At least 1,300 applicants from around the world have applied for one of six spots in the inaugural class of Billings Clinic’s Internal Medicine Residency Program, which is designed to train primary-care physicians.
About 200 of the applicants are U.S. graduates; the balance are from all corners of the globe.
Only 100 or so candidates will be invited to interview on the Billings Clinic campus. The grueling process began Tuesday and will continue into January.
In addition to the six internal medicine residency slots, four additional spots will be reserved for applicants who need only a one-year clinical base before going elsewhere to train in a specialty area such as radiology, ophthalmology, dermatology and anesthesiology.
The Internal Medicine Residency Program is the first of its kind in Montana and Wyoming. It was accredited earlier this year for three years by the Chicago-based Accreditation Council for Graduate Medical Education, the maximum length of time for an initial accreditation. It was one of only four internal-medicine residency programs in the country to achieve accreditation.
At full capacity, the residency program could be producing as many as six new doctors a year.
The hope is that those new doctors will choose to practice in Montana, where most counties have a shortage of primary-care physicians and 10 counties have no physician at all.
The program will open to the first class of students in July 2014.
Dr. Roger Bush, program director, is pleased with the sizable number of applicants but not surprised.
“With healthcare reform … and the growth in the number of medical school graduates, there’s a lot more demand for these types of physicians than there was a few years ago,” Bush said. “Ten years ago, not very many people considered general internal medicine or primary care, now it looks like it’s going to be much more popular.”
Given the country's reputation for healthcare education, Bush said he is not surprised that more than 1,000 of the applicants are from outside the United States.
“While we don’t have the best outcomes for our healthcare delivery in the world, it’s generally acknowledged we have the best graduate medical education system in the world,” Bush said.
A big question during the interview process is whether or not the candidate has ties to the area.
“Our aim is not to train super sub-specialists; we want to train super generalists,” Bush said. “We want people that are set up to be really great docs but also really great general docs in the region.”
Kale Knudson, 31, a Montana native, is a fourth-year medical student in the WWAMI Regional Medical Education Program offered through the University of Washington School of Medicine and is completing a rotation in Billings.
He was among the first three candidates interviewed this week for the Billings Clinic program.
Both he and his wife grew up in Highwood, a tiny farm and ranch community 25 miles east of Great Falls. Though he has applied at 26 residency programs throughout the country, his eye is on a spot in the Billings Clinic program.
“My goal is to live in Montana,” Knudson said. “If I’m going to work here, it’s only logical to train here.”
Billings Clinic’s program coincides with predictions that in the next decade, the country will be short an estimated 50,000 primary-care physicians to meet the need. Compounding the shortage is health care reform under the Affordable Care Act, which is expected to flood the system with new patients. More than 30 million Americans will be newly eligible for health care, according to Dr. Bill Iobst, vice president of academic affairs for the American Board of Internal Medicine.
More than 20,000 Montanans live in counties without a primary-care physician, according to MHA — An Association of Montana Health Care Providers. And at least 52 of the state’s 56 counties are federally designated primary-care physician shortage areas.
A residency typically is the final step in 11 years of post-secondary training. A high school graduate planning to become a physician needs four years of college for a bachelor’s degree, four years of medical school and then three more years as a resident under another doctor’s guidance.
There are currently 385 certified internal-medicine residency programs in the country. Only one program was accredited to start July 1, 2013. Six accredited programs began July 1, 2012, according to the Accreditation Council for Graduate Medical Education.
Montana is among the most successful states for retaining physicians who complete a residency program in the state, with a retention rate of 60 to 75 percent, according to the Association of American Medical Colleges. Montana is home to the Montana Family Residency Program at RiverStone Health in Billings and the Family Medicine Residency of Western Montana in Missoula. RiverStone Health also has a dental residency program.
Since its inception in 1996, more than 70 percent of the graduates of the Montana Family Medicine Residency have stayed in Montana.