New UM docs ready to cross Montana to begin rural family medicine

When Cassie Lopez and her husband, Brian, interviewed with the Family Medicine Residency program at the University of Montana, the school's focus on rural care led them to cancel their remaining interviews with competing medical programs.

Now, several years later, the two new doctors are gearing up to start their full-spectrum practice in Lewistown – population 5,800.

“We met with both programs from Montana and immediately fell in love with the rural emphasis this program has,” said Lopez. “We wanted a change from a big academic hospital to a community based program. When we came to interview, we canceled all our interviews after this one.”

Lopez and her husband graduated with 10 fellow doctors in Missoula on Sunday – a ceremony that marked the end of one chapter and the start of another. Of the 12 graduates, 11 have accepted employment in Montana, and eight will practice in rural and underserved areas.

The timing may be perfect.

According to the Montana Department of Labor and Industry, 11 Montana counties are currently without a physician, and all but three of the state's 56 counties are considered medically underserved. As baby boomers look to retire in the coming years, the problem is expected to grow more acute, just as aging Montanans look for accessible medical care.

“We're still hoping to replace doctors in rural areas and counties that don't have any doctors, but it'll continue to be a struggle for some time,” said Rebecca Morgan, the project manager with the UM Family Medicine Residency program.

“In some of those smaller towns, it's really hard sometimes to get to a larger town. It's the lack of transportation, the lack of dollars to travel distances, and people want to stay in their own town, especially the elderly. It's tough to get in a car and drive to a larger metropolitan area.”

The UM program, an affiliation of the University of Washington's Family Medicine Residency Network, launched in 2013 with a focus on placing new doctors in rural settings and addressing Montana's medical shortage.

The first class graduated from the program in 2016, and coupled with Sunday's graduating class, roughly 73 percent of the program's graduates have stayed to practice in Montana. The latest batch of doctors will land in Missoula, Polson, Libby, Columbia Falls and Lewistown, along with rural Oregon.

“Montana is chronically underserved for primary care in rural places,” said Dr. Ned Vasquez, director of the UM program. “Residency programs are one of the most effective ways to increase the pipeline so there are more primary care physicians to go into these small towns, as well as the community health centers.”

The program’s sponsoring hospitals in Western Montana include Kalispell Regional Healthcare, as well as Providence St. Patrick Hospital and Community Medical Center in Missoula. Residents also conduct clinical training at Partnership Health Center in Missoula and Flathead Community Health Center in Kalispell.

But while the program's residents work closely with western Montana's largest hospitals and clinics, they also rotate though a network of rural settings, including Blackfeet Community Hospital in Browning and St. Luke's Community Healthcare in Ronan, which also serves Polson.

It's there where Dr. Tyler Thorson will base his practice this September, serving the community's 4,800 residents.

“The whole point of this program was to train rural family docs, specifically for Montana,” said Thorson, who graduated Sunday. “In a rural setting, I'll be doing hospital, ER, OB clinic, all of it. You really get to know your patients. You know them not only as patients, but as community members, sometimes as friends or neighbors.”

Vasquez said the program's rural focus makes it nationally unique – a draw that attracted more than 850 applications from medical students across the country this past year. More than 250 doctors across western Montana now work with the residents, who enter 10 rural communities during their training.

As the program grows, Vasquez said, it will retain that rural focus.

“In our coming year, we'll move some of our surgery rotations out into rural communities that have general surgeons,” he said. “That will be our main area of emphasis, to push more training out to rural places because it makes it more likely that people will go there after they're done with their education.”

When the program began in 2013, Vasquez said, it claimed 10 students with four faculty and a handful of administrators to carry out the mission.

Now, the program has 30 residents, 13 faculty and more than half a dozen administrators. This year, four new medical schools will also be represented, including Tulane, Baylor, the University of Kentucky and Northeast College of Osteopathic Medicine.

“In a rural area, you're really able to establish a good relationship with your patients,” said Lopez. “In a rural area, you're also expected to do more medicine because there's not as many resources, whereas in a big city of a few million people working as a family physician, sometimes you feel like your job is just to refer them to specialists. You lose some of that wonderful medicine aspect, that old-school family doc that people have in mind.”