Rocking Full-scope Family Medicine for Rural Patients

January 07, 2019 12:50 pm David Mitchell

Every April for the past three years, Mendocino County, Calif., has been host to a unique concert that has raised more than $200,000 for the area's new family medicine residency program. This year, the event will move to mid-June to coincide with the introduction of the residency program's first class.

[Noemi Doohan, M.D., Ph.D.]

"It's going to be extremely festive when Rural Health Rocks(www.ruralhealthrocks.com) happens this year," said Noemi "Mimi" Doohan, M.D., Ph.D., director of the Adventist Health Ukiah Valley (AHUV) Family Medicine Residency Program(www.adventisthealth.org) in Ukiah, Calif. "The community has been waiting for this first group of residents for a long time."

Doohan was working as a hospitalist in 2015 at AHUV when (then) CEO and president Gwen Matthews, M.S.N., M.Sc., M.B.A., asked her to start a new training program. The 49-bed rural hospital had never offered graduate medical education, so Doohan's imposing task included obtaining accreditation from the Accreditation Council for Graduate Medical Education for both the hospital and the program.

She also was tasked with recruiting faculty -- family physicians and subspecialists -- in a service area of about 100,000 people that had an acute lack of physicians.

"There was a wave of physicians coming into rural communities 30 years ago," she said. "Those docs are retiring, and we need to increase training opportunities in rural settings to produce and attract more family doctors in rural practice. This is a way to reopen that pipeline."

Doohan said the program, which is sponsored by AHUV and affiliated with the University of California-Davis (UC-Davis),(health.ucdavis.edu) is one of only two rural training tracks in California. The program, through its partnership with UC-Davis, will offer the full scope of family medicine training, including obstetrics.

During their intern year, a class of six residents will be based at UC-Davis and will experience inpatient rotations at UC-Davis Medical Center and the Sacramento Veterans Affairs Medical Center, as well as an obstetrics rotation at the Adventist Rideout Hospital in Marysville. The residents then will spend their second and third years in Ukiah.

"They will have an intense first year at UC-Davis doing inpatient care so that when they come to our rural community they will be prepared," Doohan said. "Out here, there is a shortage of primary care doctors and specialists."

Doohan has been through the start-up process before. She was director of inpatient teaching at Eisenhower Medical Center Family Medicine Residency in La Quinta, Calif., when that program launched in 2013.

Adventist Health asked her to duplicate another experience, creating a street medicine program for unsheltered homeless people in Ukiah similar to what she built more than a decade ago with Doctors Without Walls in Santa Barbara.(www.independent.com)

"We will have a special clinical program and curriculum that will make our residency program unique," she said.

Doohan said that during match interviews, a common theme was applicants' desire to care for the full scope of diverse needs of the rural underserved population.

"That's showing up as practice preference among the applicants coming through," she said. "They've inspired us greatly."

More than 600 medical students applied for six spots. AHUV interviewed 50.

"It's impressive for a new program to have so many strong applicants for an inaugural class," Doohan said. "It's exciting. It shows that the next generation of family doctors are interested in rural and full-scope practice."

It was in Santa Barbara that Doohan started her first practice, and it also was there that she met Grammy winner and former Doobie Brothers singer and keyboardist Michael McDonald and his wife, Grammy-nominated musician Amy Holland. Those friendships helped Doohan and Family Medicine Education for Mendocino County,(www.fmemc.org) a local nonprofit created to support the residency program, recruit a notable collection of local and Nashville-based musicians for Rural Health Rocks.

Doohan said musicians have been eager to help.

"The shortage of primary care physicians is a cross-cutting issue," she said. "Everybody knows about it, and it's something we all care about. It's been uplifting to see people rally around the start of this new program."