can practice as independent physicians. Residencies often last longer, depending on the medical specialty.

Residency spots are hard to come by in Eastern Washington and are largely concentrated in the Spokane area. For hospitals and clinics looking to recruit doctors, that’s a problem, because physicians are more likely to stay and practice medicine in the state where they complete their residencies.

“It’s a constant effort to recruit physicians. Some retire, and some move on for a whole host of other reasons,” said Tricia Grantham, president of the hospital district board that oversees Pullman Regional. “So that recruitment and retention is always a challenge in a small town.”

In the past decade, 56% of physicians who completed residencies in Washington stayed and practiced in the state, according to data from the Association of American Medical Colleges.

The Pullman Regional Hospital district has seven elected commissioners. With the same boundaries as the city of Pullman, the district is funded through a combination of local taxes, donations and federal reimbursements.

The hospital expansion is expected to cost $40 million. If the $29 million bond passes, the hospital plans to use its own funds and money from its foundation to make up the difference.

Pullman residents already are paying the last portion of a bond passed in 2001 to fund construction of the hospital. The new bond would take effect as the old one expires, raising property taxes within city limits. The hospital estimates that for a home assessed at $250,000, the new bond would raise taxes $167 per year.

Pullman residents were asked to vote on the new bond in a single-issue ballot in April. It received 64% of the vote, but turnout was too low. Hospital officials are more confident this time.

Grantham, the hospital district board president, said a citizens committee has been educating voters about the bond. She said residents have posed questions about the impact to their property taxes, but she’s heard little pushback about how the hospital would use the money.

While the new building space would help meet requirements for the proposed family medicine residency, it would also enable the hospital to expand services in various specialties, from psychiatry to obstetrics and gynecology. Grantham said the hospital currently has a growing patient base, but no room to expand services.

“It’s become crystal clear to everyone who knows this facility: We don’t have the space for adding new specialties,” Grantham said. “And there’s going to be a constant demand for those specialties, and where are we going to put you?”

Pullman Regional leaders have long wanted to establish a residency.

Adams, the CEO, said hospital officials started looking at options several years ago, in conversations with Providence Health & Services and the University of Washington. They would have launched a “rural training track” – part of a residency program that takes place in a rural community for up to two years but is connected to a larger, usually more urban, hospital.

Pullman Regional submitted an initial application to establish a residency in conjunction with Providence Holy Family Hospital, Adams said. The application fell short in some areas, so it didn’t receive a final judgment from the Accreditation Council for Graduate Medical Education.

Then WSU opened its medical school, presenting a new option, Adams said. “That little hiatus with Providence and WSU’s decision to enter into the medical education arena presented us with an interesting opportunity,” he said.

Pullman Regional approached WSU and proposed collaborating in several areas, hospital and university leaders said. They signed a memorandum of understanding in November 2018.

Adams said the parties began exploring ways to establish a full family medicine residency in Pullman, not just a rural training track. They are preparing a new application to be submitted in a couple of years.

Dr. Jonathan Espenschied, WSU’s dean of graduate and continuing medical education, has been developing the curriculum for nearly two years. He also has applied for grants to fund the program, including $750,000 from the federal Health Resources and Services Administration and $5.5 million from Premera Blue Cross.

The residency program is tentatively expected to launch in July 2022, with three residents to start and 12 at capacity.

It is not common nationally for full residency programs to be based in critical access hospitals like Pullman Regional.

By definition, critical access hospitals are small facilities, with 25 or fewer beds, that have 24-hour emergency departments among other qualifications. They are reimbursed differently through Medicare and Medicaid, sometimes at a lower rate than urban hospitals if they provide graduate medical education.

“Critical access hospitals are penalized, if you will, for trying to set up residency programs because of that reimbursement model,” Espenschied said. “I’m hoping we can use this as a model, to show it can be done in a critical access hospital.”

Even if the bond passes, funding the residency program will be an ongoing challenge. Adams said money “is even more limited for critical access hospitals, so that’s probably one of our biggest infrastructure challenges.”

WSU and Pullman Regional will submit their application to the Accreditation Council for Graduate Medical Education. Dr. Lynne Kirk, the council’s chief accreditation officer, noted that family medicine residents must treat many types of patients, from babies to the elderly.

“Family medicine doctors are trained to meet a wide variety of their patients’ health care needs, so they need those experiences with enough depth in each of those areas,” Kirk said.

In addition to the accreditation requirements, Adams said Pullman Regional plans to create a separate clinic where residents could provide primary care to patients outside of a hospital setting.

Pullman Regional also would use bond funding to digitize and streamline its medical records system using Epic software, enabling the hospital to connect with other systems in Spokane and Seattle.

Grantham said she hopes the residency will encourage physicians to continue practicing in Pullman.

“They tend to stay where they do their residency,” Grantham said. “Maybe not forever, but they may say, ‘This was a pretty cool experience. I’m going to stick around.’ ”