California Wildfires Bring Out the Best in Family Medicine

Santa Rosa Residencies to Resume Candidate Interviews

October 25, 2017 11:45 am Sheri Porter

Natural disasters don't pick winners or losers, but they surely do spawn tales of strength and heroism and fortitude. Such is the case with the recent spate of wind-whipped fires in California that include seven named fires from San Jose north to Redwood Valley.

Residents training at the Sutter Santa Rosa Family Medicine Residency program, along with their program director, Tara Scott, M.D., (back row, fifth from left) take time for a quick photo in the "command center" where they've gathered to map out patient care during the Tubbs fire.

Residents of Santa Rosa, in Sonoma County, will recall for decades to come the devastation brought upon their city by the Tubbs fire that, according to the local newspaper, The Press Democrat, killed at least 22 people and burned some 5,300 structures,

The fire, which was 94 percent contained on Oct. 25, is now listed as the state's most destructive wildfire in history.

But still there is a strong message of hope.

On Oct. 16, Kevin Grumbach, M.D., chair of the University of California, San Francisco, (UCSF) Department of Family and Community Medicine, relayed this message in an email to the Association of Departments of Family Medicine(www.adfammed.org ) -- representing some 150 departments across the country -- with news of two UCSF-affiliated, community-based family medicine residency programs located in Santa Rosa.  

Story Highlights
  • The recent wildfires in California affected two family medicine residencies in Santa Rosa, one a long-established program and the other just beginning interviews for its inaugural class in 2018.
  • Residents at the Sutter Santa Rosa Family Medicine Residency program served heroically, evacuating hospital patients and caring for evacuees in shelters for many days.
  • Family physicians continue to play a huge role in providing patient care to thousands of displaced residents, prompting reflection on the flexibility and indispensability of those trained in family medicine.  

One is the longstanding program at Sutter Hospital in Santa Rosa and the other is a new program at Kaiser Permanente Santa Rosa that will start its first residency class on July 1, 2018.

He asked those reading his email to share with all interested parties a clear message that both training programs will resume 2018 applicant interviews shortly.

"These events serve as a reminder of the particular value of having family physicians as the consummate generalists, able to flexibly deploy themselves and answer the call for whatever health services are needed in any type of setting," said Grumbach.

"This was certainly one more validation of why the nation needs excellent residency programs like these training great family doctors."

Residents to the Rescue

Tara Scott, M.D., program director of the Sutter Santa Rosa Family Medicine Residency, told AAFP News that her residents were among those who served so heroically on Oct. 8, the night the fire began, and into the early morning hours of Oct. 9.

"The residents on call stayed in the hospital stabilizing patients and preparing for transport while flames literally surrounded the hospital," said Scott. "After many hours fearing for their own lives, they rode through the city in the early morning on buses and ambulances, through the fire zone, with patients in their care, and they helped continue the care wherever they were taken."

On the first morning after the outbreak, with the residents' outpatient clinic destroyed, Scott, residents and assembled faculty "set up a base at a community hospital we have never been involved with," and worked on logistics and communications tactics, said Scott.  

The Coffey Park neighborhood of Santa Rosa, Calif., stands as a stark reminder of the devastation dealt by the recent Tubbs fire -- the most destructive wildfire in California history.

Two of the community's three hospitals and three major health systems were down, and so Sutter residents, faculty and alumni worked together to evaluate next steps.

"We sent faculty and residents who were safe and able to work into the community hospital that was swamped with the surge of evacuees, and to the shelters to care for the hundreds of medically fragile patients who were brought in," said Scott.

She noted that eight days after it was evacuated, Sutter Hospital reopened, and inpatient and OB services "resumed without a hitch." The shelter populations are declining and most patient care is being handled by providers outside the residency community, she added.

"Many leaders in family medicine from around the state … have shown up at the shelters to help in the community efforts," said Scott. In addition, graduates of the Sutter program came from near and far and have "worked side-by-side with faculty and current residents."

