Billings Clinic's internal medicine residency program earns accreditation

2013-05-23T10:30:00Z 2014-08-25T07:35:20Z Billings Clinic's internal medicine residency program earns accreditationBy CINDY UKEN cuken@billingsgazette.com The Billings Gazette

It’s official: Billings Clinic’s new internal-medicine program has earned accreditation.

The program, designed to train primary-care physicians in the region, is the first of its kind in Montana and Wyoming. It has been accredited 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 throughout the nation that achieved 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 startup investment of "several million dollars" will be underwritten by Billings Clinic, Billings Clinic Foundation and grants.

The next step is to recruit students and some faculty members. Though the formal application process won't begin until September, there has already been a "heartwarming interest from students," said Dr. Roger Bush, director of the program. 

The program will open to the first class of students in July 2014. The program will feature six positions each year in the three-year curriculum, a total of 18 slots when full.

The core faculty will be composed of about two dozen Billings Clinic physicians, drawn from the hospital’s 240 physicians, and nearly 100 nurse practitioners and physician assistants.

The program will not only provide training in the outpatient and hospital settings but also "will teach our methods for providing care to our rural communities through collaboration, technology, and outreach clinics,” Bush said.

"Our strategy is to be a learning laboratory to provide better care, better health, better costs and to bring joy to the work of caring for others," Bush said.

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 in the coming years. 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.

Montana has been feeling the squeeze for several years. Hiring enough internists is so difficult, Billings Clinic and other hospitals are in perpetual recruitment mode.

Lack of access to primary care was identified as the most pressing health care need in a 2011 assessment that Billings Clinic, St. Vincent Healthcare and RiverStone Health conducted.

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.

He said “homegrown” internal-medicine physicians will best fill the void because no one will have to explain to them the context of a miner in Colstrip or a rancher in Malta.

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.

This is not Billings Clinic’s first time teaching. The not-for-profit hospital has a history of educating students, including 30 years of involvement with the WWAMI program offered through the University of Washington School of Medicine. It also has spent 15 years working with residents in the Montana Family Medicine Residency.

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.

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