“If you’re not in the continual planning phase, if you’re not creating your own doctors, you won’t be prepared,” says Amy Carrasco, the director of graduate medical education at Kadlec Regional Medical Center. “We’re hoping to feed the southeast corner of Washington state.”

With the help of the UW School of Medicine’s Family Medicine Residency Network, Kadlec, located in Richland, Wash., just developed a family medicine residency: they’re accepting their first applications this fall. The impetus behind the new program? Carrasco is well aware that many baby boom physicians in Washington — and all over the country — are going to retire fairly soon. Which means even fewer physicians for rural areas, like the ones around Richland.

Suzanne Allen, M.D., vice dean for regional affairs, says UW Medicine has been making “a very concerted effort to increase the number of residency programs.” Her reasoning is the same as Carrasco’s: a looming shortage of physicians. Increasing the number of seats in medical schools isn’t enough; the number of residency slots — training spaces around the country where newly minted physicians learn their chosen specialties — are the other half of the equation. By 2017, Allen says, we’ll have more graduating medical students than first-year residency positions.

This is why Allen and her colleagues are looking for partners like Kadlec to train residents; since 2010, the UW School of Medicine has had two GME summits to encourage hospitals and clinics to become residency sites. The results are good: a family medicine residency at Kadlec, a psychiatry residency in Spokane and new programs in Puyallup and Tacoma. There also are new programs in Montana, Idaho and Alaska.

What’s the benefit to the community? It’s likely that residents will stick around. “If you look at national data, you’re much more likely to stay within a 100-mile radius of your residency,” says Allen.

This is what Richland-area physicians are counting on. It also explains some of their enthusiasm to join the program and teach. “Physicians from all specialties were calling me and saying ‘I want to be involved,’” says Carrasco.

One of these physicians, Erick Isaacson, M.D. ’78, FAAFP, shares in all the excitement; in fact, he’s the residency’s new director. What’s more, he’s not only an alumnus of the UW School of Medicine, but also of Kadlec: he was born at the medical center some 60 years ago.

“The need in our region for primary care — WWAMI in general, southeast Washington in particular — exceeds our current GME resources,” says Isaacson, a family medicine physician. “I’ve been a physician for more than 33 years, and developing this residency and teaching seems to be the perfect thing to do next.”

Residencies — the years of intensive training in which M.D.s focus on a specialty such as surgery, pediatrics or family medicine — are part of the process of becoming a physician. Today, there aren’t enough residency slots in hospitals and other patient-care sites to keep up with the national demand for physicians. And creating residency slots is no simple matter.

The challenge. Healthcare institutions are paid to support residencies, and the money comes through Medicare and Medicaid. Unfortunately, the funding level was capped in 1997, and residency programs are expensive: $1 or $2 million a year. Communities that want residents can’t always afford the program.

The urban-rural divide. Institutions only get paid if a resident works in the institution, usually located in a town or city. So while the U.S. needs more physicians in rural areas, it’s hard to get funding for rural residencies.

What UW Medicine is advocating for in Washington, D.C. A new funding model, with Washington, Wyoming, Alaska, Montana and Idaho (WWAMI) serving as the pilot program. The money would follow the resident; funding would be distributed to potential residency sites based on the workforce needs of the community.

Erick Isaacson, M.D. ’78, FAAFP, was born at Kadlec Regional Medical Center in Richland, Wash. Now, as Kadlec’s new family medicine residency director, he’s going to teach there, too. Below is his story.

After arriving at Whitman College for my freshman year, I experienced a crisis of self-confidence. It was clear the pre-med students were a confident and competitive group. At the end of my sophomore year, though, I realized that I was as capable as they were, so I took pre-med prerequisites. Then I entered medical school at the UW School of Medicine; WWAMI had been up and running for about two years. It was such a standout concept.

WWAMI made me realize Iwanted to pursue family medicine, but I have to credit my family physician, another UW School of Medicine alumnus, for pulling me back to the Richland area. Norman Erie, M.D. ’58, was a great encouragement to me in my pre-med studies, and we had kept in contact throughout my medical training. As I was looking for a place to practice, he was looking for a full-time partner. I was thrilled at the chance to work with him, and my wife and I were committed to returning to the Pacific Northwest to be near family and friends.

I have been in practice for more than 33 years, and with some families, I take care of four generations. I’ve also cared for friends I have known since childhood, classmates, former teachers and mentors. Family medicine is all about continuity of care for patients. And now, with the new residency at Kadlec, I’m training physicians to take my place in this community.

Photo courtesy of Kadlec Regional Medical Center.