Providence to cut six family medicine resident spots and end sports fellowship

Family Medicine Residency Spokane, with 30 physician residents assigned to care for local patients, faces a big cut by June. 

By trimming the number of new medical school graduates from 10 to four each year, the move could reduce patients’ access to care at a University District clinic, although Providence administrators said this week they intend to fill any gaps in care with the region’s other advanced medical training programs.

A sports medicine fellowship with one position will also end next year, and a transitional one-year program for residents entering specialties is being reduced to eight slots from a high of 18. Other Spokane residency programs weren’t cut, including 10 internal medicine positions, two in rural family medicine in Colville and three in an obstetrics fellowship.

The 52-year-old family residency program in Spokane grew from seven to 10 residents a year nearly a decade ago. It was tied into the Affordable Care Act and intended to meet a 2014 goal to bolster the number of family medicine physicians practicing in Eastern Washington. Health care leaders formed the Spokane Teaching Health Consortium, a partnership between Providence Health Care, Empire Health Foundation and Washington State University.

The Spokane Teaching Health Center, at 624 E. Front Ave., opened in 2016 with 56 exam rooms.

Providence administrators said the residency cuts stem from a reduction in Graduate Medical Education funding, a mix of federal dollars designated for hospitals or academic centers. In that mix, some Health Resources and Services Administration funding was uncertain. And MultiCare plans to regain its Deaconess-appointed residency slots and funding that the hospital system has long allowed Providence to manage.

The lower number of residency slots isn’t the only upheaval. Dr. Sarah Wilhelm, former director for Family Medicine Residency Spokane, posted July 16 on LinkedIn about the changes. By Friday that same week, she posted that she is no longer a Providence employee. Wilhelm declined to be interviewed, and Providence said it can’t discuss personnel issues. An interim director is expected to be appointed soon.

“I had to announce to our residents and faculty that, due to funding changes and reallocation of GME training slots, Family Medicine Residency Spokane will be recruiting only 4 new residents for the Class of 2028 instead of 10,” Wilhelm first posted.

“Our program remains committed to the highest standards of excellence in training primary care physicians. I just wish we could train more of them to serve the needs of our community, not less.”

Sacred Heart, like other hospitals, is grappling with deep financial challenges since the COVID-19 pandemic. The hospital had $175.5 million in operating losses in 2023, according to Department of Health data.

For all residency programs it supports, including a newly launched pediatric residency with WSU that will eventually have 18 positions, Providence would have had to cover a $14 million-a-year cost above available funding for 2025, up from $10 million, said Dr. Cara Beatty, a regional Providence clinical network chief executive.

The residency reductions will save $2 to $3 million, she said.

Traci Couture Richmond, the teaching clinic’s executive director, said administrators plan to search for sources of additional funding to bring back some Spokane family medicine resident positions after next summer. Those residents’ salaries range from $66,000 to $78,600, its website said. They are employed by Providence.

A Providence Tri-Cities program trains eight family medicine residents a year.

“It’s no surprise to anybody that health care funding of all sorts is becoming more challenging,” Beatty said.

The higher residency costs next year weren’t sustainable.

“We’re just really finding that our costs are going up far higher than our revenue across the board; we looked at all kinds of options,” she said. “Unfortunately, we came to the really hard decision that the least painful way forward was to cut back those numbers of residents in family medicine.”

Family medicine residents and faculty cared for about 19,500 patients in the teaching center’s clinic over 12 months to July 1, program leaders said.

“If our workforce is cut by 60%, that means close to 12,000 primary care visits per year,” said Dr. Bryan Stamm, a family medicine doctor who has supervised its residents for 34 years. Many clinic patients face poverty, food insecurity or substance abuse, he said.

“We see new patients in our clinic on a daily basis. We hear they can’t get an appointment anywhere else,” he said. “Other primary care clinics are either closed or booked out for six months, or more, for new appointments. Some practices have limited the number of Medicare, Medicaid patients they’re willing to take.”

Dr. Paul Russell, also a preceptor physician, graduated from the same program in 1976.

“We’re going to have a lot of patients who will have to be turned away,” Russell said. “We’re just not going to have the bodies to see them. CHAS is there, but a lot of them are probably going to end up in the emergency room.”

Couture Richmond said there is a plan to cover gaps.

“We actually are a hub for health sciences in Spokane,” she said, adding that the center could pull from WSU’s nurse practitioner program, local physician assistant training and other advanced programs.

“Our goal is that patient care and access will not be significantly impacted. How we get there is yet to be determined,” Couture Richmond said.

The federal Centers for Medicare & Medicaid Services, which provides part of the mix in residency funding, caps the nationwide number of hospital residency slots, which haven’t been updated since 1996, Couture Richmond said. HRSA-funded resident training, however, can go to teaching health centers.

MultiCare Deaconess Hospital holds designated federal funding for residency education. After MultiCare in 2017 purchased Deaconess and Valley hospitals and Rockwood Clinic, it continued previous owner Community Health Systems’ agreement to lend that federal funding to Providence. Several months ago, MultiCare “communicated the decision to end the lending agreement … over time to minimize impact,” a statement said.

MultiCare said it plans to continue ongoing financial support for residents rotating at Deaconess from Providence and the teaching center, separate from the federal funding. It plans a residency program.

“MultiCare is establishing an internal medicine residency program in Spokane, intended to start in July 2026, to address our region’s significant shortage of primary care physicians.”

Beatty said MultiCare’s decision had some impact on the residency cuts, but it was understandable.

“I have a huge amount of respect for MultiCare and know they’re facing the same kind of financial pressures that we are,” Beatty said. “We obviously respect their decision.”

She said that local training for primary care physicians hasn’t yielded as many Spokane-based practitioners as thought, and Providence recently recruited 18 such doctors or advanced practice providers outside of that approach.

From 1974 to 2023, the Spokane family residency program graduated 375. It is academically affiliated with the University of Washington School of Medicine. A majority of family medicine graduates have stayed in the Pacific Northwest, often in rural towns, Stamm said. Others work at MultiCare, Providence and local clinics.

“At least in the past, over 80% of our graduates stayed in the (Northwest) area,” Stamm said. “Many of them are rural. Primary care should be the basis of health care in this country, the front line. We can prevent a lot of diseases if we provide the appropriate care at the appropriate time.”

Primary care physicians often include pediatricians, family medicine and internal medicine doctors, psychiatrists and OB/GYNs.

“It was a choice by Providence to only downsize the family residency program,” said Dr. Judith Pauwels, a UW professor emeritus and family medicine doctor who worked with the Spokane program through UW.

“It’s the saddest part of that decision for all of us,” she said, “understanding there is an incredible need for family physicians in rural areas in our Pacific Northwest region. Spokane family medicine has been there since the 1970s and has been one of the major producers of family physicians for the east side of our state.

“It has historically been the prime trainer of broad-scope family physicians capable of doing obstetrics to meet the needs of all the obstetric deserts developing, as well as the needs of small communities. It’s devastating news. It’s a devastating blow to the workforce.”

It’s also a blow for patients, Stamm said.

“Many of the patients we see are the most vulnerable,” he said. “Providence in the past has been very supportive of that as part of our mission. Unfortunately, this proposed cut in residents is driven by finances. To a certain extent, we understand that. Most hospitals were hit hard by COVID.”