Scott said that two residents lost their homes. "The devastation of large portions of our town has not even begun to sink in for many of us."

However, Scott said, "Many of us experienced the privilege of being able to serve in a time of intense need for our community. While some around us were unable to find ways to be useful in those early days, we were always needed, and that helped many of us cope with the disaster and uncertainty and loss.

"After this experience, I am forever emboldened in my belief that family doctors are perfectly suited to help the community in times of peace and disaster."

Meeting Patients' Needs

Lisa Ward, M.D., president-elect of the California AFP, is chief medical officer of Santa Rosa Community Health, and she oversees nine outpatient clinics including the Vista Family Health Center -- now destroyed -- where Sutter residents saw their own patients.

"Our nine clinics together take care of 50,000 people in our town of 175,000," said Ward. "We care for almost one in every three people in this town, and Vista was our flagship clinic; we cared for 24,000 people there. We've lost half of our clinic space in that one building."

After the initial fire response, the focus for the past two weeks has been to give patients access to care regardless of health insurance coverage or legal status, said Ward.

"Now we're directing patients to the eight other clinics. Literally, we will take care of any soul who can walk through our doors who doesn't already have a health home," said Ward. She expects it will be at least a year before the Vista clinic is rebuilt and ready to reopen to patients.

To make up the lost space, the community health system is setting up mobile vans and modular clinics. "It's the end of week two and we will have 10 new exam rooms by the end of next week," said Ward.

"There have been moments of extraordinary lows and highs," she added. "We intend -- and I fully believe we will have -- the kind of space we need to take care of our patients."

Ward said her system is responsible for the 36 Sutter family medicine residents as well as a nurse practitioner program with 15 NP residents. "We are committed to an uninterrupted clinical education for all of those 51 people."

She called the response to the fire "an extraordinary example of collaboration and an inspiring experience."

Planning for a Future Residency

Patricia Hiserote, D.O., is program director for the Kaiser Permanente Family Medicine Santa Rosa Residency that is just now interviewing residents for the launch its very first class in the summer of 2018.

In an interview with AAFP News, Hiserote and her associate program director Rachel Friedman, M.D., talked about the evacuation of the Santa Rosa Kaiser Permanente Hospital on Oct. 9. "As Kaiser Permanente physicians, we're taught to call in to see if any help is needed, and the hospital had already started evacuating," said Hiserote.

She told of the last ICU patient "being wheeled out by four of our colleagues and the fire encroaching in the background. Fire surrounded our hospital and medical center on three sides."

More than 75 physician colleagues and 180 staff members lost their homes, she said.

"It's a war zone. It changed our normal greeting from 'Hi, how are you?' to 'Are you safe? Are you evacuated? Are you displaced? Do you need anything?'" said Hiserote.

The program had planned to start interviewing potential 2018 residents Oct. 10-11, the week the fires began. "Obviously we canceled those interviews and rescheduled," she said, but only after receiving the OK to do so from the medical command center charged with ensuring the urgent care centers and shelters were adequately staffed.

"At one point, 25,000 people in our town evacuated, so one in seven people left home without knowing if they would have a home to come back to," said Friedman. "There's not a person in our community who's not been touched by this."

Hiserote said she's been in continuous contact with Scott and the Sutter residency program. "Dr. Scott has active residents, and so at Kaiser Permanente, we are willing to do whatever is necessary -- including having her residents at our continuity site. Even though we've evolved into two separate programs, we're too small a town to not be closely related," said Hiserote.

Friedman added that in the face of disaster, the entire family medicine community -- in the Bay Area and beyond -- has been "unbelievably warm and supportive."

"It's just made us so proud to be family physicians, and to be able to bring new residents -- and a new program -- into our community to help with this," she said.

Related AAFP News Coverage
Fresh Perspectives blog: Up in Smoke: Western Fires Pose Public Health Hazard
(9/29/2017)

Fresh Perspectives blog: Will You Be Prepared When Disaster Strikes?
(10/11/2017)

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