Spring 2014
Meeting Rural Nevada’s Health Care Needs with a New Residency

synapse: University of Nevada, Reno School of Medicine

Humboldt General Hospital in Winnemucca

Humboldt General Hospital in Winnemucca is the rural location for the School of Medicine’s new rural family medicine residency training program. Photo by Keith Clark

Rural family medicine residency program to train doctors for rural practice

By Anne McMillin, APR

Backed by research indicating that 60 percent of medical residents who train in Nevada remain in state to practice, the School of Medicine opens a new rural family medicine residency training program this summer.

After several years of pursuing a family medicine residency program in rural Nevada, the Department of Family and Community Medicine in Las Vegas announced this winter the successful accreditation for a rural family medicine residency program in Winnemucca.

“I am delighted to announce the initial accreditation of this program that is in collaboration with the Las Vegas family medicine department and Humboldt General Hospital in Winnemucca. This is truly an achievement of momentous proportions and a great example of the statewide nature of the school,” said Miriam Bar-on, M.D., associate dean for graduate medical education.

The Accreditation Council for Graduate Medicine Education’s Review Committee commended the new residency program for “its demonstrated substantial compliance with the ACGME’s Institutional and/or program requirements for Graduate Medical Education without citations.”

Elissa Palmer, M.D., chair of the Las Vegas family medicine department, said such a commendation is rare for initial accreditations, and credits the team effort among School of Medicine leadership, her department, the administration and staff of Humboldt General Hospital and community doctors in Winnemucca for the program’s accreditation success.

“Our vision has been to increase access to health care for the people of Nevada and produce family medicine physicians for our state,” Palmer said. “Having a rural residency program will help do this while creating a training program that can be replicated in other rural communities.”

Brad Granath, M.D., site director for the rural residency program at Humboldt General Hospital, said the new residency program, which begins on July 1, 2014, is “a very long-term project requiring vision and perseverance but with wonderful benefits for our community.”

Granath said the need for a rural training model stems from the inability of the traditional family medicine residency model to produce doctors who are suited to practice in a rural setting, without convenient access to specialists commonly found in the metropolitan medical setting.

“Family doctors trained in the traditional manner become dependent on having a specialist immediately available to handle every problem,” he explained, adding that this convenience is not possible in rural areas that often lack medical specialists.

The rural family medicine track model has been around for 30 years and has been dramatically more successful in training doctors for practice in a rural setting. Doctors have their first year at a metropolitan medical center getting high volume specialty training, but then spend the final two years of their residency training with rural physicians.

Rural track training programs require an especially rigorous curriculum which describes in great detail all the educational goals and skills that the doctor must master.

“We are extremely fortunate to have a strong partner in the School of Medicine to help us do the highly technical work of providing the depth of scholarship and guide us through the overwhelming complexity of applying for the credentialing of this program,” Granath concluded.

According to Aron Rogers, D.O., program director of both the existing family medicine residency in Las Vegas and the new rural family medicine residency program, the three-year rural training program allows physicians to gain experience while working under the supervision of an attending physician.

It is set up in a “1-2 format” with the first year completed in common with the other family medicine residents in Las Vegas, while the second and third years are completed in the rural setting of Winnemucca. This allows for two new residents in each of the three years of the program.

Benefits of having this rural residency training program in Winnemucca include an increased number of physicians in the community, improved patient access to quality essential health care services, workforce development and training and increased opportunity for recruitment and retention of health care professionals in Winnemucca and other rural communities.

Through the School of Medicine’s Nevada State Office of Rural Health, a connection was made with Humboldt General Hospital as that facility was embarking on a 35,860 square-foot expansion as part of a vision to improve delivery of care to the rural community. The expansion included new clinic space dedicated to the rural residency.

Jim Parrish, chief executive officer at Humboldt General Hospital said they are thrilled to be a residency site.

“We embarked on this journey nearly 10 years ago, and our investment in facilities, staff and education has culminated in this very exciting program for Humboldt General Hospital and the School of Medicine,” he said.

“Working with the medical school has been a joy, and because of the knowledge and insight we have received from them, we are a much-improved organization. We are proud to be one of the few Critical Access Hospitals selected as a residency site.”

Members of the team sharing the vision to bring the residency to Winnemucca include Parrish; Sandi Lehman, chief financial officer, Humboldt General Hospital; Granath; Kurt Kracaw, M.D., assistant rural residency site director; Len Perkinson, M.D., Humboldt General’s chief of staff; Shouping Li, M.D., Ph.D., director, cardiology; the Winnemucca medical community and the entire staff at Humboldt General Hospital. From the School of Medicine, Palmer, Rogers; Gerald Ackerman, director, State Office of Rural Health; Kelly O’Shaughnessy, director, Nevada Rural Health Network; the Office of Graduate Medical Education and the entire Las Vegas family medicine department were among the leaders in the team seeing this residency to fruition.