Dr. David V. Evans, Dr. Russell Maier and Dr. Glen Stream: Reduction of family medicine residency program is tragic loss to Spokane community

By Dr. David V. Evans, Dr. Russell Maier and Dr. Glen Stream

The elimination of six of 12 residents from the Spokane Family Medicine residency program is a devastating blow to the primary care workforce needs of Eastern Washington. While the decision to reduce the residency class in half may have been influenced by multiple factors, it will immediately impact patient access to care in Spokane and ultimately access to care in the eastern part of the state.

The Center of Health Workforce Studies at the University of Washington, in a 2021 report, shows Washington has 14% fewer primary care physicians per 100,000 people than the nation as a whole. Within Washington state, Eastern Washington trails Western Washington with 17% fewer primary care physicians per 100,000 people, with deeper disparities in more rural areas. Of the 20 counties predominantly east of the cascades, all are federally designated Health Professional Shortage Areas for Primary Care. Additionally, Eastern Washington primary care physicians are older, pointing toward further workforce deficits in the future as these physicians approach retirement.

The Spokesman-Review reported that significantly fewer slots were cut from the existing transitional year residency. Transitional year residents, in contrast to family medicine residents, train for just one year and then they leave the community to enter residencies in anesthesiology, radiology and other hospital-based programs. Given that 50% or more of residents practice near where they complete residency, using valuable residency slots to help other regions is a disservice to the community.

Elimination of family medicine residency slots may be most felt in the area of maternity care. According to a 2023 March of Dimes maternity care report, six Eastern Washington counties have no physicians who deliver babies, leaving those mothers and their families a long car ride from care. Less than 1% of Washington’s maternity care providers practice in rural counties. It is family physicians who most often deliver babies in rural areas. A 2021 national study of 185 rural hospitals showed that in 27% of these hospitals only family physicians delivered babies. In the 10 Washington Critical Access Hospitals studied, 70% reported only family physicians provided maternity care. Spokane Family Medicine’s strong emphasis on maternity care, including its additional post-residency training focused on obstetrics, is now at risk in this downsized program.

Where physicians train for residency matters. The Association of American Medical Colleges reports that 57% of resident physicians go on to practice in the state in which they trained. In 2021, 45% of Washington’s primary care physicians had completed residency in the state. Of 193 family physicians in Spokane County, 67 (35%) are graduates of the Spokane Family Medicine Residency.

Spokane is an ideal site to train family physicians. The city hosts two world-class medical schools, both with a commitment to primary care in Washington. In fact, there are more medical students based in Spokane than in Seattle. Spokane’s proximity to the state’s most underserved communities allows access for residents to explore rural practice while taking advantage of the high-quality training environments of multiple excellent hospitals and health systems. This is, in part, why the Spokane Family Medicine residency was formed in 1976 and has been a mainstay of the health care community and region for half a century.

It is impossible to know the behind the closed doors discussions and the factors influencing the final decision to make these cuts. Certainly, they were not easy decisions to make. What is certain is that cutting 50% of the residents from the Spokane Family Medicine residency program is a tragic loss to the local community, its patients, maternity care in Eastern Washington, and the region as a whole.

Dr. David V. Evans is the Rosenblatt Family Endowed Professor of Rural Health with the Department of Family Medicine at the University of Washington; Dr. Russell Maier, FAAFP, is the associate dean for Graduate Medical Education at the College of Osteopathic Medicine at the Pacific Northwest University of Health Sciences; and Spokane Dr. Glen Stream is the past president of the American Academy of Family Physicians. The opinions of the authors are their own and do not necessarily represent the policies of their employers.